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Indications

Paroxetine is an antidepressant used to treat depression, panic disorder, social anxiety disorder, generalised anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Low-dose forms are used in some countries for hot flushes around the menopause, and doctors sometimes use it for premature ejaculation.

How It Works

Paroxetine is a selective serotonin reuptake inhibitor (SSRI). Serotonin is a brain chemical that helps control mood, anxiety and sleep. Paroxetine stops nerve cells from taking serotonin back too quickly, so more of it stays active between nerve cells. The benefit builds up gradually, usually over 2 to 6 weeks.

Dosage and Administration

Take once a day in the morning with food, swallowing the tablet whole. For depression, a common adult starting dose is 20 mg daily. For anxiety disorders and OCD, doctors often start lower and increase step by step, as prescribed. Older adults and people with liver or kidney problems usually need lower doses. Keep taking it even when you feel better, and do not stop suddenly; your doctor will reduce the dose slowly over several weeks.

Interactions

• Do not take with or within 14 days of MAO inhibitors (e.g. Moclobemide, Selegiline), or with Thioridazine or Pimozide.
• Other serotonin medicines such as Tramadol, Triptans (e.g. Sumatriptan), Lithium, Linezolid, other antidepressants and St John's Wort raise the risk of serotonin syndrome.
• Aspirin, Ibuprofen and other painkillers of this type, Warfarin and Clopidogrel increase bleeding risk.
• Paroxetine reduces the effect of Tamoxifen and raises levels of Metoprolol, Risperidone, Atomoxetine and some tricyclic antidepressants.
• Avoid alcohol.

Contraindications

• Allergy to Paroxetine.
• Use with MAO inhibitors, Thioridazine or Pimozide.
• Not recommended for children and teenagers under 18 years.

Side Effects

Common effects include nausea, drowsiness or trouble sleeping, dizziness, sweating, dry mouth, constipation or diarrhoea, weight gain, yawning, shaking, blurred vision and sexual problems (low sex drive, delayed orgasm or erection problems). Stopping suddenly can cause dizziness, electric-shock sensations, anxiety and sleep upset.

Get urgent medical help if you have thoughts of suicide or self-harm, especially early in treatment or after a dose change, severe agitation, fever with sweating, muscle stiffness or twitching and confusion (possible serotonin syndrome), a seizure, unusual bleeding or bruising, black stools, sudden eye pain with blurred vision, or a severe allergic reaction.

Pregnancy and Lactation

Paroxetine is usually avoided in pregnancy, especially early pregnancy, because of a possible link with heart defects in the baby; use late in pregnancy can affect the newborn's breathing and cause withdrawal. If you are pregnant or planning pregnancy, talk to your doctor before making any change. Small amounts pass into breast milk; it is sometimes used during breastfeeding with medical advice.

Precautions and Warnings

Mood can worsen and suicidal thoughts can appear in the first weeks, especially in young adults, so family and doctors should watch closely. Tell your doctor about bipolar disorder, epilepsy, glaucoma, bleeding problems, heart, liver or kidney disease and diabetes. It may cause low sodium in older people. Take care when driving until you know how it affects you.

Overdose

Overdose may cause vomiting, drowsiness, shaking, fast heartbeat, fever, dilated pupils, seizures and serotonin syndrome. Seek emergency medical help at once.

Therapeutic Class

Antidepressant, selective serotonin reuptake inhibitor (SSRI).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.