From the FDA Drug Label
A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate
The recommended duration to withhold paroxetine post-operatively is not explicitly stated.
- A gradual reduction in dose is recommended, but the duration is not specified.
- The decision to withhold paroxetine should be made on a case-by-case basis, considering the individual patient's needs and medical history 1 1.
From the Research
Paroxetine should typically be continued throughout the perioperative period without interruption, as the risks of discontinuation, including withdrawal syndrome and recurrence of the underlying psychiatric condition, outweigh the potential benefits in most surgical situations. The half-life of paroxetine is approximately 21 hours, meaning that blood levels drop significantly within 1-2 days of discontinuation, which can trigger withdrawal effects such as dizziness, sensory disturbances, anxiety, agitation, and flu-like symptoms 2. These effects could complicate postoperative recovery and potentially lead to a longer hospital stay or increased morbidity. Additionally, stopping paroxetine before surgery may lead to recurrence of the psychiatric condition it was prescribed to treat, potentially complicating postoperative care and recovery 3.
Some studies have suggested that perioperative use of selective serotonin reuptake inhibitors (SSRIs) like paroxetine may be associated with adverse outcomes, such as increased risk of bleeding or mortality 4. However, these findings are not consistent across all studies, and the overall evidence suggests that the benefits of continuing paroxetine during the perioperative period outweigh the risks. If there are specific concerns about drug interactions with anesthesia or other perioperative medications, these should be discussed with the anesthesiologist and psychiatrist, but generally, the risks of discontinuation outweigh the potential benefits in most surgical situations.
Key points to consider when managing paroxetine in the perioperative period include:
- The risk of withdrawal syndrome with abrupt discontinuation of paroxetine
- The potential for recurrence of the underlying psychiatric condition with discontinuation of paroxetine
- The importance of discussing potential drug interactions with anesthesia or other perioperative medications with the anesthesiologist and psychiatrist
- The need to weigh the risks and benefits of continuing paroxetine during the perioperative period on a case-by-case basis. It is essential to consider the individual patient's circumstances and medical history when making decisions about paroxetine management in the perioperative period, and to prioritize minimizing morbidity, mortality, and improving quality of life 5, 3.