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NERVOUS SYSTEM › PSYCHOANALEPTICS › ANTIDEPRESSANTS › Selective serotonin reuptake inhibitors
paroxetine
N06AB05
Forms & Strengths
- Tablets: 10 mg, 20 mg, 30 mg, 40 mg
- Extended-release tablets: 12.5 mg, 25 mg, 37.5 mg
- Oral suspension: 10 mg/5 mL
Adult Dosing
- Major Depressive Disorder: Initial 20 mg once daily; max 50 mg/day (IR) or 62.5 mg/day (ER)
- Obsessive-Compulsive Disorder: Initial 20 mg once daily; target 40 mg/day; max 60 mg/day
- Panic Disorder: Initial 10 mg once daily; target 40 mg/day; max 60 mg/day (IR) or 75 mg/day (ER)
- Social Anxiety Disorder: Initial 20 mg once daily; max 60 mg/day (IR) or 37.5 mg/day (ER)
- Generalized Anxiety Disorder: Initial 20 mg once daily; max 50 mg/day (IR) or 60 mg/day (ER)
- Vasomotor symptoms of menopause (Paxil CR low dose): 7.5 mg once daily at bedtime
Pediatric Dosing
- Safety and efficacy not established in pediatric patients under 18 years for psychiatric disorders
- Generally not recommended in children and adolescents due to increased risk of suicidal ideation and behavior
Indications
- Major Depressive Disorder
- Obsessive-Compulsive Disorder
- Panic Disorder
- Social Anxiety Disorder
- Generalized Anxiety Disorder
- Posttraumatic Stress Disorder
- Moderate to severe vasomotor symptoms associated with menopause
Mechanism of Action
- Selective serotonin reuptake inhibitor (SSRI)
- Potently and selectively inhibits neuronal reuptake of serotonin (5-HT) in the central nervous system
- Weak inhibitor of norepinephrine and dopamine neuronal reuptake
Contraindications
- Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing them
- Concomitant use with thioridazine or pimozide
- Hypersensitivity to paroxetine or any component of the formulation
- Pregnancy (Category D / Known risk of congenital anomalies, particularly cardiac defects)
Adverse Reactions
- Common: Nausea, somnolence, insomnia, sexual dysfunction, fatigue, dizziness, constipation, dry mouth
- Serious: Serotonin syndrome, suicidal thoughts/behaviors, QT prolongation, abnormal bleeding, hyponatremia, angle-closure glaucoma, activation of mania
- Discontinuation syndrome: Dizziness, sensory disturbances, anxiety, irritability, headache
Drug Interactions
- MAOIs: Increased risk of serotonin syndrome (hypertensive crisis, hyperthermia, myoclonus)
- CYP2D6 substrates (e.g., tricyclic antidepressants, antipsychotics): Paroxetine is a potent CYP2D6 inhibitor, increasing plasma concentrations of these drugs
- CYP3A4 inducers/inhibitors (e.g., carbamazepine, rifampin): May alter paroxetine clearance
- Serotonergic agents (triptans, lithium, tramadol, St. John's wort): Increased risk of serotonin syndrome
- Anticoagulants/Antiplatelets (NSAIDs, warfarin): Increased risk of bleeding events
- Alcohol: CNS depression and psychomotor impairment may be enhanced
Curated Content: Needs Vetting Before Put to Clinical Use