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Paxil
paroxetine
General Information
Paxil was the third SSRI to be released in the U.S.A. It shares most
of the properties discussed on the SSRI page.
Paxil is available in 10mg, 20mg, and 40mg tablets, which are scored.
The usual theraputic dosage is 20-50 mg per day, but some patients appear
to have an optimum response at lower dosages, even 5 mg per day.
Unique Properties
Paxil is probably the most sedating and least activating of the SSRI's.
This makes it a good choice for an SSRI for people with prominent symptoms
of anxiety. For the same reason, it may be less likely to cause insomnia
than Prozac or Zoloft. The downside of this is that it may be less helpful,
at least initially, in releaving loss of energy and fatigue.
Paxil in also unusual in that it has significant "anticholinergic"
properties. This means that, unlike the other SSRI's, it tends to block
the action of the neurotransmitter acetyl choline. This can result in a
few of the side effects seen with the tricyclic antidepressants, including
dry mouth, dry eyes, or blurry vision. Again, this effect is very weak compaired
to the tricyclic antidepressants, and these side effects are seldom problematic.
Paxil's metabolism is also unique. It has about a 2 hour half-life, not
that different from Zoloft and Luvox. However, unlike Prozac and Zoloft,
it inhibits its own metabolism. As a result, doubling the dose of Paxil
will more than double its blood level. This means that dosage increases,
particularly at higher dosages, should be made cautiously.
Specific Drug Interactions
Like Prozac, Paxil is a relatively strong inhibitor of one of the liver
enzyme systems which breaks down other drugs (the cytochrome P450 2D6 system).
As a result, it may be more likely to interact with other drugs than some
of the other SSRI's, and adjustments in dosages may be necessary. These
include some tricyclic antidepressants, antipsychotics, certain cardiac
antiarrhythmics, Dilantin, Tegretol, some beta blockers, codine, and trazadone.
None of the SSRI's should not be combined with Seldane, Hisminal, and Propulsid.
Like all SSRI's, Paxil can cause the Serotonin
Syndrome if mixed with other agents which increase serotonin.
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