Paroxetine withdrawal
Trade names
Paxil. Paroxetine. Reksetin.
Subgroup
Selective serotonin reuptake inhibitors.
The main components of psychotropic activity profile are antidepressant and protivotrevozhnogo effect in moderately stimulatory (activated) effect. The effect is manifested after 10 days.
Mechanism of
Inhibits the reuptake of serotonin neurons, enhances serotonergic transmission in the CNS.
Pharmacokinetics
Completely absorbed in the gastrointestinal tract. Time to achieve Cmax in the blood – 5,2 hours Relations to plasma proteins – 95%. Intensively metabolized, metabolites do not show pharmacological activity. Approximately 64% excreted in the urine and 36% – through the digestive tract (in unmodified form – 2% and 1% respectively). T1 / 2 – 21 h. The equilibrium concentration is reached after approximately 10 days at a daily intake of 30 mg.
Indications
* Depression of various etiologies;
* Obsessive-compulsive disorder;
* Panic disorder with agoraphobia and without it;
* Social anxiety disorder / social phobia;
* Generalized anxiety disorder;
* Post-traumatic stress disorder.
Contraindications
* Simultaneous reception of MAO inhibitors and the period of 14 days after their cancellation;
* Simultaneous reception thioridazine;
* Simultaneous administration of drugs containing tryptophan;
* Pregnancy;
* Lactation (breastfeeding);
* Childhood and adolescence to 18 years;
* Hypersensitivity to paroxetine and other components of the drug.
Restrictions apply
-Closure glaucoma, prostate adenoma.
Side effects
Drowsiness or sleeplessness, tremors, nervousness, irritability CNS, violation of concentration, emotional lability, amnesia, dizziness, paresis of accommodation, mydriasis, eye pain, noise and pain in the ears, rise or fall in blood pressure, syncope, tachycardia or bradycardia, cardiac conduction, and peripheral circulation, cough, rhinitis, dipnoe, tachypnea, nausea, decreased appetite, indigestion, increase in liver transaminases, stomatitis, arthralgia, arthritis, dysuria, polyuria, urinary incontinence, urinary retention, amenorrhea, dysmenorrhea, miscarriage, mastitis , abnormal ejaculation, decreased libido and potency, peripheral edema, decrease or increase in body mass, anemia, leukopenia, allergic reaction (itching, rash, chills).
Rarely – Violations of thinking, akinesia, ataxia, seizures, hallucinations, hyperkinesia, manic or paranoid reactions, delirium, euphoria, large seizures, aggressiveness, nystagmus, stupor, autism, decreased visual acuity, cataract, conjunctivitis, glaucoma, exophthalmos, angina pectoris, myocardial infarction, cerebrovascular accident, heart rhythm disturbances, eosinophilia, leukocytosis, lymphocytosis, monocytosis, hematuria, nefrourolitiaz, renal failure, dermatitis, nodular erythema, hyperpigmentation.
Interaction
Absorption and pharmacokinetics of the drug did not change at all or changes only partially influenced by food, antacids, digoxin, propranolol and ethanol.
Co-therapy with lithium should be undertaken with caution and under the control of the concentration of lithium in the blood, as experience combined use of paroxetine and lithium is limited.
Metabolism and pharmacokinetic parameters can be changed while the application of drugs that induce or inhibit protein metabolism. If concomitant use of paroxetine with drugs inhibiting the metabolism of enzymes (cimetidine), used doses should be limited to the lower boundary of the normal level. , In combination with drugs induce the metabolism enzymes (carbamazepine, phenytoin, sodium valproate) does not require changes in the initial doses paroksetinaa. Subsequent dose adjustment should be carried out depending on the clinical effect.
If concomitant use of paroxetine with drugs metabolized by cytochrome P450 CYP2D6 (tricyclic antidepressants (amitriptyline, nortriptyline, imipramine, desipramine), phenothiazine antipsychotics (thioridazine, perphenazine), and class IC antiarrhythmic drugs (propafenone, flekainid) and metoprolol), there is an increase in their concentrations in blood plasma. The combination of paroxetine with terfenadine and other drugs, is a substrate for CYP3A4 isoenzyme, does not cause adverse reactions.
Concomitant use of paroxetine with MAO inhibitors, tryptophan can cause the development of serotonin syndrome, which manifests itself agitation, anxiety, disorders of the gastrointestinal tract, including diarrhea.
Daily administration of paroxetine significantly increases protsiklidina in plasma. In the presence of anticholinergic symptoms protsiklidina dose should be reduced.
The interaction of paroxetine with warfarin may increase bleeding time when unmodified prothrombin time.
Unlike antidepressants, which inhibit the seizure of norepinephrine, paroxetine inhibits the much weaker antihypertensive effects guanetidina.
Dosage and administration of adult
Inside, 1 time per day, morning, along with the meal – 20 mg. Tablets should be swallowed whole, without chewing, drinking water. With insufficient effects may increase the dose of 10 mg / day with an interval of at least 1 week (maximum dose – 50 mg / day). In the elderly, malnourished patients, as well as impaired renal function and liver initial dose – 10 mg / day, maximum – 40 mg / day.
Dosage and administration in pediatric practice
Use of the drug in children (under 18) is not recommended because safety and efficacy of its use in children has not been established.
Pregnancy and lactation
Safety of use in pregnancy has not been studied, so it should not be used during pregnancy and lactation (breastfeeding), except in cases where a medical point of view of the potential benefits of treatment exceed the possible risks associated with taking this medication. In the appointment during lactation should abandon breastfeeding.
Overdose
Symptoms: increased above side effects, as well as vomiting, headache, dilated pupils, fever, change in blood pressure, involuntary muscle contractions, agitation, anxiety, tachycardia. Patients usually do not develop serious complications, even when receiving up to 200 mg of paroxetine. Sometimes it develops a coma and EEG changes, very rarely a fatal outcome occurs when the combined use of paroxetine with psychotropic drugs with alcohol or without it.
Treatment: Standard measures used in an overdose of antidepressants (catharsis through artificial vomiting or lavage, the appointment of 20-30 mg of activated charcoal every 4-6 hours during the first days after the overdose). The specific bad side effects of paxil antidote is known. Careful monitoring and control of vital functions.
Cautions
The drug should be used with caution in hepatic failure, renal failure, angle-closure glaucoma, prostatic hyperplasia, maniyah, heart disease, epilepsy, convulsive states, in the presence of risk factors for increased bleeding and predisposing diseases, coupled with the electric pulse therapy and oral anticoagulants .
In sharp cancellation may develop symptoms such as dizziness, paresthesia, sleep disturbances, agitation, anxiety, nausea and sweating.
If observed against the background of treatment increased liver enzymes retained for a long time, paxil attorneys california, receiving the drug should be discontinued.
Paxil did not potentiate the effect of alcohol on psychomotor functions, however patients are advised to refrain from alcohol.
Does not cause cognitive impairment or psychomotor retardation. Nevertheless, as in the treatment of any psychotropic drugs, patients should exercise caution when driving and work with side effects of paxil moving machinery.