Pregnancy Risk Category C
How supplied
Tablets: 10 mg, 20 mg, 30 mg, 40 mg
Action
Unknown. Probably linked to drug's inhibition of CNS neuronal uptake of serotonin.
Indications & dosage
Depression--
Adults: initially, 20 mg P.O. daily, preferably in the morning as indicated. If patient doesn't respond after full antidepressant effect has occurred, dose may be increased in 10-mg/day increments at weekly intervals, to maximum of 50 mg daily.
Elderly: initially, 10 mg P.O. daily, preferably in the morning as indicated. If patient doesn't respond after full antidepressant effect has occurred, dose may be increased in 10-mg/day increments at weekly intervals, to maximum of 40 mg daily.
Obsessive-compulsive disorder--
Adults: initially, 20 mg P.O. daily, preferably in the morning. Dose may increased in 10-mg/day increments at weekly intervals. Recommended daily dose is 40 mg daily. Maximum dose is 60 mg/day.
Panic disorder--
Adults: initially, 10 mg P.O. daily. Dose may be increased in 10-mg increments at no less than weekly intervals, to maximum of 60 mg/day.
NEW INDICATION: Social anxiety disorder--
Adults: initially, 20 mg P.O. daily, preferably in the morning. Dosage range is 20 to 60 mg/day. Adjust dosage to maintain patient on lowest effective dose.
Adjust-a-dose: For debilitated patients or those with renal or hepatic failure, initially, 10 mg P.O. daily, preferably in the morning. If patient doesn't respond after full antidepressant effect has occurred, dose may be increased in 10-mg/day increments at weekly intervals, to maximum of 40 mg daily.
Adverse reactions
CNS: somnolence, dizziness, insomnia, tremor, nervousness, anxiety, paresthesia, confusion, headache, agitation, asthenia.
CV: palpitations, vasodilation, orthostatic hypotension.
EENT: lump or tightness in throat.
GI: dry mouth, nausea, constipation, diarrhea, flatulence, vomiting, dyspepsia, dysgeusia, increased appetite, abdominal pain.
GU: ejaculatory disturbances, male genital disorders (including anorgasmy, erectile difficulties, delayed ejaculation or orgasm, impotence, and sexual dysfunction), urinary frequency, other urinary disorders, female genital disorders (including anorgasmy, difficulty with orgasm).
Musculoskeletal: myopathy, myalgia, myasthenia.
Skin: rash, pruritus, diaphoresis.
Other: yawning, decreased libido.
Interactions
Drug-drug. Cimetidine: decreased hepatic metabolism of paroxetine, leading to risk of toxicity. Dosage adjustments may be necessary.
Digoxin: may decrease digoxin levels. Monitor closely.
MAO inhibitors: may increase risk of serious, sometimes fatal, adverse reactions. Avoid concomitant use.
Phenobarbital, phenytoin: may alter pharmacokinetics of both drugs. Dosage adjustments may be necessary.
Procyclidine: may increase procyclidine levels. Monitor for excessive anticholinergic effects.
Theophylline: decreased clearance. Dose reductions are necessary.
Tryptophan: may increase incidence of adverse reactions, such as diaphoresis, headache, nausea, and dizziness. Avoid concomitant use.
Warfarin: increased risk of bleeding. Use concomitantly with caution.
Drug-herb. St. John's wort: may result in sedative-hypnotic intoxication. Avoid concurrent use.
Drug-lifestyle. Alcohol use: may alter psychomotor function. Limit intake.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to drug and in those taking MAO inhibitors; also contraindicated within 14 days of discontinuing MAO inhibitor therapy.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING