initial doses of atomoxetine are recommended with strong CYP2D6 inhibitors.avapritinibMonitor Closely (1)paroxetine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.axitinibMonitor Closely (1)paroxetine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.azithromycinMinor (1)azithromycin and paroxetine both increase QTc interval. Minor/Significance Unknown.benzhydrocodone/acetaminophenMonitor Closely (1)benzhydrocodone/acetaminophen, paroxetine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.betrixabanMonitor Closely (1)paroxetine, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.brexpiprazoleMonitor Closely (1)paroxetine will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer half of the usual brexpiprazole dose when coadministered with strong CYP2D6 inhibitors. If also administered with a strong/moderate CYP3A4 inhibitor, administer a quarter of brexpiprazole dose. NOTE: In MDD clinical trials, brexpiprazole dosage was not adjusted for strong CYP2D6 inhibitors (eg, paroxetine, fluoxetine); thus, CYP considerations are already factored into general dosing recommendations and brexpiprazole may be administered without dosage adjustment in patients with MDD.bumetanideMinor (1)bumetanide, paroxetine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible additive hyponatremia.buprenorphineMonitor Closely (1)buprenorphine and paroxetine both increase QTc interval. Use Caution/Monitor.buprenorphine buccalMonitor Closely (1)buprenorphine buccal and paroxetine both increase QTc interval. Use Caution/Monitor.buprenorphine subdermal implantMonitor Closely (1)paroxetine, buprenorphine subdermal implant. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected.Serious - Use Alternative (1)buprenorphine subdermal implant and paroxetine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine transdermalMonitor Closely (1)buprenorphine transdermal and paroxetine both increase QTc interval. Use Caution/Monitor.buprenorphine, long-acting injectionMonitor Closely (2)paroxetine, buprenorphine, long-acting injection. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Concomitant use could result in life-threatening serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation, and during dose adjustment of the serotonergic drug. Discontinue buprenorphine if serotonin syndrome is suspected. buprenorphine, long-acting injection and paroxetine both increase QTc interval. Use Caution/Monitor.bupropionSerious - Use Alternative (2)bupropion will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. paroxetine increases toxicity of bupropion by unspecified interaction mechanism. Avoid or Use Alternate Drug. May lower seizure threshold; keep bupropion dose as low as possible.buspironeSerious - Use Alternative (1)paroxetine and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.cariprazineMonitor Closely (1)paroxetine, cariprazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).carvedilolSerious - Use Alternative (1)paroxetine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.celandineMinor (1)celandine decreases effects of paroxetine by pharmacodynamic antagonism. Minor/Significance Unknown. Based on animal studies.celecoxibMonitor Closely (1)paroxetine, celecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.Minor (1)celecoxib will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.cenobamateMonitor Closely (1)cenobamate, paroxetine. Either increases effects of the other by sedation. Use Caution/Monitor.chloroquineMinor (1)chloroquine will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.chlorpromazineMonitor Closely (1)chlorpromazine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)paroxetine will increase the level or effect of chlorpromazine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.choline magnesium trisalicylateMonitor Closely (1)paroxetine, choline magnesium trisalicylate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.cimetidineMonitor Closely (1)cimetidine will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.citalopramSerious - Use Alternative (1)citalopram and paroxetine both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.clarithromycinMonitor Closely (1)clarithromycin and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.clobazamMonitor Closely (1)clobazam will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly. clomipramineMonitor Closely (1)clomipramine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)paroxetine and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug. paroxetine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.clonidineMonitor Closely (1)clonidine, paroxetine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.clopidogrelMonitor Closely (1)paroxetine increases effects of clopidogrel by pharmacodynamic synergism. Use Caution/Monitor. SSRIs affect platelet activation; coadministration of SSRIs with clopidogrel may increase the risk of bleeding.clozapineMonitor Closely (2)paroxetine increases levels of clozapine by decreasing metabolism. Use Caution/Monitor. Plasma levels of clozapine may be increased, resulting in increased pharmacologic and toxic effects. Adjust clozapine dose as needed when initiating or discontinuing certain SSRIs. . paroxetine, clozapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).cobicistatMonitor Closely (1)cobicistat will increase the level or effect of paroxetine by Other (see comment). Use Caution/Monitor. Carefully titrate dose of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitor its response during coadministration with SSRIs and cobicistat. cocaine topicalMonitor Closely (1)paroxetine and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.codeineMonitor Closely (1)paroxetine will decrease the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.cyclobenzaprineSerious - Use Alternative (1)paroxetine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.cyproheptadineMonitor Closely (1)cyproheptadine decreases effects of paroxetine by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SSRIs.dacomitinibSerious - Use Alternative (1)dacomitinib will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities. daridorexantMonitor Closely (1)paroxetine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. darifenacinMinor (1)darifenacin will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.darunavirMonitor Closely (2)darunavir decreases levels of paroxetine by Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Carefully titrate SSRI dose based on clinical assessment of antidepressant response. darunavir will increase the level or effect of paroxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with SSRIs, TCAs, or trazodone may require dose titration of antidepressant to desired effect (eg, using the lowest feasible initial or maintenance dose). Monitor for antidepressant response.dasatinibMonitor Closely (1)dasatinib and paroxetine both increase QTc interval. Use Caution/Monitor.defibrotideMonitor Closely (1)defibrotide increases effects of paroxetine by Other (see comment). Use Caution/Monitor. Comment: Defibrotide may enhance effects of platelet inhibitors.desipramineMonitor Closely (1)desipramine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)paroxetine and desipramine both increase serotonin levels. Avoid or Use Alternate Drug. paroxetine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.desvenlafaxineMonitor Closely (1)desvenlafaxine will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgSerious - Use Alternative (1)paroxetine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.deutetrabenazineMonitor Closely (2)deutetrabenazine and paroxetine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation). paroxetine will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.dexfenfluramineMonitor Closely (2)paroxetine and dexfenfluramine both increase serotonin levels. Modify Therapy/Monitor Closely. paroxetine will increase the level or effect of dexfenfluramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.dexmethylphenidateMinor (1)dexmethylphenidate increases effects of paroxetine by decreasing metabolism. Minor/Significance Unknown.dextroamphetamineMonitor Closely (2)paroxetine and dextroamphetamine both increase serotonin levels. Modify Therapy/Monitor Closely. paroxetine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.dextroamphetamine transdermalMonitor Closely (2)paroxetine, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s). paroxetine will increase the level or effect of dextroamphetamine transdermal by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during dextroamphetamine initiation and after a dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and CYP2D6 inhibitor.dextromethorphanSerious - Use Alternative (2)paroxetine and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug. paroxetine will increase the level or effect of dextromethorphan by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.diazepam intranasalMonitor Closely (1)diazepam intranasal, paroxetine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.dichlorphenamideMonitor Closely (1)dichlorphenamide and paroxetine both decrease serum potassium. Use Caution/Monitor.diclofenacMonitor Closely (1)paroxetine, diclofenac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.difelikefalinMonitor Closely (1)difelikefalin and paroxetine both increase sedation. Use Caution/Monitor.diflunisalMonitor Closely (1)paroxetine, diflunisal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.dihydroergotamineMonitor Closely (1)paroxetine and dihydroergotamine both increase serotonin levels. Modify Therapy/Monitor Closely.dihydroergotamine intranasalMonitor Closely (1)paroxetine and dihydroergotamine intranasal both increase serotonin levels. Modify Therapy/Monitor Closely.diphenhydramineMinor (1)diphenhydramine will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.disopyramideSerious - Use Alternative (1)disopyramide and paroxetine both increase QTc interval. Avoid or Use Alternate Drug.dofetilideMonitor Closely (1)dofetilide and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.dolasetronMonitor Closely (1)dolasetron and paroxetine both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)dolasetron, paroxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.donepezilMonitor Closely (2)donepezil and paroxetine both increase QTc interval. Use Caution/Monitor. paroxetine will increase the level or effect of donepezil by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.dosulepinSerious - Use Alternative (1)paroxetine and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.doxepinMonitor Closely (1)doxepin and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)paroxetine and doxepin both increase serotonin levels. Avoid or Use Alternate Drug. paroxetine will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.dronedaroneMonitor Closely (2)dronedarone and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely. dronedarone will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.droperidolMonitor Closely (1)droperidol and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.duloxetineSerious - Use Alternative (2)duloxetine and paroxetine both increase serotonin levels. Avoid or Use Alternate Drug. paroxetine will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.Minor (1)duloxetine