Today we're gonna be discussing an antidepressant medication that's classified as an SSRI.
It's name is paroxetine its brand name is Paxil.
Before we talk about the medication itself just keep in mind that this article is for information purposes only and not to be used as a source of recommendations for your personal healthcare.
As I mentioned paroxetine is classified as an SSRI which stands for a selective serotonin reuptake inhibitor.
So depression would be the most common use of paroxetine, however there are some other indications where it's used as well so I'll go over some of those for you.
So besides regular MDD (major depressive disorder) it can also be used for recurrent MDD as well as for prophylaxis of MDD, it can be used to treat the depressed phase in bipolar disorder.
As long as there's an anti manic agent on board it is indicated for obsessive-compulsive disorder or OCD.
It can be used in panic disorder with or without agoraphobia, paroxetine can be used in social anxiety disorder as well as post-traumatic stress disorder or PTSD.
Paxil can be used to treat premenstrual dysphoric disorder, can be used in generalized anxiety disorder as well as dysthymia, and you may also see it used in postpartum depression.
The exact mechanism of action of SSRIs is unknown, however through the inhibition of uptake of serotonin it does cause an increase in serotonin concentrations in the synapse causes a down regulation of post synaptic receptors, one example of these receptors would be the 5ht 2a receptor.
Now before if somebody was to use paroxetine or paxil there are some precautions or warnings that they should be made.
Aware of first is that all patients who are starting these types of medications must be monitored closely for any signs of worsening of depression as well as the appearance of suicidal ideation.
These thoughts are more common in younger individuals, however can happen in any population, especially when there's a change in dose.
Whether that be an increase in dose or a decrease in dose SSRIs in general may impair a patient's ability to perform hazardous tasks such as operating heavy machinery or driving an automobile so the best practice would be not to perform these tasks until the patient has an understanding of how the medication makes them feel because paroxetine does affect serotonin levels.
If somebody was using this medication with other medications that also affect serotonin levels, this could put the patient at an increased risk of experiencing serotonin syndrome.
Paroxetine is one of the three SSRIs that can displace highly protein down medications so if you're using a medication that is highly protein bound you can expect higher plasma concentrations of that medication.
Rockstein is also one of the SSRIs, it does have an effect on the cytochrome p450 system so this can cause a problem with certain medications in terms of drug interactions.
And finally as a rule of thumb we generally try to give the lowest possible effective dose to individuals who have kidney and liver problems.
Now when somebody is made aware of the warnings and precautions associated with paxil and start using the medication they can expect to start taking the medication really in many different forms.
It's available in tablet form in 10, 20, 30 and 40 milligram, there's an oral suspension that comes in at a strength of 5 milligrams per 5 ml, there are controlled release tablets that can mimic strengths of 12.
5 milligrams, 25 milligrams as well as 37 point 5 milligrams and there's also a brand name packs Eva that has a different salt in the tablets but again these tablets would still be 10, 20, 30 and 40 milligram.
In terms of dosing the only rule of thumb here is that you would start off on a low dose and slowly increase that dose over time upon initiation.
You would typically stay on the initial dose for one to two weeks just to make sure that you have reached steady-state before you start increasing the medication or physician and pharmacist will help you come up with a plan of how to increase the medication.
Appropriately one thing that should be noted especially upon initiation of therapy is that these types of medications do take some time to work, it can take anywhere from weeks to months before you notice the maximum benefit from the medication.
Unfortunately when people start the medication they may experience side effects but not much benefit.
Many of these patients would stop taking the medication unless they're made aware that they do have to push through that period of time and get to the point where they can actually have a chance of experiencing max benefit.
Now as with all medications there are some adverse reactions or side effects that individuals may experience while using paroxetine so I'll list some of those here for you now.
Some people they use paroxetine noticed drowsiness or sedation while others experience insomnia, both of these side effects come in at a rate of over ten percent where two percent of people may experience a feeling of excitement or even hypomania and less than two percent experienced disorientation or confusion headaches happen as well in about 10% of people.
Some people may experience anticholinergics side effects while using paxil such as dry mouth, urinary retention, constipation or sweating.
Of these side effects dry mouth, constipation and sweating happen about 10% of the time while the other anticholinergic side effects happen about 2% of the time, 10% of people using this medication may experience extrapyramidal side effects such as a tremor, more than 10% of patients may experience orthostatic hypotension and a small amount may notice a change on an ECG or arrhythmia or tachycardia.
Paroxetine seems to be a little bit better on the gut compared to other SSRIs, with GI distress only coming in at 10%.
As we seen with other SSRIs that it happens in 30% occasionally for 10% of people, do notice weight gain with paroxetine and unfortunately over 30% of people experience sexual disturbances.
That's all we're going to talk about.
Author: Garrett Campbell