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 taper-phase regimen used in GAD and PTSD clinical trials involved an incremental decrease in the daily dose by 10 mg/day at weekly intervals When a daily dose of 20 mg/day was reached, patients were continued on this dose for 1 week before treatment was stopped.
The recommended tapering protocol for Paroxetine (Paxil) is a gradual reduction in dose. The specific regimen used in clinical trials involved:
- Decreasing the daily dose by 10 mg/day at weekly intervals
- Continuing the patient on a dose of 20 mg/day for 1 week before stopping treatment If intolerable symptoms occur during tapering, the previously prescribed dose may be resumed and the tapering continued at a more gradual rate 1.
From the Research
Tapering Protocol for Paroxetine (Paxil)
- To minimize the symptoms of antidepressant discontinuation, gradual tapering is necessary for all serotonin reuptake inhibitors (SRIs) except fluoxetine, which has an extended half-life 2.
- Agents with shorter half-lives such as paroxetine should be tapered gradually 2.
- Gradual tapering of paroxetine is recommended for patients receiving more than 20 mg/day to avoid sudden and impairing effects such as marked sleep disturbances and dizziness 3.
- The symptoms of discontinuation may be somatic (e.g., dizziness and light-headedness; nausea and vomiting; fatigue, lethargy, myalgia, chills, and other flu-like symptoms; sensory and sleep disturbances) or psychological (anxiety and/or agitation, crying spells, irritability) 2.
- For more severe symptoms, it may be necessary to reinstitute the dosage of the original antidepressant and slow the rate of taper 2.