III. Indications

IV. Pregnancy Risk

  1. Category D
  2. Neonatal withdrawal risk
    1. Sanz (2005) Lancet 365:482-7 [PubMed]
  3. Increased Atrial and Ventricular Septal Defects
    1. Associated with first trimester exposure
    2. Associated with a two fold increased risk
    3. (2006) Obstet Gynecol 108:1601-3 [PubMed]

V. Background

  1. Cost: $81 per month

VI. Preparations

  1. Paxil (Paroxetine hydrochloride)
    1. Generic Paxil is available in United States in 2003
    2. Tablets (lower doses scored): 10, 20, 30, and 40 mg
    3. Oral Suspension: 10 mg/5 ml
  2. Paxil CR Tablets: 12.5, 25, and 37.5 mg
    1. Marketed as reducing GI upset with standard Paxil
    2. Must be swallowed whole without chewing
  3. Brisdelle Capsule (Paroxetine): 7.5 mg
    1. Released in 2013 specifically targeting Hot Flushes
    2. Paroxetine 10 mg generic tablet daily is nearly equivalent (at 6% of the Brisdelle cost)
  4. Pexeva (Paroxetine mesylate)
    1. Likely has similar activity to Paxil but not proven
    2. Was significantly less expensive than original trade name Paxil

VII. Dosing: Paxil

  1. Start
    1. Adults: 20 mg PO qhs
    2. Elderly: 10 mg qd
  2. Titrate
    1. Adults: Increase by 10 mg every 2 weeks
  3. Maximum: 60 mg PO qhs

VIII. Mechanism

  1. Selective Serotonin Reuptake Inhibitor (SSRI)
  2. Increased Norepinephrine reuptake inhibitor activity
  3. Increased Anticholinergic activity

IX. Pharmacokinetics

  1. Half Life: 1 day (shorter than most other SSRIs)

X. Drug Interactions

  1. Inhibits Cytochrome P450-2D6
  2. Raises Warfarin (Coumadin) levels and associated INR
  3. Raises Tricyclic Antidepressant levels
  4. Highly protein bound
    1. Interacts with other protein bound medications
  5. Allow 2 week wash-out prior to starting MAO inhibitor

XI. Adverse Effects

  1. Anticholinergic side effects (Sedation, Constipation)
    1. Avoid in elderly with cognitive disorders
  2. Sedating on the Sedation to excitation continuum
    1. Most sedating of the SSRIs (administer at bedtime)
    2. Some patients may have paradoxical activation
  3. Sexual Dysfunction (inhibits nitric oxide synthetase)
    1. See Antidepressant Induced Sexual Dysfunction
    2. More common than with Fluoxetine or Sertraline
  4. Dysesthesia (skin Paresthesias)
  5. Dry Mouth
  6. Constipation
  7. Antidepressant Withdrawal on stopping medication
    1. Reduce dose by 10 mg per day every 5-7 days
    2. Taper down to 5-10 mg before discontinuing
  8. Less anxiety (more Anxiolytic) than other SSRIs
    1. Similar to Serzone on this spectrum
  9. Weight gain
    1. More common than with Fluoxetine or Sertraline

XII. Precautions

  1. Use caution in Pediatric Depression
    1. Use may be associated with higher Suicide Risk

XIII. Resources

  1. Paxil Website (GlaxoSmithKline)
    1. http://www.paxil.com

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Cost: Medications

PAROXETINE (on 2/19/2015 at Target.com)
PAROXETINE 10 MG* Tablet #90 for $10.00 $0.11 each
PAROXETINE 20 MG* Tablet #90 for $10.00 $0.11 each
paroxetine (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
PAROXETINE CR 12.5 MG TABLET Generic $4.31 each
PAROXETINE CR 25 MG TABLET Generic $4.47 each
PAROXETINE CR 37.5 MG TABLET Generic $4.51 each
PAROXETINE ER 12.5 MG TABLET Generic $4.31 each
PAROXETINE ER 25 MG TABLET Generic $4.47 each
PAROXETINE ER 37.5 MG TABLET Generic $4.51 each
PAROXETINE HCL 10 MG TABLET Generic $0.09 each
PAROXETINE HCL 20 MG TABLET Generic $0.10 each
PAROXETINE HCL 30 MG TABLET Generic $0.13 each
PAROXETINE HCL 40 MG TABLET Generic $0.13 each
paxil (on 3/4/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
PAXIL 10 MG TABLET Generic $0.09 each
PAXIL 10 MG/5 ML SUSPENSION $1.07 per ml
PAXIL 20 MG TABLET Generic $0.10 each
PAXIL 30 MG TABLET Generic $0.13 each
PAXIL 40 MG TABLET Generic $0.13 each
PAXIL CR 12.5 MG TABLET Generic $4.31 each
PAXIL CR 25 MG TABLET Generic $4.47 each
PAXIL CR 37.5 MG TABLET Generic $4.51 each
pexeva (on 1/5/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
PEXEVA 40 MG TABLET $10.88 each
brisdelle (on 3/23/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
BRISDELLE 7.5 MG CAPSULE $5.71 each

Ontology: Paroxetine (C0070122)

Definition (CHV) a kind of depression treatment drug
Definition (MSH) A serotonin uptake inhibitor that is effective in the treatment of depression.
Definition (CSP) serotonin uptake inhibitor used in the treatment of depression.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D017374
SnomedCT 96214003, 321963000, 372595009
LNC LP17979-3, MTHU004267
English Paroxetine, Piperidine, 3-((1,3-benzodioxol-5-yloxy)methyl)-4-(4-fluorophenyl)-, (3S-trans)-, (-)-trans-4-(p-fluorophenyl)-3-((3,4-(methylenedioxy)phenoxy)methyl)piperidine, Piperidine, 3-((1,3-benzodioxol-5-yloxy)methyl)-4-(4-fluorophenyl)-, (3s-trans)-, (-)-(3S,4R)-4-(p-Fluorophenyl)-3-((3,4-(methylenedioxy)phenoxy)methyl)piperidine, Paroxetine [Chemical/Ingredient], PAROXETINE, PARoxetine, paroxetine, Paroxetine (product), Paroxetine (substance)
Swedish Paroxetin
Czech paroxetin
Finnish Paroksetiini
Russian PAROKSETIN, ПАРОКСЕТИН
Japanese パロキセチン
Polish Paroksetyna
Spanish paroxetina (producto), paroxetina (sustancia), paroxetina, Paroxetina
French Paroxétine
German Paroxetin
Italian Paroxetina
Portuguese Paroxetina

Ontology: Paxil (C0376414)

Definition (CHV) a kind of chemical substance
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D017374
English paxil, Paxil

Ontology: Pexeva (C1602496)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
English Pexeva