From the Guidelines
Paroxetine should be used with caution in adults, particularly in the first month of treatment, due to an increased risk of suicidal behaviors, and its use in children and adolescents is not recommended due to the potential for increased suicidal thoughts and acts. The American College of Physicians recommends that when clinicians choose pharmacologic therapy to treat patients with acute major depression, they select second-generation antidepressants, including paroxetine, on the basis of adverse effect profiles, cost, and patient preferences 1. Some key points to consider when prescribing paroxetine include:
- Starting dose: 20 mg once daily for adults with depression, which may be increased gradually to a maximum of 50 mg daily if needed 1
- Common side effects: nausea, drowsiness, dry mouth, insomnia, sexual dysfunction, and dizziness, which often improve after a few weeks of treatment 1
- Importance of regular monitoring: clinicians should assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1 to 2 weeks of initiation of therapy 1
- Potential interactions: paroxetine may interact with other medications, particularly MAO inhibitors, triptans, and certain pain medications, so always inform your healthcare provider about all medications you're taking 1
- Risk of suicidal behaviors: the risk for suicidal behaviors is greater during the first 1 to 2 months of treatment, particularly in adults under 30 years old, and paroxetine has a higher rate of sexual dysfunction compared to other SSRIs 1. It's essential to weigh the benefits and risks of paroxetine and closely monitor patients, especially during the initial treatment phase, to minimize the risk of adverse effects and ensure the best possible outcome for patients with depression and other conditions treated with this medication.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Overview of Paroxetine
- Paroxetine is a selective serotonin reuptake inhibitor (SSRI) with antidepressant and anxiolytic activity 2, 3, 4.
- It is used to treat various psychiatric disorders, including major depressive disorder, obsessive-compulsive disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder 2, 3, 4, 5.
Efficacy of Paroxetine
- Paroxetine has been shown to be effective in treating major depressive disorder, with a significant reduction in symptoms compared to placebo 2, 3.
- It is also effective in treating anxiety disorders, including obsessive-compulsive disorder, panic disorder, social anxiety disorder, and generalized anxiety disorder 2, 3, 4, 5.
- Paroxetine has been shown to be as effective as tricyclic antidepressants (TCAs) and other SSRIs in treating major depressive disorder 2, 3.
Tolerability and Safety of Paroxetine
- Paroxetine is generally well tolerated, with a tolerability profile similar to that of other SSRIs 2, 3, 4, 5.
- The most common adverse events associated with paroxetine include nausea, sexual dysfunction, somnolence, asthenia, headache, constipation, dizziness, sweating, tremor, and decreased appetite 2, 3.
- Paroxetine has a benign adverse event profile, with serious adverse events being extremely rare even in overdose 4, 5, 6.
Use of Paroxetine in Elderly Patients
- Paroxetine is well tolerated in elderly patients, although there is wide interindividual variation in its pharmacokinetics 4, 6.
- Elimination of paroxetine is reduced in severe renal and hepatic impairment, and higher plasma concentrations and slower elimination are noted in elderly patients 4, 6.
- There is limited information on the use of paroxetine in elderly patients, particularly those over 75 years old, but its safety profile allows for its prescription in this population 6.