Meclizine With Paxil (Paroxetine) Interaction

In our latest question and answer, the pharmacist discusses whether or not there is a drug interaction between meclizine and Paxil (paroxetine).

Question

Can I take meclizine with Paxil?

Asked by Julie On Jul 30, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Jul 31, 2018

Meclizine and paroxetine (Paxil) can be taken together; however, they should be used together with caution since they can both cause central nervous system depression and sleepiness. They should also be used with caution with other medications that can cause central nervous system depression.


Using medications together that cause central nervous system depression can cause someone to be even more sleepy and potentially uncoordinated. It is recommended to see how both medications affect you in regard to feeling sleepy before performing certain activities like driving or operating heavy machinery.


Central Nervous System (CNS) Depression

Medications with CNS depressant activity can slow down normal brain activity to an extent, with the effect differing per class of medication. During the first few days of taking medications that can cause CNS depression, you may feel drowsy or not as coordinated. This should get better within a few days after the body starts to get used to the medication(s).

Examples of medications that can cause CNS depression:
  • Opioids
  • Barbiturates
  • Benzodiazepines
  • Non-benzodiazepine sleep medications
  • Antihistamines
  • Antidepressants
  • Antipsychotics
  • Muscle relaxers
  • Alcohol


Meclizine

According to the prescribing information, meclizine can be used for nausea, vomiting, and dizziness.


Precautions/Warnings
  • Use with caution when driving or operating heavy machinery
  • Avoid alcohol while taking meclizine
  • Use with caution if having: asthma, glaucoma, or enlarged prostate


Side effects
  • Dry mouth
  • Drowsiness
  • Headache
  • Fatigue
  • Upset stomach
  • Blurred vision


Other information
  • Meclizine should not be used in children under the age of 12 since it has not been studied in this age group
  • Anaphylactic reactions have occurred and meclizine should not be used in those with a hypersensitivity to the active or inactive ingredient(s)


Paroxetine (Paxil)

According to the prescribing information, paroxetine can be used for major depressive disorder, obsessive compulsive disorder, panic disorder, social anxiety disorder, generalized anxiety disorder, and posttraumatic stress disorder.


Precautions/Warnings
  • Potential for worsening depression and suicide risk, especially for people ages 18-24 years old with depression or other psychiatric disorders
  • People should be screened for bipolar disorder before use, as an antidepressant alone may cause hypomanic or manic episodes
  • Risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions (NMS), especially with concomitant use with other medications that could increase serotonin levels
    • Medications affecting serotonin
      • Medications that can increase serotonin levels: tryptophan, St. John's Wort, tramadol, buspirone, lithium, fentanyl, tricyclic antidepressants, triptans
      • Medications that decrease metabolism of serotonin and may cause build up: monoamine oxidase inhibitors (MAOIs), linezolid, methylene blue
  • Symptoms of serotonin syndrome or NMS
    • Agitation
    • Hallucinations
    • Rapid heartbeat
    • Blood pressure fluctuations
    • Fever
    • Severe nausea, vomiting, diarrhea
    • Muscle rigidity
  • May cause weight loss, decreased sodium levels, abnormal bleeding (increased risk with anticoagulants, aspirin, nonsteroidal anti-inflammatory drugs)
  • Should only be used if benefits outweigh risks during pregnancy
    • Paroxetine has shown a potential to cause defects when taken during pregnancy


Contraindications
  • Use with monoamine oxidase inhibitors (MAOIs) or using paroxetine or MAOIs within 14 days of one another, including linezolid or methylene blue
  • Concomitant use with thioridazine or pimozide
  • Use with a hypersensitivity to the medication or any inactive ingredients


Side effects
  • Nausea
  • Sleepiness
  • Lack of energy
  • Insomnia
  • Dizziness
  • Headache
  • Dry mouth
  • Constipation
  • Diarrhea
  • Sweating
  • Tremor
  • Decrease sex drive or ejaculatory issues


Other information
  • Do not stop taking SSRIs abruptly
    • Doses typically need tapering down in order to avoid side effects of stopping the medication
    • Potential effects of stopping the medication include: mood changes (irritability, agitation, anxiety), confusion, headache, insomnia, dizziness, and lethargy

About the Pharmacist

Dr. Anna Staudt Pharm.D

Dr. Anna Staudt graduated in 2017 with a Doctor of Pharmacy degree. She is completing a pharmacy fellowship focused on ambulatory care. Her current practice site is at a Federally Qualified Health Center (FQHC) where she deals with the underserved.

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