Paroxetine Dosing for Hypersexual Behaviors in the Elderly
For elderly patients with hypersexual behaviors, start paroxetine at 10 mg/day with careful titration up to 20 mg/day as needed, while monitoring for side effects. 1, 2
Initial Dosing and Titration
- Starting dose: 10 mg/day for elderly patients 1
- Titration: Increase by 10 mg increments at intervals of at least 1 week if needed 1
- Maximum recommended dose: 40 mg/day for elderly patients with renal or hepatic impairment 1
The FDA label specifically recommends a lower starting dose of 10 mg/day for elderly patients due to their increased plasma concentrations (70-80% greater) and slower elimination of paroxetine compared to younger adults 1. This cautious approach helps minimize adverse effects while achieving therapeutic benefit.
Evidence for Treating Hypersexual Behaviors
Selective serotonin reuptake inhibitors (SSRIs) like paroxetine are recommended as first-line treatment for hypersexual behaviors in cognitively impaired elderly patients 2. A five-year study of 39 geriatric outpatients with cognitive impairment and sexual disinhibition found that SSRIs should be tried before considering hormonal therapies such as estrogen or antiandrogens 2.
Monitoring and Side Effect Considerations
When using paroxetine in elderly patients, monitor for:
- Anticholinergic effects: Paroxetine has more anticholinergic effects than other SSRIs and is generally not preferred in older adults 3
- Sexual dysfunction: While treating hypersexuality, be aware that paroxetine itself can cause sexual dysfunction in other contexts 4
- Drug interactions: Paroxetine inhibits CYP2D6 and can interact with other medications commonly prescribed to elderly patients 1
Duration of Treatment
Treatment for hypersexual behaviors will likely be needed on a continuing basis. The American Urological Association notes that sexual behavior changes typically return upon discontinuation of SSRI therapy 3. Therefore, long-term treatment may be necessary with periodic reassessment of the need for continued therapy.
Alternative Options
If paroxetine is not effective or poorly tolerated:
- Consider other SSRIs like sertraline (50-200 mg/day) 3
- For patients with severe renal or hepatic impairment, dose adjustments are necessary 1
- Citalopram or escitalopram may be better alternatives for elderly patients due to fewer anticholinergic effects and drug interactions 3
Important Caveats
- Abrupt discontinuation should be avoided; taper over 10-14 days if switching medications 1
- Paroxetine has a higher risk of withdrawal symptoms compared to other SSRIs due to its shorter half-life
- Monitor for increased risk of upper gastrointestinal bleeding, especially if the patient is also taking NSAIDs 3
- Paroxetine is well-tolerated in patients aged 65-75, but fewer studies have examined its use in those over 75 5
By following these dosing guidelines and monitoring protocols, paroxetine can be effectively and safely used to manage hypersexual behaviors in elderly patients while minimizing adverse effects.