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| Paroxetine (Systemic) |
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| Category: Antianxiety agent; antidepressant;
antiobsessional agent; antipanic agent |
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| Commonly used brand name(s): Paxil; Paxil
CR; Paxil A; Paxil B; Paxil C; Paxil D; Paxil E; Paxil F; Paxil
G; Paxil H; Paxil H; Paxil H; Paxil H; Paxil H; Paxil H; Paxil
H; Paxil H; Paxil H; Paxil H; Paxil H; Paxil H; Paxil H; Paxil
H; Paxil H... more
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| VA Classification: Primary CN103, CN104
| Secondary CN850 |
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The following highlights have been
selected on the basis of their potential clinical significance (
= major clinical significance) |
| General Dosing Information |
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| Paroxetine Hydrochloride Oral Suspension |
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| Usual adult dose |
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Antianxiety or |
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Antidepressant or |
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Antiobsessional agent |
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Oral, initially 20 mg (base) once a day,
usually in the morning .
The dosage may be increased, as needed and tolerated, by 10 mg a day
at intervals of at least seven days . |
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Antipanic agent |
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Oral, initially 10 mg (base) once a day,
usually in the morning .
The dosage may be increased, as needed and tolerated, by 10 mg a day
at intervals of at least seven days . |
| NOTE: For most patients,
20 mg a day is the optimal dosage for treatment of depression .
For treatment of obsessive-compulsive disorder and panic disorder,
40 mg a day is the recommended dosage . |
| Paroxetine Hydrochloride Tablets |
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| Usual adult dose |
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See Paroxetine Hydrochloride Oral Suspension |
| Paroxetine Hydrochloride Extended-Release
Tablets |
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| Usual adult dose |
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Antidepressant |
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Oral, initially 25 milligrams (mg) once
a day, usually in the morning. The dosage may be increased, as needed
and tolerated, by 12.5 mg a day at intervals of at least seven days
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| NOTE: Debilitated patients
and patients with severe renal or hepatic function impairment should
receive an initial dosage of 12.5 mg a day, with upward titration
as needed, to a maximum of 50 mg a day . |
| Side/Adverse Effects |
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| Those Indicating Need for Medical Attention |
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| Incidence less frequent |
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Agitation |
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Myalgia, myasthenia, or myopathy
(muscle pain or weakness) |
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Palpitation
(fast or irregular heartbeat) |
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Skin rash |
| Incidence rare |
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Abnormal bleeding |
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Red or purple patches on skin |
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Extrapyramidal symptoms |
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including akinesia
or hypokinesia
(absence of or decrease in body movements) |
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dyskinesia
(unusual or incomplete body movements) |
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dystonia (unusual
or sudden body or facial movements) |
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inability to move eyes |
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dysarthria
(difficulty in speaking) |
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hyponatremia
(confusion) |
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drowsiness |
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dryness of mouth |
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increased thirst |
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lack of energy |
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seizures |
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mania or hypomania
(talking, feeling, and acting with excitement and activity you cannot
control) |
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serotonin syndrome
(diarrhea) |
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fever |
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increased sweating |
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mood or behavior changes |
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overactive reflexes |
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racing heartbeat |
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restlessness |
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shivering or shaking |
| Drug Interactions and/or Related Problems |
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| Combinations containing any of the following
medications, depending on the amount present, may also interact with
this medication. |
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Antidepressants, tricyclic
(TCAs) |
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Astemizole |
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Moclobemide |
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Monoamine oxidase (MAO) inhibitors,
including furazolidone, procarbazine, and selegiline |
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Serotonergics or other medications
or substances with serotonergic activity (see Appendix II) |
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Warfarin |
| Medical Considerations/Contraindications |
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| Risk-benefit should be considered
when the following medical problems exist: |
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Hepatic function impairment,
severe |
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Renal function impairment,
severe |
| Patient Monitoring |
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Careful supervision of patients
with suicidal tendencies |
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recommended especially during early treatment
phase before peak effectiveness of paroxetine is achieved ;
prescribing the smallest number of tablets necessary for good patient
management is recommended to decrease risk of overdose |
| Laboratory Value Alterations |
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| With physiology/laboratory
test values |
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Hematocrit or |
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Hemoglobin or |
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White blood cell counts |
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may be decreased |
| Patient Consultation |
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| Before Using this Medication |
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Conditions affecting use, especially: |
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Sensitivity to paroxetine |
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Pregnancy: No difference in birth
outcome was found between 267 SSRI-exposed pregnancies (97 to paroxetine)
and 267 pregnancies exposed to known nonteratogenic medications or
procedures; behavioral effects were not studied |
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Breast-feeding: Distributed into
breast milk |
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Contraindicated medications |
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Monoamine oxidase (MAO) inhibitors |
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Other medications, especially astemizole,
moclobemide, serotonergics or other medications or substances with
serotonergic activity, tricyclic antidepressants, and warfarin |
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Other medical problems, especially severe
hepatic or renal function impairment |
| Proper Use of this Medication |
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Compliance with therapy; not taking more
or less medicine than prescribed |
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Four or more weeks of therapy may be required
before antidepressant effects are achieved; antiobsessional and antipanic
effects may require several weeks to achieve |
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Proper dosing: Taking as soon as
possible ;
continuing on regular schedule with next dose ;
not doubling doses |
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Proper storage |
| Precautions While Using this Medication |
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Not taking paroxetine within 2 weeks of
taking a monoamine oxidase (MAO) inhibitor; not starting an MAO inhibitor
within 2 weeks of discontinuing paroxetine |
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Possible blurred vision, drowsiness, impairment
of judgment, thinking, or motor skills; caution when driving or doing
jobs requiring alertness until effects of medication are known |
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