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Paroxetine
Aka: Paroxetine, Paxil, Paroxetine hydrochloride, Pexeva, Paroxetine mesylate, Brisdelle
- Mechanism
- Selective Serotonin Reuptake Inhibitor (SSRI)
- Indications
- Major Depression
- Comorbid Generalized anxiety or Panic Attacks
- Obsessive Compulsive Disorder
- Suppression of premature ejaculation
- Social Anxiety Disorder or Social Phobia
- Post-Traumatic Stress Disorder
- Pregnancy Risk
- Category D
- Neonatal withdrawal risk
- Sanz (2005) Lancet 365:482-7 [PubMed]
- Increased Atrial and Ventricular Septal Defects
- Associated with first trimester exposure
- Associated with a two fold increased risk
- (2006) Obstet Gynecol 108:1601-3 [PubMed]
- Background
- Cost: $81 per month
- Preparations
- Paxil (Paroxetine hydrochloride)
- Generic Paxil is available in United States in 2003
- Tablets (lower doses scored): 10, 20, 30, and 40 mg
- Oral Suspension: 10 mg/5 ml
- Paxil CR Tablets: 12.5, 25, and 37.5 mg
- Marketed as reducing GI upset with standard Paxil
- Must be swallowed whole without chewing
- Brisdelle Capsule (Paroxetine): 7.5 mg
- Released in 2013 specifically targeting Hot Flushes
- Paroxetine 10 mg generic tablet daily is nearly equivalent (at 6% of the Brisdelle cost)
- Pexeva (Paroxetine mesylate)
- Likely has similar activity to Paxil but not proven
- Was significantly less expensive than original trade name Paxil
- Dosing: Paxil
- Start
- Adults: 20 mg PO qhs
- Elderly: 10 mg qd
- Titrate
- Adults: Increase by 10 mg every 2 weeks
- Maximum: 60 mg PO qhs
- Mechanism
- Selective Serotonin Reuptake Inhibitor (SSRI)
- Increased Norepinephrine reuptake inhibitor activity
- Increased Anticholinergic activity
- Pharmacokinetics
- Half Life: 1 day (shorter than most other SSRIs)
-
Drug Interactions
- Inhibits Cytochrome P450-2D6
- Raises Warfarin (Coumadin) levels and associated INR
- Raises Tricyclic Antidepressant levels
- Highly protein bound
- Interacts with other protein bound medications
- Allow 2 week wash-out prior to starting MAO inhibitor
- Adverse Effects
- Anticholinergic side effects (Sedation, Constipation)
- Avoid in elderly with cognitive disorders
- Sedating on the sedation to excitation continuum
- Most sedating of the SSRIs (administer at bedtime)
- Some patients may have paradoxical activation
- Sexual Dysfunction (inhibits nitric oxide synthetase)
- See Antidepressant Induced Sexual Dysfunction
- More common than with Fluoxetine or Sertraline
- Dysesthesia (skin Paresthesias)
- Dry Mouth
- Constipation
- Antidepressant Withdrawal on stopping medication
- Reduce dose by 10 mg per day every 5-7 days
- Taper down to 5-10 mg before discontinuing
- Less anxiety (more Anxiolytic) than other SSRIs
- Similar to Serzone on this spectrum
- Weight gain
- More common than with Fluoxetine or Sertraline
- Precautions
- Use caution in Pediatric Depression
- Use may be associated with higher Suicide Risk
- Resources
- Paxil Website (GlaxoSmithKline)
- http://www.paxil.com