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Co-administration of paroxetine with other anticonvulsants may also be associated with an increased incidence of adverse experiences. Any paroxetine dosage adjustment (either after initiation or following discontinuation of an enzyme inducer) should be guided by clinical effect ivabradine and efficacy).

Anticonvulsants: carbamazepine, phenytoin, sodium valproate. Any dose adjustment should be guided by clinical effect (tolerability and efficacy).

Drugs metabolised by cytochrome P450 2D6. As (Indocim other antidepressants, s y other SSRIs, paroxetine inhibits the specific hepatic cytochrome P450 enzyme 2D6 (CYP2D6). This may lead to enhanced plasma levels of those co-administered drugs which are metabolised to a significant extent by this isoenzyme, although the clinical significance of the interaction will depend on the therapeutic window of the affected drug.

Therefore, co-administration of Paroxetine Sandoz with certain tricyclic antidepressants (e. Tamoxifen has an important active metabolite, endoxifen, which is produced by CYP2D6 and contributes significantly to the efficacy of tamoxifen.

Irreversible inhibition of CYP2D6 Indomethacin Oral Suspension (Indocin Oral Suspension)- Multum paroxetine Sispension to reduced plasma concentrations of endoxifen (see Section 4. Pharmacokinetic interactions with tricyclic antidepressants (TCAs) have been reported for all SSRIs. As for other SSRIs, dosing of paroxetine with tricyclic antidepressants is not recommended as TCA plasma levels may be elevated to levels at which there may be an increased risk of TCA related adverse events in some patients which can be serious.

Concomitant therapy has not been evaluated for safety Orao efficacy. The effects of concomitant administration of paroxetine with neuroleptics and antiarrhythmics have not been studied.

Co-administration may lead to pharmacokinetic interactions and, therefore, should be approached with caution because of the potential increased risk of serious adverse events in some patients, e. SSRIs may reduce plasma cholinesterase activity resulting in a prolongation of the neuromuscular blocking action of mivacurium and suxamethonium.

Administration of thioridazine alone can lead to QTc interval prolongation with associated serious ventricular arrhythmia such as torsades de pointes and sudden death.

As with other drugs which inhibit the hepatic enzyme CYP450 2D6 (including other antidepressants), paroxetine can elevate plasma levels of thioridazine. Therefore, Indomethacin Oral Suspension (Indocin Oral Suspension)- Multum should not be administered with thioridazine (see Section 4.

Drugs metabolised by cytochrome P450 3A4. An in vivo interaction study involving the co-administration under steady state conditions of paroxetine and terfenadine, a substrate for Multhm CYP3A4, revealed no significant effect of paroxetine on terfenadine pharmacokinetics. Paroxetine's extent of (Indocib of CYP3A4 activity is not likely to be of clinical significance when it is administered with terfenadine or other drugs that are CYP3A4 substrates.

Daily administration of paroxetine increases significantly the plasma levels of procyclidine. If anticholinergic effects are seen, the dose of procyclidine should be reduced. A study of the interaction between paroxetine and diazepam showed no alteration in the pharmacokinetics of paroxetine that would warrant changes in the dose of paroxetine for patients receiving both drugs.

Experience in a limited number of healthy subjects has shown that paroxetine does not increase the sedation and drowsiness associated with haloperidol, amylobarbitone or oxazepam, when given in combination. As with other SSRIs, co-administration with serotonergic Suspenskon may lead to an incidence of 5-HT associated effects (serotonin syndrome) (see Section 4.

Caution should be advised and a closer clinical monitoring is required when serotonergic drugs (such as L-tryptophan, triptans, tramadol, linezolid, methylthioninium chloride (methylene blue), SSRIs, Indomethacin Oral Suspension (Indocin Oral Suspension)- Multum, pethidine and St. John's wort (Hypericum perforatum) preparations) are combined with paroxetine.

Concomitant use of paroxetine and MAO inhibitors (including linezolid, an antibiotic which is a reversible nonselective MAO inhibitor) and methylthioninium chloride (methylene blue) is contraindicated because of the risk of serotonin syndrome. Caution is also Indomethacin Oral Suspension (Indocin Oral Suspension)- Multum with fentanyl used in general anaesthesia or in the treatment Indomethacin Oral Suspension (Indocin Oral Suspension)- Multum chronic pain.

Symptoms may include agitation, confusion, diaphoresis, hallucinations, hyperreflexia, myoclonus, shivering, tachycardia and tremor.



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