How to discontinue Paroxetine (Selective Serotonin Reuptake Inhibitor) 10 mg?

How to Safely Discontinue Paroxetine 10 mg

Paroxetine should be discontinued through a gradual tapering schedule over several weeks rather than abrupt cessation to minimize withdrawal symptoms.

Understanding Paroxetine Discontinuation

Paroxetine is a selective serotonin reuptake inhibitor (SSRI) with a relatively short half-life that is associated with a significant risk of discontinuation syndrome when stopped abruptly. The FDA label specifically recommends a taper-phase regimen rather than abrupt discontinuation 1.

Withdrawal Symptoms to Monitor

Discontinuation symptoms typically appear within 24-48 hours after reducing or stopping paroxetine and may include:

• Physical symptoms: dizziness, vertigo, electric shock-like sensations, nausea, fatigue, flu-like symptoms, headache, paresthesia
• Psychological symptoms: anxiety, irritability, agitation, confusion, insomnia, abnormal dreams

These symptoms are generally mild to moderate but can be distressing and impact daily functioning 2, 3.

Recommended Tapering Schedule

For paroxetine 10 mg, follow this tapering schedule:

1. Weeks 1-2: Reduce from 10 mg to 5 mg daily
2. Weeks 3-4: Take 5 mg every other day
3. Weeks 5-6: Discontinue completely

Key Points for Successful Tapering:

• Slower is better: If withdrawal symptoms emerge, slow the taper further by extending each step to 2-4 weeks 2
• Use liquid formulation: For more precise dose reductions, consider using the liquid formulation of paroxetine if available
• Monitor closely: Assess for withdrawal symptoms during each step of the taper
• Be prepared to adjust: If intolerable symptoms occur, return to the previous dose and resume tapering at a more gradual rate 1

Special Considerations

High-Risk Patients

Patients with the following factors may need an even more gradual taper:

• Prior history of discontinuation symptoms
• Longer duration of paroxetine treatment
• Higher doses prior to tapering
• Concomitant medications
• Alcohol consumption 3

Managing Breakthrough Symptoms

If significant withdrawal symptoms occur during tapering:

1. Return to the previous well-tolerated dose
2. Stabilize for 1-2 weeks
3. Resume tapering with smaller decrements (e.g., 2.5 mg reductions using the liquid formulation)
4. Extend the time between dose reductions 1, 2

Common Pitfalls to Avoid

1. Mistaking withdrawal for relapse: Withdrawal symptoms typically appear within days of dose reduction and include distinctive symptoms like dizziness and electric shock sensations, whereas depression relapse usually develops more gradually 2

2. Tapering too quickly: Paroxetine has been associated with more severe discontinuation symptoms compared to other SSRIs due to its shorter half-life 3, 4

3. Poor patient education: Ensure patients understand the difference between withdrawal symptoms and relapse to prevent unnecessary concern 2

4. Inadequate monitoring: Regular follow-up during the tapering process is essential to adjust the schedule as needed 5

By following this structured approach to discontinuing paroxetine, the risk of significant withdrawal symptoms can be minimized while ensuring patient comfort and safety throughout the process.