Paroxetine Digoxin

Galantamine (Razadyne) [Cholinesterase Inhibitor] Uses Alzheimer Dz Action Acetylcholinesterase inhibitor Dose 4 mg PO bid, T to 8 mg bid after 4 wk may T to 12 mg bid in 4 wk Caution [B, ] T Effect w/ suc-cinylcholine, amiodarone, dildazem, verapamil, NSAIDs, digoxin X- effect w/ anticholinergics, T risk of death vs placebo Contra Severe renal/hepadc impair Disp Tabs, soln SE GI disturbances, wt loss, sleep disturbances, dizziness, HA Interactions T Effects W/ amitriptyline, cimeddine, erythromycin, fluoxetine, fluvoxamine, ketoconazole, paroxetine, quinidine EMS Use succinylcholine w/ caudon, may need a reduced dose monitor ECG for induced conduction abnormalities OD May cause cholinergic Sxs (SLUDGE), muscle weakness, resp depression, and Szs atropine may be used as antidote... 

St. John s wort Mild to moderate depression Gastrointestinal upset, photo-sensitivity. Mild serotonin syndrome with the following medications paroxetine, trazodone, sertraline, and nefazodone. May decrease digoxin levels. May decrease cyclosporine serum concentrations. Combined oral contraceptives—breakthrough bleeding. 

Clinically important, potentially hazardous interactions with alprazolam, aprepitant, astemizole, atorvastatin, benzodiazepines, carbamazepine, chlordiazepoxide, cilostazol, clonazepam, clorazepate, colchicine, conivaptan, cyclosporine, dabigatran, dasatinib, diazepam, digoxin, dihydroergotamine, disopyramide, ergot alkaloids, fesoterodine, fluoxetine, flurazepam, fluvastatin, HMG-CoA reductase inhibitors, imatinib, ixabepilone, lapatinib, lopinavir, lorazepam, lovastatin, methylprednisolone, methysergide, midazolam, nilotinib, oxazepam, paroxetine, pimozide, pravastatin, prednisone, quazepam, repaglinide, rimonabant, rivaroxaban, sertraline, silodosin, simvastatin, solifenacin, temazepam, temsirolimus, tolvaptan, trabectedin, triazolam, warfarin, zidovudine... 

Bannister S J, Houser VP, Hulse JD, Kisicki JC, Rasmussen JGC. Evaluation of the potential for interactions of paroxetine with diazepam, cimetidine, warfarin, and digoxin. Acta Psychi-atrScand( 9S9) 80 (Suppl 350), 102-6. 

The concurrent use of ranolazine and moderate or potent inhibitors of CYP3A4, such as some azoles, diltiazem, grapefruit juice, macrolides, protease inhibitors, or verapamil will result in increased levels of ranolazine, and can predispose the patient to adverse effects including QT interval prolongation. Cimetidine and paroxetine do not interact to a clinically significant extent. Ranolazine may increase levels of ciclosporin, digoxin or simvastatin. 

Citalopram, fiuvoxamine, paroxetine, and sertraline appear not to affect the pharmacokinetics of digoxin. However, one case-control study found a small increased risk of digoxin toxicity after starting sertraline, paroxetine, fluoxetine or fiuvoxamine, and two isolated reports describe increased serum digoxin levels attributed to the use of fluoxetine or paroxetine. 

A study in healthy subjects found that paroxetine 30 mg daily had no effect on the pharmacokinetics of digoxin 250 micrograms daily. The pharmacokinetics of paroxetine were unaffected by digoxin. ... 

An isolated report describes a 93-year-old woman with congestive heart failure who developed increased serum digoxin levels on two occasions when fluoxetine was added. Another case report describes digoxin toxicity in a 68-year-old woman with atrial fibrillation and depression, which was attributed to the addition of paroxetine 20 mg daily. Her digoxin levels reached 5.2 nanograms/mL. ... 

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