Does Paxil interact with Ibuprofen? (+1 cases)

In this article, we will discuss if Paxil has a possible drug interaction with ibuprofen. Paxil (paroxetine) is a selective serotonin reuptake inhibitor (SSRI) that is used in depression and anxiety disorders. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used for the management of pain, inflammation and fever.

Does Paxil interact with Ibuprofen?

Yes, Paxil may have a drug interaction with ibuprofen. Taking Paxil with ibuprofen can significantly increase the risk of gastrointestinal bleeding. If you are taking Paxil, you should always consult your doctor before taking ibuprofen.

Ibuprofen is an anti-inflammatory drug and pain reliever which is extensively used by the public and can be acquired without a prescription from pharmacies. This increases the chance of incorrect dosing and possible drug interaction with Paxil. 

When on antidepressants, it is always wise to stick with the treatment plan and avoid unnecessary use of over-the-counter (OTC) drugs. If it is necessary to take ibuprofen, always consult the pharmacist available in the pharmacy and tell him about your medical history.

How does Paxil interact with Ibuprofen?

Paxil may increase the risk of bleeding in patients receiving ulcerogenic medication like ibuprofen. Ibuprofen can also cause acute thrombocytopenia. Paxil, being a potent SSRI, may interact similarly to ibuprofen and disrupt the platelets. 

In very rare cases, Paxil-ibuprofen-induced drug interaction can lead to bleeding events including epistaxis, hematoma, and haemorrhages. Patients who take both NSAIDs and SSRIs have a higher risk of upper gastrointestinal bleeding when compared to patients who take neither group of drugs.

Does ibuprofen reduce the effectiveness of Paxil?

Ibuprofen reduces the effectiveness of Paxil, making it less likely that someone using both may get depression relief. Researchers have discovered that when taking both medications, 40% of patients responded to the antidepressant, while the administration of antidepressants alone helped 55% of the patients (1). 

Researchers have also discovered that mice given ibuprofen had reduced levels of P11 in their brains. This protein helps in the effectiveness of antidepressants and is implicated in depression (2).

What does the research suggest?

In a study carried out at the University of East Anglia, the researchers examined more than 100 cases of patients who experienced stomach bleeding as a result of SSRIs and discovered that 2/3rd of the patients were also on pain relievers.

Another research suggests that Paxil may disrupt platelet function and cause bleeding. Platelet serotonin is critical in hemostasis and Paxil can increase the release of serotonin from platelets (3). While Paxil poses only a small risk of harm, the risk significantly increases when combined with ibuprofen.

When to consult the doctor?

Before starting the treatment, the doctor may be aware of the risks, but the benefits of using ibuprofen with Paxil must have been the best course of treatment for the underlying condition.

Seek immediate consultation if the patient has unusual bleeding or bruising. The doctor will take necessary measures and monitor the patient closely for potential adverse consequences.

What are the possible symptoms of Paxil-ibuprofen interaction?

Paxil-ibuprofen possible drug interaction can lead to the following side effects:

• Red or black tarry stool,
• dizziness,
• lightheadedness,
• severe headache,
• weakness,
• vomiting or coughing up fresh or dried blood.

How to reduce the chances of ibuprofen-Paxil drug interaction?

Changing the time of Paxil administration would not possibly reduce the chances of getting drug-drug interaction because the elimination half-life of Paxil is around 21-24 hours. This means 50% of the drug remains in the body after 24 hours. Taking ibuprofen at any time of the day might still interact with Paxil present in the body.

The doctor might prescribe a different antidepressant such as tricyclics (except for clomipramine). Tricyclics do not alter the serotonin reuptake and will present with lesser side effects when given with ibuprofen.

When alternate therapy is not possible in patients, the doctor might prescribe histamine-2-receptor antagonists, or a proton pump inhibitor to reduce the chances of ulceration and other gastrointestinal irritation caused by ibuprofen (4).

Which painkiller can be taken with Paxil?

If the patient must take a pain killer, paracetamol may be a better option than nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. The finding suggests that combining Paxil with NSAID increases the risk of gastrointestinal bleeding by six times (5).

What other drugs interact with Paxil to cause bleeding?

Drugs that can interact with Paxil and cause the likelihood of bleeding include:

• other NSAIDs like aspirin, naproxen and diclofenac,
• anticoagulant medicines like warfarin,
• some antipsychotic medicines like chlorpromazine, and
• antiplatelet medicine like aspirin or clopidogril.

What other drugs reduce the effectiveness of Paxil?

Drugs that can increase the breakdown of Paxil in the body and reduce its effectiveness include:

• phenobarbitol,
• ritonavir, 
• phenytoin,
• fosphenytoin, and
• carbamazepine.

Conclusion

In this article, we discussed the interaction between ibuprofen and Paxil. Both drugs increase the risk of bleeding when given concomitantly. You should always consult your doctor before taking any OTC  drug while you are taking Paxil. Women need to monitor their menstrual bleeding or any sign of vaginal bleeding while taking the two drugs.

References