paroxetine, Paxil, Paxil CR, Pexeva

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

What is the dosage for paroxetine?

The recommended dose is 20-60 mg daily of immediate release tablets or 12.5-75 mg daily using controlled release tablets. Paroxetine is given as a single daily dose, usually in the morning. As with all anti-depressants, the full effect may not occur until after a few weeks of therapy.

Doses for obsessive-compulsive disorders and panic disorders are often higher than those for depression. Doses often are adjusted to find the optimal dose.

Elderly patients, debilitated persons, and patients with certain kidney or liver diseases may need lower doses because they metabolize and eliminate paroxetine more slowly and, therefore, are prone to develop high blood levels and toxicity.

Which drugs or supplements interact with paroxetine?

All SSRIs, including paroxetine, should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl, Carbex), and procarbazine (Matulane) or other drugs that inhibit monoamine oxidase such as linezolid (Zyvox) and intravenous methylene blue.

Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. (A period of 14 days without treatment should lapse when switching between paroxetine and MAOIs.) Similar reactions occur when paroxetine is combined with other drugs for example, tryptophan, St. John's wort, meperidine (Demerol), tramadol (Ultram) that increase serotonin in the brain.

Paroxetine may increase the effect of the blood thinner, warfarin (Coumadin), leading to excessive bleeding. Therefore, warfarin therapy should be monitored more frequently in patients who are also taking paroxetine. Combining SSRIs such as paroxetine with aspirin, nonsteroidal anti-inflammatory drugs or other drugs that affect bleeding may increase the likelihood of upper gastrointestinal bleeding. Phenytoin (Dilantin) and phenobarbital may decrease the amount of paroxetine in the body and possibly reduce its effectiveness.

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