Home Drug Guide Paroxetine Hydrochloride

Drug Guide

Generic Name

Paroxetine Hydrochloride

Brand Names Paxil, Paxil CR

Classification

Therapeutic: Antidepressant, Selective Serotonin Reuptake Inhibitor (SSRI)

Pharmacological: Selective Serotonin Reuptake Inhibitor (SSRI)

FDA Approved Indications

  • Major depressive disorder
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder
  • Social anxiety disorder
  • Post-traumatic stress disorder (PTSD)
  • Generalized anxiety disorder (GAD)
  • Hot flashes associated with menopause

Mechanism of Action

Paroxetine selectively inhibits the reuptake of serotonin into presynaptic neurons, increasing serotonin levels in the synaptic cleft and enhancing serotonergic neurotransmission.

Dosage and Administration

Adult: Typically 20 mg once daily, with adjustments based on response and tolerability.

Pediatric: Not generally recommended below age 18 except for OCD in children aged 7-17, starting at 10-20 mg/day.

Geriatric: Start at lower doses (e.g., 10 mg daily) due to increased sensitivity.

Renal Impairment: Use with caution; may require dose adjustments.

Hepatic Impairment: Start at lower doses; monitor closely.

Pharmacokinetics

Absorption: Well absorbed orally, with high bioavailability.

Distribution: Widely distributed; protein binding approximately 95%.

Metabolism: Primarily hepatic via CYP2D6 and CYP3A4.

Excretion: Metabolites excreted in urine; small amount excreted unchanged in urine.

Half Life: Approximately 21 hours, allowing once daily dosing.

Contraindications

  • Hypersensitivity to paroxetine or excipients.
  • Concomitant use with monoamine oxidase inhibitors (MAOIs).

Precautions

  • History of mania or bipolar disorder.
  • Increased risk of suicidal thoughts in young adults, adolescents, and children.
  • Use cautiously in patients with bleeding disorders or on anticoagulants.
  • Monitor for serotonin syndrome, especially when combined with other serotonergic drugs.
  • Pregnancy category D — risk of congenital malformations. Use only if benefits justify potential risks.

Adverse Reactions - Common

  • Nausea (Common)
  • Somnolence (Common)
  • Headache (Common)
  • Insomnia (Common)
  • Sweating (Common)

Adverse Reactions - Serious

  • Serotonin syndrome (Rare)
  • Suicidal ideation (Rare)
  • QT prolongation and arrhythmias (Rare)
  • Hyponatremia, especially in elderly (Rare)
  • Emotional blunting or dizziness (Uncommon)

Drug-Drug Interactions

  • MAOIs
  • Tricyclic antidepressants
  • Other serotonergic drugs (e.g., triptans, lithium, tramadol)
  • Warfarin and other anticoagulants

Drug-Food Interactions

  • Alcohol, which can increase sedation and impair judgment.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor mood, suicidal ideation, and response to therapy. Check baseline blood pressure and ECG if indicated.

Diagnoses:

  • Risk for suicide
  • Risk for bleeding
  • Imbalanced nutrition related to gastrointestinal discomfort

Implementation: Administer with food to reduce gastrointestinal upset. Advise patients not to discontinue abruptly.

Evaluation: Assess for therapeutic effectiveness and side effects. Adjust dose accordingly.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Do not stop medication suddenly without consulting healthcare provider.
  • Report worsening depression, suicidal thoughts, or unusual bleeding.
  • Limit alcohol intake.
  • Be aware of potential side effects like nausea, dizziness, or sleep disturbances.

Special Considerations

Black Box Warnings:

  • Increased risk of suicidal thinking and behavior in children, adolescents, and young adults.

Genetic Factors: Consider CYP2D6 polymorphisms affecting metabolism.

Lab Test Interference: May cause false-positive urine screening for drugs of abuse.

Overdose Management

Signs/Symptoms: Dizziness, tremors, vomiting, tachycardia, seizures, serotonin syndrome.

Treatment: Supportive care, activated charcoal if recent ingestion, benzodiazepines for agitation, serotonin antagonists for serotonin syndrome, and intensive care monitoring as needed.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable for at least 24 months when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.