paroxetine: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
paroxetine: clinical details
Prescribing considerations
- Avoid abrupt discontinuation; paroxetine has a comparatively high frequency of withdrawal reactions.
- It is not licensed for patients under 18 and trial data identified increased suicidal behaviour and hostility in this group.
- Use caution with epilepsy, diabetes, cardiac disease, glaucoma, bleeding predisposition, hyponatraemia risk, and hepatic or severe renal impairment.
- Review pregnancy plans and tamoxifen treatment before prescribing.
- Assess prescribed, non-prescription and herbal products for serotonergic, bleeding and CYP2D6-mediated interactions.
Contraindications and cautions
- Hypersensitivity to paroxetine or a product excipient
- Concurrent use with monoamine oxidase inhibitors, subject only to the exceptional monitored linezolid circumstances described in the SmPC
- Concurrent use with thioridazine
- Concurrent use with pimozide
Monitoring
- Clinical response, tolerability and adherence
- Suicidal thoughts, clinical worsening or unusual behavioural changes, particularly early in treatment and after treatment changes
- Serotonin toxicity when other serotonergic agents are involved
- Bleeding in patients taking anticoagulants, antiplatelets or NSAIDs
- Symptoms of hyponatraemia in older adults and other susceptible patients
- Glycaemic control in diabetes
- Withdrawal symptoms during reduction or after missed tablets
- Newborn adaptation when exposure continues late in pregnancy
Clinical pharmacology
Paroxetine is a potent, selective serotonin-reuptake inhibitor and a potent CYP2D6 inhibitor. It undergoes extensive first-pass metabolism, has non-linear pharmacokinetics in some patients, is highly protein bound and is eliminated mainly after metabolism.
Formulation and product differences
- The selected product is a white, round, film-coated, scored tablet that can be divided into equal halves.
- The tablet should be swallowed rather than chewed.
- Excipients include mannitol; the product is essentially sodium-free.
paroxetine preparations and strengths
Tablet
Route: Oral
Strengths: 20 mg, 30 mg
paroxetine interactions
Check prescribed, non-prescription and herbal products before starting paroxetine. Important interactions include:
Monoamine oxidase inhibitors, including moclobemide and linezolid
The combination is generally contraindicated because it can cause life-threatening serotonin syndrome; specific separation periods are required.
Thioridazine or pimozide
Concurrent use is contraindicated because paroxetine can raise their concentrations and increase serious heart-rhythm risk.
Serotonergic medicines, including tramadol, buprenorphine, triptans, lithium and other antidepressants
Combined use increases the risk of serotonin syndrome and requires clinical review and monitoring.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.