Paroxetine - Chris Aiken, MD

Q: Depression

Paroxetine use based on FDA approval in major depressive disorder. SSRI side effects reviewed with patient.

Q: Anxiety Disorder

Paroxetine use based on FDA approval in anxiety disorders (Generalized Anxiety Disorder, Panic Disorder, and Social Anxiety Disorder). SSRI side effects reviewed with patient.

Q: PTSD

Paroxetine use based on FDA approval in Posttraumatic Stress Disorder. SSRI side effects reviewed with patient.

Q: OCD

Paroxetine use based on FDA approval in OCD. SSRI side effects reviewed with patient.

Q: Binge Eating & Bulimia

Paroxetine use based on efficacy of this class in binge eating and bulimia. SSRI side effects reviewed with patient.

Q: Premenstrual Syndrome

Paroxetine use based on efficacy of this class in Premenstrual Syndrome. SSRI side effects reviewed with patient.

Q: Menopausal Symptoms

Paroxetine use based on controlled trials in menopausal symptoms (mood and vasomotor). SSRI side effects reviewed with patient.

Paroxetine (Paxil)

SSRI antidepressant

Major Depression³
Social Anxiety³
Panic³
PTSD³

Menopausal symptoms³
Higher WD and anticholinergic risks than other SSRIs
Worst SSRI in children and pregnancy

Features

Medication, Generic, Non-controlled

Handout

Dosing

Depression (20-30 mg/d), Anxiety disorders (40-60 mg/d), PTSD (20-50 mg/d) OCD (60-80 mg/d). Menopausal symptoms (7.5–15 mg qhs),

INTERACTIONS: Raises levels of meds metabolized through CYP 2D6, 3A4, 2B6. Raise dose by x1.3 if using with carbamazepine.

Management

Worst SSRI overall (WD risk, cognitive impairment, pregnancy teratogen, weight gain, sedation, anticholinergic and antihistaminergic).

Side effects: apathy, sexual dysfunction, sleep disruption, nausea, restless legs, akathisia. Warning: osteopenia in post-menopausal women.

AVOID: In children, pregnant women, elderly (anticholinergic).

TOLERABILITY: Apathy, sexual dysfunction, sleep disruption, nausea, restless legs, akathisia, sweating, yawning, anticholinergic, fatigue, withdrawal syndrome.

RISKS: Suicidality in age < 25, mania, osteopenia in post-menopausal women, increased bleeding, hyponatremia (mainly in elderly). Pregnancy teratogen.