PAROXETINE oral

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    Last updated: March 2024

     

    Prescription under medical supervision

     

    Therapeutic action

    • Antidepressant, selective serotonin re-uptake inhibitor (SSRI)

    Indications

    • Major depression
    • Generalised anxiety
    • Severe post-traumatic stress disorder

    Forms and strengths

    • 20 mg scored tablet

    Dosage

    Major depression

    • Adult: 10 mg once daily for 3 days, then 20 mg once daily. In case of insufficient response after 3 weeks, increase up to 40 mg daily max.

     

    Generalised anxiety, severe post-traumatic stress disorder

    • Adult: 10 to 20 mg once daily

    Duration

    • Major depression: at least 9 months. 
      Discontinue treatment gradually (e.g. half dose once daily for 2 weeks then on alternate days for 2 weeks). If signs of relapse or withdrawal occur, increase the dose then decrease it more gradually.
    • Generalised anxiety, severe post-traumatic stress disorder: 2 to 3 months after symptoms resolve.
      Discontinue treatment gradually (over at least 2 weeks).  

    Contra-indications, adverse effects, precautions

    • Administer with caution and monitor use in patients with epilepsy, diabetes, hepatic or renal impairment (start at a lower dose); history of gastrointestinal bleeding, bipolar disorders, suicidal ideation (in young adults) or closed-angle glaucoma.
    • May cause: 
      • gastrointestinal disturbances, drowsiness (caution when driving or operating machinery), fatigue, headache, dizziness, seizures, sexual dysfunction, blurred vision, hyponatraemia especially in older patients;
      • mental disorders: anxiety, insomnia, agitation, aggressive behaviour, suicidal ideation in young adults;
      • frequent withdrawal symptoms if discontinued abruptly: dizziness, paraesthesia, nightmares, anxiety, tremors and headaches.
    • Avoid combination with:
      • aspirin, NSAIDs and warfarin (risk of bleeding);
      • serotonergic drugs: other SSRI, tricyclic antidepressants, ondansetron, tramadol, etc. (risk of serotonin syndrome).
    • Monitor combination with: risperidone (increased plasma concentration), drugs which lower the seizure threshold (antipsychotics, mefloquine, etc.).
    • Avoid alcohol during treatment (increased risk of adverse effects).
    • Pregnancy and breast-feeding: re-evaluate whether the treatment is still necessary; if it is continued, maintain paroxetine at effective dose. Observe the neonate (risk of agitation, tremors, hypotony, respiratory difficulties, sleeping disorders, etc.) if the mother was under treatment in the 3rd trimester of pregnancy. If treatment starts during pregnancy or breast-feeding, preferably use sertraline. 

    Remarks

    • It is necessary to wait at least 2 to 3 weeks before assessing the antidepressant effect. This must be explained to the patient.

    Storage

     
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    –  Below 25 °C
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