What is the recommended dosage of Paroxetine (Selective Serotonin Reuptake Inhibitor) HCl 20MG Oral Tablet?

Paroxetine HCl 20mg Dosing Recommendations

For most psychiatric indications, paroxetine 20mg daily is both the recommended starting dose and the optimal maintenance dose for the majority of patients. 1

Standard Dosing by Indication

Major Depressive Disorder

• Starting dose: 20mg once daily (typically in the morning, with or without food) 1, 2
• Optimal dose for most patients: 20mg daily 2
• For inadequate response after 1-3 weeks, increase in 10mg increments at weekly intervals 1, 2
• Maximum dose: 50mg daily 2
• The 20mg starting dose represents the minimal effective dose 2

Obsessive-Compulsive Disorder (OCD)

• Starting dose: 20mg once daily 1
• Target dose range: 20-60mg daily 1, 3
• Increase in 10mg increments at minimum 1-week intervals 1
• Maximum dose: 60mg daily 1
• Long-term maintenance demonstrated efficacy in 6-month relapse prevention trials 1

Panic Disorder

• Starting dose: 10mg once daily (lower than other indications) 1
• Target dose: 40mg daily 1
• Increase in 10mg increments at minimum 1-week intervals 1
• Maximum dose: 60mg daily 1

Social Anxiety Disorder

• Recommended dose: 20mg once daily 1
• This is both the starting and optimal dose 1
• Doses up to 60mg daily have been studied, but no additional benefit demonstrated above 20mg 1

Generalized Anxiety Disorder (GAD)

• Recommended dose: 20mg once daily 1
• This is the established effective dose 1
• Insufficient evidence for benefit at doses higher than 20mg daily 1

Post-Traumatic Stress Disorder (PTSD)

• Recommended dose: 20mg once daily 1
• Dose range studied: 20-50mg daily, but fixed-dose trials showed no additional benefit at 40mg versus 20mg 1
• Increase in 10mg increments at minimum 1-week intervals if needed 1

Special Populations

Elderly or Debilitated Patients

• Starting dose: 10mg daily 1
• Maximum dose: 40mg daily (lower than general adult population) 1, 4
• More cautious titration required 4

Severe Renal or Hepatic Impairment

• Starting dose: 10mg daily 1
• Maximum dose: 40mg daily 1

Pregnant Women (Third Trimester)

• Consider tapering paroxetine in the third trimester due to neonatal complications requiring prolonged hospitalization, respiratory support, and tube feeding 1
• Carefully weigh risks versus benefits when treating during this period 1

Practical Titration Guidelines

Key principle: Dose increases should occur no more frequently than weekly intervals 1, 2

• Standard increment: 10mg 1, 2
• Timing of reassessment: 1-3 weeks after dose initiation or change 2
• Administration: Single daily dose, usually morning 1, 2
• Food: Can be taken with or without food 1

Common Pitfalls to Avoid

• Don't increase doses too rapidly: Paroxetine requires adequate time at each dose level to assess response 2
• Don't exceed maximum doses: 50mg for depression, 60mg for OCD/panic disorder, 40mg for elderly patients 1
• Don't use standard adult doses in elderly patients: Start at 10mg and cap at 40mg 1
• Don't combine with MAOIs: Requires 14-day washout period in either direction 1
• Don't abruptly discontinue: Taper when stopping to avoid withdrawal syndrome 4

Maintenance Considerations

For responding patients, continue treatment on the lowest effective dosage with periodic reassessment 1

• OCD: 6-month maintenance demonstrated in relapse prevention trials 1
• Panic disorder: 3-month maintenance demonstrated 1
• Social anxiety disorder and GAD: Continuation reasonable given chronic nature, though efficacy beyond 12 weeks not established in controlled trials 1
• PTSD: Similar considerations as other anxiety disorders 1

Tolerability Profile

Most common adverse events include nausea, sexual dysfunction, somnolence, asthenia, headache, constipation, dizziness, sweating, tremor, and decreased appetite 3, 5

Paroxetine is generally better tolerated than tricyclic antidepressants and has similar tolerability to other SSRIs 3, 5