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Pharmacologic class:乐动体育开户 Selective serotonin reuptake inhibitor (SSRI)
Therapeutic class:乐动体育开户 Antidepressant, anxiolytic
Pregnancy risk category C
FDA Box Warning
• Drug may increase risk of suicidal thinking and behavior in children and adolescents with major depressive disorder and other psychiatric disorders. Risk must be balanced with clinical need, as depression itself increases suicide risk. With patient of any age, observe closely for clinical worsening, suicidality, and unusual behavior changes when therapy begins. Advise family and caregivers to observe patient closely and communicate with prescriber as needed.
乐动体育开户• Drug isn't approved for use in pediatric patients.
Unknown. Thought to inhibit neuronal reuptake of serotonin in CNS.
Oral suspension: 10 mg/5 ml in 250-ml bottle
Tablets:乐动体育开户 10 mg, 20 mg, 30 mg, 40 mg
Tablets (controlled-release): 12.5 mg, 25 mg, 37.5 mg
Tablets:乐动体育开户 10 mg, 20 mg, 30 mg, 40 mg
Indications and dosages
➣乐动体育开户 Major depressive disorder
Adults:乐动体育开户 Initially, 20 mg/day P.O. (immediate-release) as a single dose; may increase as needed by 10 mg/day at weekly intervals (range is 20 to 50 mg); daily dosages of approximately 30 mg may maintain efficacy for up to 1 year. Or initially, 25 mg P.O. (controlled-release) daily; may increase by 12.5 mg/day at weekly intervals, up to 62.5 mg/day. Or, 20 mg/day P.O. (paroxetine mesylate) as a single dose in morning; may increase as needed by 10 mg/day at weekly intervals up to maximum of 50 mg/day; daily dosages of approximately 30 mg may maintain efficacy for up to 1 year.
➣乐动体育开户 Obsessive-compulsive disorder
Adults: Initially, 20 mg/day P.O. (immediate-release); increase as needed by 10 mg/day at weekly intervals, up to 60 mg P.O. (range is 20 to 60 mg/day). Or, initially 20 mg P.O. (paroxetine mesylate); may increase as needed by 10 mg/day at weekly intervals up to maximum of 60 mg/day; recommended dosage is 40 mg/day.
➣ Panic disorder
Adults: Initially, 10 mg/day P.O. (immediate-release); may increase as needed by 10 mg/day at weekly intervals, up to 40 mg P.O. (range is 10 to 60 mg/day); maximum dosage is 60 mg/day, with dosage adjustments made to maintain patient on lowest effective dosage. Or initially, 12.5 mg/day P.O. (controlled-release); may increase by 12.5 mg/day at weekly intervals, to a maximum of 75 mg/day. Or, 10 mg/day P.O. (paroxetine mesylate) daily in morning; may increase as needed by 10 mg/day at weekly intervals up to maximum of 60 mg/day. Target dosage is 40 mg/day. Maintain patient on lowest effective dosage.
➣ Posttraumatic stress disorder
Adults:乐动体育开户 Initially, 20 mg/day P.O.; range is 20 to 50 mg/day. Make any dosage increases if needed in increments of 10 mg/day at intervals of at least 1 week. For maintenance, adjust to lowest effective dosage.
➣乐动体育开户 Generalized anxiety disorder
Adults: Initially, 20 mg/day P.O.; range is 20 to 50 mg/day; however, dosages greater than 20 mg/day may not provide added benefit. Make any dosage increases if needed in increments of 10 mg/day at intervals of at least 1 week. Or, 20 mg/day P.O. (paroxetine mesylate) daily in morning.
➣ Premenstrual dysphoric disorder
Adults:乐动体育开户 12.5 to 25 mg/day P.O. (controlled-release) daily. May give either daily throughout menstrual cycle or only during luteal phase cycle (per pre-scriber). Make any dosage changes if needed at intervals of at least 1 week.
• Hepatic impairment, severe renal impairment
乐动体育开户• Elderly or debilitated patients
• Hypersensitivity to drug or its components
乐动体育开户• MAO inhibitor use within past 14 days
• Concurrent thioridazine use
乐动体育开户Use cautiously in:
• severe renal or hepatic impairment
乐动体育开户• narrow-angle glaucoma
乐动体育开户• diseases or conditions that may affect metabolism or hemodynamic responses
乐动体育开户• history of seizures, mania, or suicide attempt
• increased risk of suicide attempt, hyponatremia, or abnormal bleeding
• elderly or debilitated patients
• pregnant or breastfeeding patients
• children younger than age 18 (safety not established).
乐动体育开户• Give with or without food.
• Give controlled-release tablets whole. Make sure patient doesn't chew or crush them.
☞ Don't give to patients receiving MAO inhibitors or thioridazine.
• Reassess patient periodically to gauge need for continued therapy.
CNS: anxiety, agitation, dizziness, drowsiness, asthenia, vascular headache, confusion, hangover, depression, paresthesia, tremor, twitching, myoclonus, amnesia, insomnia, abnormal dreams, unusual or severe mood changes, fatigue, cerebral ischemia, suicidal behavior or ideation (especially in child or adolescent)
CV: chest pain, hypertension, hypotension, palpitations, orthostatic hypotension, angina pectoris, ventricular or supraventricular extrasystoles, tachycardia, bradycardia, thrombophlebitis, myocardial ischemia
EENT: blurred vision, rhinitis, dry mouth
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, flatulence, anorexia
GU: urinary frequency, urinary disorders, urinary tract infection, genital disorders, ejaculatory disturbance, decreased libido
Musculoskeletal:乐动体育开户 back pain, myalgia, myasthenia, myopathy, joint pain
Respiratory: cough, bronchitis, respiratory disorders
Skin: sweating, pruritus, pallor, rash, photosensitivity, Stevens-Johnson syndrome (postmarketing reports)
Other:乐动体育开户 chills, edema, appetite and weight changes, accidental injury, yawning
Drug-drug. Cimetidine: increased paroxetine blood level
Digoxin: decreased digoxin efficacy Drugs metabolized by liver (such as amitriptyline, class IC antiarrhythmics, desipramine): decreased metabolism and increased effects of these drugs 5-hydroxytryptamine receptor agonists (such as frovatriptan, naratriptan, riza-triptan):乐动体育开户 weakness, hyperreflexia, incoordination
MAO inhibitors:乐动体育开户 potentially fatal reactions (hyperthermia, rigidity, myoclonus, autonomic instability, fluctuating vital signs, extreme agitation, delirium, coma)
Phenobarbital, phenytoin:乐动体育开户 decreased paroxetine efficacy
Tamoxifen: decreased tamoxifen concentration
Theophylline: increased risk of theophylline toxicity
Thioridazine:乐动体育开户 increased thioridazine blood level, serious ventricular arrhythmias, sudden death
Tryptophan: headache, nausea, sweating, dizziness
Warfarin: increased risk of bleeding (without altering prothrombin time)
Drug-diagnostic tests. Alkaline phosphatase, bilirubin, glucose: increased levels 5-hydroxyindole acetic acid, vanillyl-mandelic acid: decreased levels
Urinary catecholamines: false increases
Drug-herbs. S-adenosylmethionine (SAM-e), St. John's wort:乐动体育开户 increased risk of adverse serotonergic effects, including serotonin syndrome
乐动体育开户• Check for signs and symptoms of toxicity, including drowsiness, nausea, tremor, tachycardia, confusion, and dizziness.
乐动体育开户• Assess vital signs and cardiovascular status.
☞乐动体育开户 Monitor neurologic status. Watch closely for depression and suicidal behavior and ideation (especially in child or adolescent).
• Evaluate respiratory status. Stay alert for signs and symptoms of infection.
☞乐动体育开户 Monitor patient for signs and symptoms of Stevens-Johnson syndrome.
• Tell patient to swallow controlled-release tablets whole without chewing or crushing them.
☞ Describe signs and symptoms of drug toxicity. Tell patient to report these immediately.
☞乐动体育开户 Teach patient or caregiver to recognize and immediately report signs of suicidal intent or expressions of suicidal ideation (especially in child or adolescent).
☞乐动体育开户 Teach patient or caregiver to immediately report rash if it occurs.
乐动体育开户• Tell patient to continue to take drug even if he feels better. Caution him not to stop therapy abruptly.
乐动体育开户• Advise patient to consult prescriber before taking other prescription drugs or over-the-counter preparations.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects him.
乐动体育开户• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.
Paxil®Paroxetine, see there.
Patient discussion about Paxil
Q. has anyone gained weight because of heavy tiredness and sleep while taking paxil? Has anyone gained weight because of heavy tiredness and sleep while taking Paxil? My mom is taking paxil for the past 2 years. It is good that while taking Paxil she is well off with her episodes. But its side effects are more than the benefits. She has a continuous fatigue and headache, nausea, blurred vision, restlessness, constipation, loss of libido and weight gain. Because of her excessive weight gain and continuous fatigue and headache she has stopped taking her medicines. Now I am scared that her bipolar episodes could revert back