Hi, In my opinion both Sotalol and Paxil can individually cause arrhythmias of heart particularly QT prolongation and ventricular afibrillation. Though Paroxetene, is considered as the most safe drug out of all anti-depressive and rarely cause any serious bad effect on heart-rhythm, still the chances of arrhythmia increase while it is being used with Sotalol. Hence it is always better to avoid this combination, if possible. If both these drugs are to be used together, then the close watch on the heart rhythm is advised. Similarly, Paroxetene and Tramadol-Acetaminophen both may increase the blood level of Serotinin. Too much increased level of Serotinin may cause sometimes potentially serious side effects of raised BP, increased heart rate leading to shock many a times. Hence a close watch by your doctor is advised in this matter also. You may safely use Cefalosporine group of antibiotics with Sotalol, as these are not known to interact with each other. If still there is persisting problem,then it is always better to go for a culture and sensitivity test and use the appropriate antibiotic taking its interaction with Sotalol into consideration. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Satnarain Bansal, General & Family Physician