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Last updated: November 2021
- Antidepressant, selective serotonin re-uptake inhibitor (SSRI)
- Major depression
- Generalised anxiety
- Severe post-traumatic stress disorder
Forms and strengths
- 20 mg scored tablet
- 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
- 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 or closed-angle glaucoma.
- May cause:
- gastrointestinal disturbances, drowsiness, fatigue, headache, dizziness, seizures, sexual dysfunction, blurred vision, hyponatraemia especially in older patients;
- mental disorders: anxiety, insomnia, agitation, aggressive behaviour, suicidal ideation;
- frequent withdrawal symptoms if discontinued abruptly: dizziness, paraesthesia, nightmares, anxiety, tremors and headaches.
- Avoid combination with:
- alcohol (risk of drowsiness); 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.).
- 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.
- It is necessary to wait at least 2 to 3 weeks before assessing the antidepressant effect. This must be explained to the patient.