Paroxetine

Antidepressant · SSRIs

Indications

All types of depressive illness, depression accompanied by anxiety. Obsessive compulsive disorder. Panic disorder with or without agoraphobia. Symptoms of social phobia. Generalized anxiety disorder. Premenstrual dysphoric disorder (PMDD). Post-traumatic stress disorder (PTSD).

Dosage

Depression: Adults: Initially 20 mg once daily in the morning with food. If necessary increase gradually after minimum 2 wk in 10 mg increments; max 50 mg daily. Obsessive compulsive disorder: Adults: Initially 20 mg once daily in the morning with food. Increase wkly 10 mg increments to 40 mg daily; max 60 mg daily. Panic disorders: Adults: Initially 10 mg once daily in the morning with food. Increase wkly in 10 mg increments to 40 mg daily; max 50 mg daily. Social phobia: Adults: Initially 20 mg once daily in the morning with food. If necessary increase gradually after minimum 2 wk in 10 mg increments at intervals of at least a wk; max 50 mg daily. Elderly: Initially adult starting dose once daily. If necessary increase in wkly 10 mg increments; max 40 mg daily. Generalized anxiety disorder: Adults: Initially 20 mg once daily, preferably in the morning (if dose is increased, adjust in…

Adverse Effects

GI upset, decreased appetite, anorexia, somnolence, sweating, tremor, headache, asthaenia, dry mouth, dizziness, blurred vision, yawning, abnormal dreams, insomnia, agitation, weight gain, impaired concentration, elevated cholesterol levels, sexual dysfunction, dystonic reactions, akathisia. Rarely, serotonin or neuroleptic malignant syndrome, hyponatraemia, haemorrhage, aggression.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Caution advised or effect undetermined. Contraindications: Within 2 weeks of stopping MAOIs or 1 day of stopping moclobemide or linezolid. Precautions: Hepatic or severe renal (CrCl, 30 mL/min) impairment, serotonin syndrome, cardiovascular disease, bleeding disorders, glaucoma, epilepsy (discontinue if new or increased seizures), ECT, diabetes, hyponatraemia. History of mania; discontinue if patient enters a manic phase. History of suicide-related events; monitor for suicidal ideation. Withdraw gradually. Elderly. Dose increases may be detrimental in patients who develop akathisia.

Interactions

MAOIs, pimozide, linezolid, moclobemide, perphenazine, risperidone, other antipsychotics, atomoxetine, class 1c antiarrhythmics, metoprolol, tramadol, tryptophan, lithium, phenytoin, TCADs, fosamprenavir, ritonavir, drug affecting liver enzymes (e.g. phenytoin, carbamazepine, phenobarbital, rifampicin), oral anticoagulants, NSAIDs, drugs that increase risk of bleeding, procyclidine, alcohol, St. John's Wort, other SSRIs, SNRIs, 5HT1 agonists/triptans, other serotonergic drugs, tamoxifen. Liquid only: Drugs affecting gastric pH, neuromuscular blockers, pravastatin.

Advice to Patient

Take controlled release tablets with or without meals. Do not chew or crush, swallow whole. Avoid taking controlled release tablets within 2 hours of taking an antacid. Take film-coated tablets with meals. Do not chew, swallow whole. Take medication in morning. Do not take aspirin and NSAIDs during therapy. Do not stop taking medication abruptly, gradually lower the dose and then stop. Contact prescriber if there is chest pain, palpitations, fast heartbeat, change in vision, eye pain, difficulty in breathing, stomach pain, blood in stool, constant lack of sleep, increased sleepiness during daytime, muscle cramps, tremors, weakness, change in gait or if there is worsening of condition. Avoid alcohol and caffeine during therapy. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Change position slowly from sitting or lying to…

Pharmacokinetics

Onset of action: Depression: The onset of action is within a week; however, individual response varies greatly and full response may not be seen until 8 to 12 weeks after initiation of treatment; antiobsessional and antipanic effects: Up to several weeks. Absorption: Completely absorbed following oral administration. Metabolism: Extensively hepatic. Bioavailability: Immediate release tablet and oral suspension have equal bioavailability. Half-life elimination: Paxil: 21 hours; Paxil CR: 15 to 20 hours; Pexeva: 33.2 hours. Time to peak: Capsules: Median: 6 hours (range: 3 to 8 hours). Tablets, oral suspension: Immediate release: Mean: 5.2 to 8.1 hours. Tablets: Controlled release: 6 to 10 hours. Excretion: Urine (64%, 2% as unchanged drug); feces (36% primarily via bile, <1% as unchanged drug).

Brands with this active ingredient

Compiled by Healify Pharmacy from published drug references. How we compile it →

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