Drug General Information (ID: DDIBUS5MVF)
Drug Name			Paroxetine		Drug Info		Brivaracetam		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidepressants				Anticonvulsants
Structure

Mechanism of Paroxetine-Brivaracetam Interaction (Severity Level: Moderate)
Antagonize the effect of antiepileptic agents Click to Show/Hide Mechanism Graph
Drug Name		Paroxetine				Brivaracetam
Mechanism		Lower seizure threshold				Antiepileptic agent
Key Mechanism Factor 1
		Factor Name		Antiepileptic agents
		Factor Description		The beneficial effects of antiepileptic drugs may be reduced, leading to an increase in seizure frequency or duration.
Mechanism Description		Antagonize the effect of Brivaracetam when combined with Paroxetine

Recommended Action
Management		SSRIs and SNRIs should be avoided in patients with unstable epilepsy, and used cautiously in patients with epilepsy controlled with anticonvulsant medications. Treatment with SSRIs and SNRIs should be discontinued if seizures develop or seizure frequency increases. Patients receiving SSRIs or SNRIs with anticonvulsants, particularly carbamazepine, eslicarbazepine, oxcarbazepine and/or valproic acid, should also have serum sodium levels measured regularly and monitored for development of hyponatremia, particularly when higher dosages of these medications are used. Signs and symptoms of hyponatremia include nausea, vomiting, headache, difficulty concentrating, memory impairment, confusion, malaise, lethargy, muscle weakness or spasms, and unsteadiness. In more severe and/or acute cases, hallucination, syncope, seizure, coma, respiratory arrest, and death may occur.

References
1	Belcastro V, Costa C, Striano P "Levetiracetam-associated hyponatremia." Seizure 17 (2008): 389-90. [PMID: 18584781]
2	Gandhi S, McArthur E, Mamdani MM, et.al "Antiepileptic drugs and hyponatremia in older adults: Two population-based cohort studies." Epilepsia 57 (2016): 2067-79. [PMID: 27896804]
3	Product Information. Savella (milnacipran). Forest Pharmaceuticals, St. Louis, MO.
4	Product Information. Aptiom (eslicarbazepine). Sunovion Pharmaceuticals Inc, Marlborough, MA.
5	Product Information. Cymbalta (duloxetine). Lilly, Eli and Company, Indianapolis, IN.
6	Product Information. Pristiq (desvenlafaxine). Wyeth Laboratories, Philadelphia, PA.
7	Product Information. Tegretol (carbamazepine). Novartis Pharmaceuticals, East Hanover, NJ.
8	Product Information. Celexa (citalopram). Forest Pharmaceuticals, St. Louis, MO.
9	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
10	Product Information. Paxil (paroxetine). GlaxoSmithKline, Research Triangle Park, NC.
11	Product Information. Prozac (fluoxetine). Dista Products Company, Indianapolis, IN.
12	Product Information. Luvox (fluvoxamine). Solvay Pharmaceuticals Inc, Marietta, GA.
13	Product Information. Effexor (venlafaxine). Wyeth-Ayerst Laboratories, Philadelphia, PA.
14	Product Information. Fetzima (levomilnacipran). Forest Pharmaceuticals, St. Louis, MO.
15	Product Information. Zoloft (sertraline). Roerig Division, New York, NY.
16	Patel KR, Meesala A, Stanilla JK "Sodium valproate-induced hyponatremia: a case report." Prim Care Companion J Clin Psychiatry 12 (2010): epub. [PMID: 21274365]
17	Product Information. Lexapro (escitalopram). Forest Pharmaceuticals, St. Louis, MO.
18	Falhammar H, Lindh JD, Calissendorff J, et.al "Differences in associations of antiepileptic drugs and hospitalization due to hyponatremia: A population-based case-control study." Seizure 59 (2018): 28-33. [PMID: 29730273]
19	Bavbek N, Alkan R, Uz E, Kaftan O, Akcay A "Hyponatremia associated with sodium valproate in a 22-year-old male." Nephrol Dial Transplant 23 (2008): epub. [PMID: 17913733]
20	Product Information. Trileptal (oxcarbazepine) Novartis Pharmaceuticals, East Hanover, NJ.