How to Safely Discontinue Paroxetine 30 mg
Paroxetine 30 mg must be tapered gradually over several weeks—never stopped abruptly—because it is the SSRI most strongly associated with discontinuation syndrome, which can cause significant morbidity including dizziness, flu-like symptoms, sensory disturbances, and psychological distress. 1
Understanding the Risk
Paroxetine carries the highest risk of discontinuation syndrome among all SSRIs due to its short half-life (approximately 21 hours) and lack of active metabolites. 2, 3 The syndrome is characterized by:
- Physical symptoms: Dizziness, vertigo, fatigue, myalgias, chills, headaches, nausea, vomiting, diarrhea, sensory disturbances (electric shock sensations/paresthesias), and imbalance 1, 4
- Psychological symptoms: Anxiety, irritability, agitation, crying spells, insomnia, excessive dreaming, and confusion 4, 3
- Timing: Symptoms typically begin within 24-48 hours after discontinuation or missed doses, peak around day 5, and usually resolve within 2-3 weeks 3, 5
- Severe cases: Fever up to 40°C has been documented during paroxetine withdrawal 6
Recommended Tapering Protocol
The safest approach is to reduce the dose by small increments at 1-2 week intervals:
- From 30 mg, reduce to 20 mg for 1-2 weeks 1
- Then reduce to 10 mg for 1-2 weeks 1
- Consider further reduction to 5 mg (if available) or alternate-day dosing before complete discontinuation 4
- If severe symptoms emerge at any step, return to the previous tolerated dose and slow the taper further 4, 3
The American Academy of Child and Adolescent Psychiatry specifically recommends dose adjustments at approximately 1-2 week intervals for shorter half-life SSRIs like paroxetine. 1
Critical Monitoring Requirements
Monitor weekly during the taper for:
- Emergence of discontinuation symptoms (use standardized rating scales if available) 1
- Distinction between withdrawal symptoms versus relapse of the underlying condition 4, 3
- Suicidal thinking, as paroxetine has been associated with increased risk compared to other SSRIs 1
Management of Withdrawal Symptoms
If mild symptoms occur:
- Reassure the patient that symptoms are typically transient and self-limiting 4
- Continue the current taper schedule if symptoms are tolerable 4
If moderate to severe symptoms develop:
- Reinstitute the previous dose immediately 4, 3
- Wait until symptoms fully resolve (typically 2-3 weeks) 3
- Resume tapering at a slower rate, using smaller dose decrements 4, 3, 6
- In severe cases documented in the literature, extremely gradual tapering over many weeks was necessary to avoid recurrent severe symptoms including fever 6
Special Considerations
Risk factors that warrant even slower tapering:
- Higher doses (30 mg is a moderate-high dose) 3
- Longer duration of treatment 3
- History of previous withdrawal syndrome with this or other medications 3
- Poor treatment compliance history 3
- Concomitant medications or alcohol use 3
Alternative strategy if standard taper fails:
- Consider cross-tapering to fluoxetine (which has a much longer half-life of 1-3 days for parent compound and 4-16 days for active metabolite), then discontinuing fluoxetine without taper 4
- This approach leverages fluoxetine's self-tapering pharmacokinetics but requires careful monitoring 4
Common Pitfalls to Avoid
- Never abruptly discontinue paroxetine, even if the patient reports feeling well—this is the primary cause of severe withdrawal syndromes 1, 4, 3
- Do not mistake withdrawal symptoms for relapse of the underlying psychiatric condition; withdrawal symptoms typically include prominent physical manifestations (dizziness, sensory disturbances) that are not characteristic of depression or anxiety recurrence 4, 3
- Do not use a fixed 4-week taper schedule—some patients require much longer tapers extending over 2-3 months, particularly those on higher doses or longer treatment durations 3, 6
- Avoid discontinuing in inpatient or short-stay settings where post-discharge monitoring cannot be ensured, as symptoms may emerge or worsen after discharge 1