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Acetaminophen, Dextromethorphan, and Doxylamine Liquid and Paxil (Paroxetine Tablets)

Determining the interaction of Acetaminophen, Dextromethorphan, and Doxylamine Liquid and Paxil (Paroxetine Tablets) and the possibility of their joint administration.

Check result:
Acetaminophen, Dextromethorphan, and Doxylamine Liquid <> Paxil (Paroxetine Tablets)
Relevance: 22.09.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using dextromethorphan together with PARoxetine may increase the effects of dextromethorphan. Contact your doctor if you experience difficulty breathing, dizziness, drowsiness, anxiety, restless feeling, nervousness, confusion, or diarrhea. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

GENERALLY AVOID: Coadministration with potent CYP450 2D6 inhibitors (e.g., quinidine, terbinafine) may significantly increase the plasma concentrations of dextromethorphan in patients who are extensive metabolizers of this isoenzyme (approximately 93% of Caucasians and more than 98% of Asians and individuals of African descent). The proposed mechanism is inhibition of the CYP450 2D6-mediated O-demethylation of dextromethorphan. Studies in humans have shown an increase in systemic exposure of dextromethorphan of up to 43-fold when given concurrently with quinidine. Increased plasma concentrations increase the risk of dextromethorphan-related adverse effects (e.g., agitation, confusion, tremor, insomnia, diarrhea, and respiratory depression) and serotonin syndrome. However, this interaction has also been used clinically, with dextromethorphan in combination with quinidine indicated by some authorities for the treatment of pseudobulbar affect. Data evaluating the impact of this interaction in patients who are poor metabolizers of CYP450 2D6 are limited; most studies include extensive metabolizers of this isoenzyme. It is expected that poor metabolizers would have elevated dextromethorphan levels without concurrent quinidine

MANAGEMENT: The combination of dextromethorphan with potent CYP450 2D6 inhibitors should be generally avoided. Some manufacturers consider the concomitant use of dextromethorphan and selective serotonin reuptake inhibitors contraindicated. If use is considered necessary, the patient should be monitored for signs of dextromethorphan adverse effects (e.g., agitation, confusion, tremor, insomnia, diarrhea, and respiratory depression) and serotonin syndrome, and advised to notify their health care professional if these adverse effects develop or worsen. Dose reduction of dextromethorphan may also be required.

References
  • "Product Information. Nuedexta (dextromethorphan-quinidine)." Avanir Pharmaceuticals, Inc, Aliso Viejo, CA.
  • Cerner Multum, Inc. "Australian Product Information." O 0
  • Capon DA, Bochner F, Kerry N, Mikus G, Danz C, Somogyi AA "The influence of CYP2d6 polymorphism and quinidine on the disposition and antitussive effect of dextromethorphan in humans." Clin Pharmacol Ther 60 (1996): 295-307
  • Zhang Y, Britto MR, Valderhaug KL, Wedlund PJ, Smith RA "Dextromethorphan: enhancing its systemic availability by way of low-dose quinidine-mediated inhibition of cytochrome P4502D6." Clin Pharmacol Ther 51 (1992): 647-55
  • Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  • Schadel M, Wu DA, Otton SV, Kalow W, Sellers EM "Pharmacokinetics of dextromethorphan and metabolites in humans: influence of the CYP2d6 phenotype and quinidine inhibition." J Clin Psychopharmacol 15 (1995): 263-9
Acetaminophen, Dextromethorphan, and Doxylamine Liquid

Generic Name: acetaminophen / dextromethorphan / doxylamine

Brand name: All-Nite, Contac Cold+Flu Cooling Night, Coricidin HBP Nighttime Multi-Symptom Cold, Night Time Cold/Flu, Nyquil Cold & Flu, Robitussin Peak Cold Nighttime Cold + Flu, Tylenol Cold & Cough Nighttime Cool Burst, Tylenol Warming Cough & Sore Throat Nightime, Tylenol Cough & Sore Throat Nightime, Tylenol Cough & Sore Throat Night Time, NyQuil Cold/Flu Relief Cherry, NyQuil Cold/Flu Relief, Nite Time Cold & Flu, Cough & Sore Throat Nighttime, Delsym Cough-Cold Nighttime, Sunmark Nite Time Cold and Flu, Delsym Nighttime Cough & Cold, Multi-Symptom Nighttime Cold & Flu Relief, Nyquil Cold & Flu Nighttime, NyQuil Nature Fusion Cold & Flu Nighttime, Clear Cough PM Multi-Symptom, Tylenol Cough/Sore Throat

Synonyms: Acetaminophen, dextromethorphan, and doxylamine

Paxil (Paroxetine Tablets)

Generic Name: paroxetine

Brand name: Paxil, Brisdelle, Paxil CR, Pexeva

Synonyms: Paxil

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.