Paroxetine Oral: Dosing and Tapering Guidance

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.

Dose

Duration

• Major depression: at least 9 months.
• Discontinue treatment gradually, for example 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 and 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 impairment, renal impairment, history of gastrointestinal bleeding, bipolar disorders, suicidal ideation in young adults, or closed-angle glaucoma.
• May cause gastrointestinal disturbances, drowsiness, fatigue, headache, dizziness, seizures, sexual dysfunction, blurred vision, and hyponatraemia especially in older patients.
• May also cause anxiety, insomnia, agitation, aggressive behaviour, and suicidal ideation in young adults.
• Frequent withdrawal symptoms occur if discontinued abruptly, including dizziness, paraesthesia, nightmares, anxiety, tremors, and headaches.
• Avoid combination with aspirin, NSAIDs, warfarin, and serotonergic drugs such as other SSRIs, tricyclic antidepressants, ondansetron, and tramadol.
• Monitor combination with risperidone and drugs that lower the seizure threshold.
• Avoid alcohol during treatment.
• Pregnancy and breast-feeding: re-evaluate whether treatment is still necessary. If continued, maintain paroxetine at the effective dose and observe the neonate if exposure occurred in the third trimester. If treatment starts during pregnancy or breast-feeding, preferably use sertraline.