Paroxetine Cardiac — MRCPsych Paper B MCQ

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ModeratePerinatal PsychiatryParoxetine CardiacMRCPsych Paper B

A woman who is 8 weeks pregnant has been taking paroxetine. Which structural congenital malformation is specifically associated with first-trimester exposure to paroxetine in current UK product information?

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Correct answer: B — Atrial or ventricular septal defects

The correct answer is B. First-trimester paroxetine exposure has been associated with a small increased risk of congenital cardiovascular malformations, particularly atrial and ventricular septal defects. Current UK product information estimates the cardiovascular-defect risk at less than 2 per 100 exposed pregnancies, compared with approximately 1 per 100 in the general population. Neural tube defects are classically associated with medicines such as valproate rather than paroxetine. Limb reduction defects, bilateral renal agenesis and orofacial clefts are not the congenital-malformation signal specifically identified for paroxetine. Treatment decisions in pregnancy require an individual risk–benefit assessment; paroxetine should not be stopped abruptly because of withdrawal and relapse risks.

Reference: Electronic Medicines Compendium, Paroxetine 20 mg Tablets, Summary of Product Characteristics, section 4.6 Fertility, pregnancy and lactation, text revised 20 May 2026. https://www.medicines.org.uk/emc/product/537/smpc