Pharm
Paroxetine
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Paroxetine
, Paxil, Paroxetine hydrochloride, Pexeva, Paroxetine mesylate, Brisdelle
Mechanism
Selective Serotonin Reuptake Inhibitor
(
SSRI
)
Indications
Major Depression
Comorbid
Gene
ralized anxiety or
Panic Attack
s
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 Defect
s
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)
Gene
ric 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
SSRI
s)
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
SSRI
s (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
Paresthesia
s)
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
SSRI
s
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
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