Seroxat/Seroxat CR Contraindications

Known hypersensitivity to active substance (s) or to any of the excipients listed in Descriptions.
Seroxat: SEROXAT is contraindicated in combination with monoamine oxidase inhibitors (MAOIs). In exceptional circumstances, linezolid (an antibiotic which is a reversible non-selective MAOI) can be given in combination with paroxetine provided that there are facilities for close observation of symptoms of serotonin syndrome and monitoring of blood pressure (see Interactions).
Treatment with paroxetine can be initiated: Two weeks after discontinuation of an irreversible MAOI or; At least 24 hours after discontinuation of a reversible MAOI (e.g. moclobemide, linezolid, methylthioninium chloride (methylene blue); a preoperative visualising agent which is a reversible non-selective MAOI).
At least two weeks should elapse between discontinuation of paroxetine and initiation of therapy with any MAOI.
SEROXAT should not be used in combination with thioridazine, because, as with other drugs which inhibit the hepatic enzyme CYP450 2D6, paroxetine can elevate plasma levels of thioridazine (see Interactions). Administration of thioridazine alone can lead to QTc interval prolongation with associated serious ventricular arrhythmia such as torsades de pointes, and sudden death.
SEROXAT should not be used in combination with pimozide (see Interactions).
Seroxat CR: Monoamine Oxidase Inhibitors: In patients receiving serotonin reuptake inhibitors (SSRIs) in combination with a MAO inhibitor, there have been reports of serious, sometimes fatal, reactions including hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma. These reactions have also been reported in patients who have recently discontinued SSRI treatment and have begun treatment on a MAO inhibitor. Some cases presented with features resembling serotonin syndrome or neuroleptic malignant syndrome (see Precautions). Therefore, SEROXAT CR should not be used in combination with MAO inhibitors [including methylthioninium chloride (methylene blue)] or within a minimum of 2 weeks of terminating treatment with MAO inhibitors. Treatment with SEROXAT CR should then be initiated cautiously and dosage increased gradually until optimal response is reached. MAO inhibitors should not be introduced within 2 weeks of cessation of therapy with SEROXAT CR.
SEROXAT CR should not be started in a patient receiving linezolid. Wait until 24 hours after the last dose of linezolid before starting SEROXAT CR.
Thioridazine: Thioridazine administration alone produces prolongation of the QTc interval, which is associated with serious ventricular arrhythmias, such as torsade de pointes-type arrhythmias, and sudden death. This effect appears to be dose-related.
An in vivo study suggests that drugs which inhibit P450 2D6, including certain SSRI's such as paroxetine, fluoxetine and fluvoxamine, will elevate plasma levels of thioridazine. Therefore, SEROXAT CR should not be used in combination with thioridazine or within a minimum of 2 weeks of terminating treatment with thioridazine. At least 2 weeks should be allowed after discontinuing SEROXAT CR therapy before initiating treatment with thioridazine.
Pimozide: The concomitant use of SEROXAT CR and pimozide is contraindicated as paroxetine has been shown to increase plasma pimozide levels. Elevation of pimozide blood concentration may result in QT interval prolongation and severe arrhythmias including torsade de pointes (see Interactions).