What is the typical dosage of Paxil (paroxetine)?

Typical Dosage of Paxil (Paroxetine)

The recommended initial dose of Paxil (paroxetine) is 20 mg once daily, which is also the minimal effective dose for most patients. 1, 2

General Dosing Guidelines

• Paroxetine should be administered as a single daily dose with or without food, usually in the morning 1
• For most conditions, the starting dose is 20 mg/day, which is also the minimal effective dose for most patients 1, 2
• Dose adjustments should occur in 10 mg/day increments at intervals of at least 1 week 1
• The maximum recommended dosage is 50 mg/day for major depression and 60 mg/day for other conditions 1

Condition-Specific Dosing

Major Depressive Disorder

• Initial dose: 20 mg/day 1
• Dose range: 20-50 mg/day 1, 3
• Maintenance therapy typically averages around 30 mg/day 1

Obsessive-Compulsive Disorder (OCD)

• Initial dose: 20 mg/day 1
• Target dose: 40 mg/day 1
• Maximum dose: 60 mg/day 1
• Dose increases in 10 mg increments at intervals of at least 1 week 1

Panic Disorder

• Initial dose: 10 mg/day (lower than for other conditions) 1
• Target dose: 40 mg/day 1
• Maximum dose: 60 mg/day 1
• Dose increases in 10 mg increments at intervals of at least 1 week 1

Social Anxiety Disorder

• Initial and recommended dose: 20 mg/day 1
• No additional benefit has been demonstrated for doses above 20 mg/day 1

Generalized Anxiety Disorder

• Initial and recommended dose: 20 mg/day 1
• No sufficient evidence to suggest benefit for doses higher than 20 mg/day 1

Special Populations

• Elderly patients: Initial dose of 10 mg/day with maximum of 40 mg/day 1, 2
• Patients with severe renal or hepatic impairment: Initial dose of 10 mg/day with maximum of 40 mg/day 1
• Debilitated patients: Initial dose of 10 mg/day with maximum of 40 mg/day 1

Important Considerations

• Paroxetine has less activating effects but more anticholinergic effects than other SSRIs 4
• Common side effects include nausea, sexual dysfunction, somnolence, dry mouth, headache, constipation, dizziness, and sweating 3, 5
• Paroxetine has been associated with discontinuation syndrome, particularly with abrupt discontinuation 4
• Concomitant administration with MAOIs is contraindicated due to risk of serotonin syndrome 4
• Paroxetine may interact with drugs metabolized by CYP2D6 4

Monitoring and Duration

• For depression, maintenance therapy is typically needed for several months or longer 1
• Periodic reassessment is recommended to determine the need for continued treatment 1
• Patients should be monitored for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of treatment or at times of dose changes 4

Paroxetine should be slowly tapered when discontinued to minimize withdrawal symptoms, which can include dizziness, sensory disturbances, anxiety, irritability, and agitation 4.