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    Paroxetine

    Topic Contents

    Paroxetine

    Drug Information

    Paroxetine is a member of the selective serotonin reuptake inhibitor (SSRI) family of drugs used to treat people with depression .

    Common brand names:

    Paxil, Paxil CR

    Summary of Interactions with Vitamins, Herbs, & Foods

    Types of interactions: Beneficial Adverse Check

    Replenish Depleted Nutrients

    • Sodium

      SSRI drugs, including paroxetine, have been reported to cause sodium depletion.1 , 2 , 3 The risk for SSRI-induced sodium depletion appears to be increased during the first few weeks of treatment in women, the elderly, and patients also using diuretics. Doctors prescribing SSRI drugs, including paroxetine, should monitor their patients for signs of sodium depletion.

    Reduce Side Effects

    • Ginkgo

      In three men and two women treated with fluoxetine or sertraline (SSRI drugs closely related to paroxetine) for depression who experienced sexual dysfunction, addition of Ginkgo biloba extract (GBE) in the amount of 240 mg per day effectively reversed the sexual dysfunction.4 This makes sense because ginkgo has been reported to help men with some forms of erectile dysfunction .5

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

    Support Medicine

    • none

    Reduces Effectiveness

    • none

    Potential Negative Interaction

    • 5-HTP

      Paroxetine increases serotonin activity in the brain. 5-HTP and L-tryptophan are converted to serotonin in the brain, and taking either of these compounds with paroxetine may increase paroxetine-induced side effects. Dietary supplements of L-tryptophan (available only by prescriptions from special compounding pharmacists) taken with paroxetine caused headache, sweating, dizziness, agitation, restlessness, nausea, vomiting, and other symptoms.6 Some doctors have used small amounts of L-tryptophan in combination with SSRIs, to increase the effectiveness of the latter. However, because of the potential for side effects, 5-HTP and L-tryptophan should never be taken in combination with paroxetine or other SSRIs, unless the combination is being closely monitored by a doctor. Foods rich in L-tryptophan do not appear to interact with paroxtine or other SSRIs.

      On the other hand, the combination of 45 mg DL-tryptophan (a synthetic variation of L-tryptophan) per pound of body weight (a relatively high dose) with zimelidine, a drug with a similar action to paroxetine, did not cause these side effects in another trial.7

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • L-Tryptophan

      Paroxetine increases serotonin activity in the brain. 5-HTP and L-tryptophan are converted to serotonin in the brain, and taking either of these compounds with paroxetine may increase paroxetine-induced side effects. Dietary supplements of L-tryptophan (available only by prescriptions from special compounding pharmacists) taken with paroxetine caused headache, sweating, dizziness, agitation, restlessness, nausea, vomiting, and other symptoms.8 Some doctors have used small amounts of L-tryptophan in combination with SSRIs, to increase the effectiveness of the latter. However, because of the potential for side effects, 5-HTP and L-tryptophan should never be taken in combination with paroxetine or other SSRIs, unless the combination is being closely monitored by a doctor. Foods rich in L-tryptophan do not appear to interact with paroxtine or other SSRIs.

      On the other hand, the combination of 45 mg DL-tryptophan (a synthetic variation of L-tryptophan) per pound of body weight (a relatively high dose) with zimelidine, a drug with a similar action to paroxetine, did not cause these side effects in another trial.9

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • St. John's Wort

      One report described a case of serotonin syndrome in a patient who took St. John's wort and trazodone , a weak SSRI drug.10 The patient reportedly experienced mental confusion, muscle twitching, sweating, flushing, and ataxia. In another case, a patient experienced grogginess, lethargy, nausea, weakness, and fatigue after taking one dose of paroxetine after ten days of St. John's wort use.11

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

    Explanation Required 

    • none

    The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers' package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

    References

    1. Spigset O, Hedenmalm K, Mortimer O. Hyponatremia as a side effect of serotonin uptake inhibitors. Lakartidningen 1998;95:3537-9 [Swedish].

    2. Strachan J, Shepherd J. Hyponatraemia associated with the use of selective serotonin re-uptake inhibitors. Aust N Z J Psychiatry 1998;32:295-8.

    3. Bouman WP, Pinner G, Johnson H. Incidence of selective serotonin reuptake inhibitor (SSRI) induced hyponatraemia due to the syndrome of antidiuretic hormone (SIADH) secretion in the elderly. Int J Geriatr Psychiatry 1998;13:12-5.

    4. Cohen AJ. Long term safety and efficacy of Ginkgo biloba extract in the treatment of anti-depressant-induced sexual dysfunction. Psychiatry On-Line http://www.priory.com/ginkgo.html.

    5. Sohn M, Sikora R. Ginkgo biloba extract in the therapy of erectile dysfunction. J Sex Educ Ther 1991;17:53-61.

    6. Threlkeld DS, ed. Central Nervous System Drugs, Antidepressants, Selective Serotonin Reuptake Inhibitors. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1997, 264q-4r.

    7. Walinder J, Carlsson A, Persson R. 5-HT reuptake inhibitors plus tryptophan in endogenous depression. Acta Psych Scand Suppl 1981;290:179-90.

    8. Threlkeld DS, ed. Central Nervous System Drugs, Antidepressants, Selective Serotonin Reuptake Inhibitors. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1997, 264q-4r.

    9. Walinder J, Carlsson A, Persson R. 5-HT reuptake inhibitors plus tryptophan in endogenous depression. Acta Psych Scand Suppl 1981;290:179-90.

    10. Demott K. St. John's wort tied to serotonin syndrome. Clinical Psychiatry News 1998;26:28.

    11. Gordon JB. SSRIs and St. John's Wort: possible toxicity? Am Fam Physician 1998;57:950.

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