II. Mechanism
III. 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
IV. Pregnancy Risk
- Category D
- Neonatal withdrawal risk
- 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]
V. Background
- Cost: $81 per month
VI. 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
VII. 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
VIII. Mechanism
- Selective Serotonin Reuptake Inhibitor (SSRI)
- Increased Norepinephrine reuptake inhibitor activity
- Increased Anticholinergic activity
IX. Pharmacokinetics
- Half Life: 1 day (shorter than most other SSRIs)
X. 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
XI. 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
XII. Precautions
- Use caution in Pediatric Depression
- Use may be associated with higher Suicide Risk
XIII. Resources
- Paxil Website (GlaxoSmithKline)
Images: Related links to external sites (from Bing)
Related Studies (from Trip Database) Open in New Window
| Paroxetine (on 6/18/2017 at Walmart.com) | ||
| Paroxetine 10mg | #30 tablets for $4.00 | $0.13 each |
| Paroxetine 10mg | #90 tablets for $10.00 | $0.11 each |
| Paroxetine 20mg | #30 tablets for $4.00 | $0.13 each |
| Paroxetine 20mg | #90 tablets for $10.00 | $0.11 each |
| paroxetine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| PAROXETINE CR 12.5 MG TABLET | Generic | $3.81 each |
| PAROXETINE CR 25 MG TABLET | Generic | $3.71 each |
| PAROXETINE CR 37.5 MG TABLET | Generic | $3.90 each |
| PAROXETINE ER 12.5 MG TABLET | Generic | $3.81 each |
| PAROXETINE ER 25 MG TABLET | Generic | $3.71 each |
| PAROXETINE ER 37.5 MG TABLET | Generic | $3.90 each |
| PAROXETINE HCL 10 MG TABLET | Generic | $0.10 each |
| PAROXETINE HCL 20 MG TABLET | Generic | $0.09 each |
| PAROXETINE HCL 30 MG TABLET | Generic | $0.12 each |
| PAROXETINE HCL 40 MG TABLET | Generic | $0.13 each |
| paxil (on 6/9/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| PAXIL 10 MG TABLET | Generic | $0.10 each |
| PAXIL 10 MG/5 ML SUSPENSION | $1.15 per ml | |
| PAXIL 20 MG TABLET | Generic | $0.09 each |
| PAXIL 30 MG TABLET | Generic | $0.12 each |
| PAXIL 40 MG TABLET | Generic | $0.13 each |
| PAXIL CR 12.5 MG TABLET | Generic | $3.81 each |
| PAXIL CR 25 MG TABLET | Generic | $3.71 each |
| PAXIL CR 37.5 MG TABLET | Generic | $3.90 each |
| brisdelle (on 1/18/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| BRISDELLE 7.5 MG CAPSULE | $5.86 each | |
Ontology: Paroxetine (C0070122)
| Definition (CHV) | a kind of depression treatment drug |
| Definition (MSH) | A serotonin uptake inhibitor that is effective in the treatment of depression. |
| Definition (CSP) | serotonin uptake inhibitor used in the treatment of depression. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D017374 |
| SnomedCT | 96214003, 321963000, 372595009 |
| LNC | LP17979-3, MTHU004267 |
| English | Paroxetine, Piperidine, 3-((1,3-benzodioxol-5-yloxy)methyl)-4-(4-fluorophenyl)-, (3S-trans)-, (-)-trans-4-(p-fluorophenyl)-3-((3,4-(methylenedioxy)phenoxy)methyl)piperidine, Piperidine, 3-((1,3-benzodioxol-5-yloxy)methyl)-4-(4-fluorophenyl)-, (3s-trans)-, (-)-(3S,4R)-4-(p-Fluorophenyl)-3-((3,4-(methylenedioxy)phenoxy)methyl)piperidine, Paroxetine [Chemical/Ingredient], PAROXETINE, PARoxetine, paroxetine, Paroxetine (product), Paroxetine (substance) |
| Swedish | Paroxetin |
| Czech | paroxetin |
| Finnish | Paroksetiini |
| Russian | PAROKSETIN, ПАРОКСЕТИН |
| Japanese | パロキセチン |
| Polish | Paroksetyna |
| Spanish | paroxetina (producto), paroxetina (sustancia), paroxetina, Paroxetina |
| French | Paroxétine |
| German | Paroxetin |
| Italian | Paroxetina |
| Portuguese | Paroxetina |
Ontology: Paxil (C0376414)
| Definition (CHV) | a kind of chemical substance |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D017374 |
| English | paxil, Paxil |
Ontology: Pexeva (C1602496)
| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| English | Pexeva |
