Paroxetine is a member of the selective serotonin reuptake inhibitor (SSRI) family of drugs
used to treat people with depression.
Summary of
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
interactions.
 May Be Beneficial: Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them. |
Sodium
|
| May Be Beneficial: Side effect
reduction/prevention—Taking these supplements may help reduce the likelihood and/or
severity of a potential side effect caused by the medication. |
Ginkgo biloba*
|
Avoid: Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results. |
5-Hydroxytryptophan (5-HTP)*
L-tryptophan*
St. John’s wort*
|
| Supportive interaction |
None known
|
| Reduced drug
absorption/bioavailability |
None known
|
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
evidence.
Interactions with Dietary Supplements
5-Hydroxytryptophan
(5-HTP) and L-trytophan
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.1 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.2
Sodium
SSRI drugs, including paroxetine, have been reported to cause sodium depletion.3
4 5 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.
Interactions with Herbs
Ginkgo
biloba
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.6 This makes sense because ginkgo has been reported to help men
with some forms of erectile
dysfunction.7
St. John’s
wort (Hypericum perforatum)
One report described a case of serotonin syndrome in a patient who took St. John’s wort
and trazodone, a weak SSRI drug.8
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.9
Interactions with Foods and Other Compounds
Food
Paroxetine may be taken with or without food.10
Alcohol
SSRI drugs, including paroxetine, may cause dizziness or drowsiness.11 Alcohol may
intensify these effects and increase the risk of accidental injury. Alcohol should be avoided
during paroxetine therapy.
References:1. 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.
2. Walinder J, Carlsson A, Persson R. 5-HT reuptake inhibitors plus
tryptophan in endogenous depression. Acta Psych Scand Suppl
1981;290:179–90.
3. Spigset O, Hedenmalm K, Mortimer O. Hyponatremia as a side effect of
serotonin uptake inhibitors. Lakartidningen 1998;95:3537–9 [Swedish].
4. Strachan J, Shepherd J. Hyponatraemia associated with the use of
selective serotonin re-uptake inhibitors. Aust N Z J Psychiatry
1998;32:295–8.
5. 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.
6. 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.
7. Sohn M, Sikora R. Ginkgo biloba extract in the therapy of erectile
dysfunction. J Sex Educ Ther 1991;17:53–61.
8. Demott K. St. John’s wort tied to serotonin syndrome.
Clinical Psychiatry News 1998;26:28.
9. Gordon JB. SSRIs and St. John’s Wort: possible toxicity? Am
Fam Physician 1998;57:950.
10. Nemeroff CB. Paroxetine: an overview of the efficacy and safety of a
new selective serotonin reuptake inhibitor in the treatment of depression. J Clin
Psychopharmacol 1993;13(6 suppl 2):10S–7S [review].
11. 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.