Paroxetine
Brand names
Usage
To treat symptoms of major
depression, obsessive-compulsive disorder,
panic
disorder, and social anxiety
disorder.
How it works
Paroxetine affects levels of
serotonin, a brain chemical
that is thought to be linked
to mood, emotions, and
mental state.
Side effects
- Serious
- Muscle pain or
fatigue, lightheadedness or
fainting,
rash,
agitation or irritability, severe drowsiness, dilated pupils,
severe dry mouth, rapid heartbeat, trembling, severe
nausea or vomiting.
- Common
- Insomnia,
dizziness, sexual dysfunction, unusual fatigue,
loss of initiative, nausea or vomiting, constipation, difficulty
urinating, headache, trembling.
- Less common
- Decreased sexual desire, blurred vision, increased or
decreased appetite, weight gain or loss, heartbeat
irregularities, change in sense of taste. Also
tingling, prickling, or
burning feeling.
Possible interactions
- Other medicaments:
Paroxetine may increase the effects of:
- benzodiazepines.
- buspirone (Buspar).
- desipramine (and potentially other tricyclic antidepressants).
- dofetilide (Tikosyn) by increasing
blood levels. Checks of patient clinical
status and dosing changes are appropriate.
- flecainide (Tambocor) because paroxetine inhibits an enzyme system
needed to remove flecainide. More frequent flecainide blood levels are prudent.
- haloperidol (Haldol), because paroxetine blocks an enzyme system needed
to remove haloperidol.
- labetalol (Normodyne), and perhaps other beta blockers,
because paroxetine inhibits an enzyme system needed to remove labetalol.
- minimally sedating antihistamines (astemizole and terfenadine), because
paroxetine may inhibit some liver systems that usually remove them from the
body.
Paroxetine taken concurrently with:
- activated charcoal will reduce absorption of paroxetine.
- astemizole (Hismanal) may lead to heart toxicity.
- dextromethorphan (the DM ingredient in many cough suppressants) may
lead to serotonin syndrome.
- digoxin (Lanoxin) may lead to lowered digoxin levels. More frequent digoxin
levels are prudent.
- fenfluramine (Pondimin) may cause toxicity (serotonin syndrome).
- lithium (Lithobid, others) may lead to increased adverse effects.
- MAO inhibitors may result in a fatal serotonin syndrome.
- naratriptan (Amerge) and other triptan-type medicines may lead to loss of
coordination and changes in reflexes.
- phenytoin (Dilantin) or fosphenytoin (Cerebyx) may result in decreased
paroxetine blood levels and lessening of therapeutic benefits. Dose increases
may be needed.
- quinidine (Quinaglute, others) may result in increased paroxetine levels and
toxicity; decreased paroxetine doses may be needed.
- risperidone (Risperdal) may lead to serotonin syndrome.
- ritonavir (Norvir) may lead to paroxetine toxicity.
- sibutramine (Meridia) increases risk of serotonin syndrome.
- sumatriptan (Imitrex) can lead to hyperreflexia and poor coordination.
- tramadol (Ultram) may lead to increased risk of seizures.
- tryptophan may result in sweating, nausea and dizziness.
- venlafaxine (Effexor) can increase risk of serious serotonin syndrome.
- warfarin (Coumadin) may result in bleeding; more frequent INR
(prothrombin time or protime) testing is recommended. Warfarin doses should
be adjusted based on laboratory results.
The following medicament may increase the effects of paroxetine:
- cimetidine (Tagamet).
- Herbal medicines or minerals:
- Since paroxetine and St. John's wort may act to
increase serotonin, the combination is not advised. Since part of the way
ginseng works may be as a MAO inhibitor, do not combine ginseng with paroxetine.
Ma huang,
yohimbe,
Indian snakeroot and
kava kava are also best
avoided while taking this medicine.
- Alcohol:
- The manufacturer recommends avoiding alcohol while taking this medicine.
- Marijuana smoking:
- Additive sedation.
- Exposure to heat:
- This medicine can cause excessive sweating. If you work or are
frequently in a hot environment, be careful to replace enough fluids to avoid
dehydration.
- Heavy exercise or exertion:
- Since this medicine may cause excessive sweating,
be careful to replace lost fluids.
- Occurrence of unrelated illness:
- Fevers may cause more severe dehydration.
- Discontinuation:
- Do not stop this medicine without talking with your doctor. For
patients taking more than 40 mg a day or who have been taking this
medicine for an extended period of time, gradual dosing decreases (tapering)
over several days is recommended.
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