PAROXETINE

Indications & Dose:

 Major depression

Social anxiety disorder

Post-traumatic stress disorder

Generalised anxiety disorder

•   BY MOUTH

Adult: 20 mg daily, dose to be taken in the morning, no evidence of greater efficacy at higher doses; maximum 50 mg per day

Elderly: 20 mg daily, dose to be taken in the morning, no evidence of greater efficacy at higher doses; maximum 40 mg per day

Obsessive-compulsive disorder

•   BY MOUTH

Adult: Initially 20 mg daily, dose to be taken in the morning, increased in steps of 10 mg, dose to be increased gradually, increased to 40 mg daily, no evidence of greater efficacy at higher doses; maximum 60 mg per day

Elderly: Initially 20 mg daily, dose to be taken in the morning, increased in steps of 10 mg, dose to be increased gradually; maximum 40 mg per day

Panic disorder

•  BY MOUTH

Adult: Initially 10 mg daily, dose to be taken in the morning, increased in steps of 10 mg, dose to be increased gradually, increased to 40 mg daily, no evidence of greater efficacy at higher doses; maximum 60 mg per day

Elderly: Initially 10 mg daily, dose to be taken in the morning, increased in steps of 10 mg, dose to be increased gradually; maximum 40 mg per day

Contraindications:

Patients taking MAOIs (or within 14 days of discontinuing an MAGI).. 

Side Effects:

Cautions:

Precautions:

History of mania; renal and hepatic disease 

Interaction:

 Drugs

Beta-blockers (metroprolol, propranolol, sotalol): Inhibition of metabolism (CYP2Db) leads to increased plasma concentrations of selective beta blockers and potential cardiac toxicity; atenolol may be safer choice

Carbamazepine: Inhibition of hepatic metabolism of carbarnazepine, but the formation of carbamazepine epoxide is not inhibited, contributing to increased toxicity

Cyproheptadine: Serotonin antagonist may partially reverse antidepressant and other effects

Dexfenfluramine: Duplicate effects on inhibition of serotonin reuptake; inhibition of dexfenfluramine metabolism (CYP2D6) exaggerates effect; both mechanisms increase risk of serotonin syndrome

Dextromethorphan: Inhibition of dextrornethorphan’s metabolism (CYP2D6) by paroxetine and additive serotonergic effects

Diuretics, loop (bumetanide, furosemide, torsemide): Possible additive hyponatremia; two fatal case reports with furosemide and paroxetine

Fenfluramine: Duplicate effects on inhibition of serotonin reuptake; inhibition of dexfenfiuramine metabolism (CYP2D6) exaggerates effect; both mechanisms increase risk of serotonin syndrome Haloperidol: Inhibition of haloperidol’s metabolism (CYP2D6) may increase risks of extrapyramidal symptoms

HMG-Co A reductase inhibitot’s (atoritastatin, lovastatin, simvastati il j: Inhibition of statin metabolism (CYP3A4), by paroxetine, may lead to rhabdomyolysis

Lithium: Neurotoxicity (tremor, confusion, ataxia, dizziness, dysarthria, and abscence seizures) reported in patients receiving this combination; mechanism unknown

MAOI’s (isocarboxazid, phenelzine, tranylcypromine): Increased CNS serotonergic effects have been associated with severe or fatal reactions with this combination

Selegiline: Sporadic cases of mania and hypertension

Tricyclic antidepressants (clomipramine, desipramine, doxepin, imipramine, nortriptyline, trazodone): Marked increases in tricyciic antidepressant levels due to inhibition of metabolism (CYP2D6)

Tryptophan :Additive serotonergic effects

Warfarin: Increased risk of bleeding 

Warnings:

Adverse Effects:

Lactations:

Limited information; milk concentrations similar to plasma following a single oral dose; thus < 1 % of the daily dose would be transferred to a breastfeeding infant 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Agitation, anxiety, asthenia, delusions, dizziness, euphoria, fatigue, hallucinations, headache, insomnia, myoclonus, nervousness, psychosis, sedation, tremor

CV: Palpitations, postural hypotension, vasodilation

EENT: Pharyngitis, visual changes

GI: Anorexia, constipation, cramps. degreased appetite, diarrhea, dry mouth, dyspepsia, flatulence, nausea, taste changes, vomiting

GU: Abnormal ejaculation, urinary frequency

MS: Arthritis; myalgia, myasthenia. myopathy, pain

RESP: Cough, dyspnea, infection. nasal congestion, pharyngitis, sitiltS headache, sinusitis

SKIN: Rash, sweating

MISC: Fever 

Patient And Carer Advice: