Paroxetine comes in immediate-release and extended-release forms under the brand names Seroxat and Paraxyl. Unipolar depression with predominance of anxiety is treated with it.

Paroxetine Uses:

• Generalized anxiety disorder (immediate release):

  • Treatment of generalized anxiety disorder.

• Major depressive disorder (unipolar) (immediate and extended-release):

  • Treatment of unipolar major depressive disorder.

• Obsessive-compulsive disorder (immediate-release):

  • Obsessions and compulsions treatment in patients with obsessive-compulsive disorder.

• Panic disorder (immediate and extended-release):

  • Treatment of panic disorder, with or without agoraphobia.

• Posttraumatic stress disorder (immediate-release):

  • Treatment of posttraumatic stress disorder.

• Premenstrual dysphoric disorder (extended-release):

  • Treatment of premenstrual dysphoric disorder.

• Social anxiety disorder (immediate and extended-release):

  • Social anxiety disorder, also called social phobia.

• Vasomotor symptoms of menopause (immediate release; 7.5 mg capsule):

  • Moderate to severe vasomotor symptoms associated with menopause.

• Off Label Use of Paroxetine in Adults:

  • Body dysmorphic disorder
  • Premature ejaculation

Paroxetine Dose in Adults

Note:

• Dose:
  • Some medical professionals advise a lower starting dose of 5 to 10 mg once daily (immediate-release) or 12.5 mg once daily (extended-release) in patients who are sensitive to side effects. This is especially true for anxiety patients who are more susceptible to the overstimulation effects of antidepressants, such as anxiety and insomnia.
• Dosage forms:
  • Both the IR and ER forms of paroxetine are available; however, they cannot be interchanged one mg for the other on a daily basis. You can convert between formulations using the equivalent stated in the section below on dosage conversions when dosing for the ER formulation is not supplied for an indication

Paroxetine Dose in the treatment of Body dysmorphic disorder (off-label):

Dosing recommendations based on expert opinion:

• Immediate release:

  • Oral: Initial dose is 20 mg once daily; based on response and tolerability, the dose may be increased gradually in increments of 20 mg per day at intervals of every 2 to 3 weeks to a usual dose of 60 mg per day. For some patients, doses up to 100 mg per day may be required for the best response; this is usually done with the help of a specialist.
  • Note: Twelve to sixteen weeks, including at least three to four of those weeks at the highest tolerable dose, constitute a sufficient trial for the evaluation of effect in body dysmorphic disorder.

Paroxetine Dose in the treatment of Generalized anxiety disorder:

• Immediate release:

  • Oral: Initial dose of 10 mg once day; dose may be increased to 50 mg once daily based on response and tolerance in increments of 10 mg/day spaced every one to two weeks.

Paroxetine Dose in the treatment of major unipolar depressive disorder:

• Immediate-release:

  • Oral: Initial dose of 20 mg once day; dose may be increased to a maximum of 50 mg/day based on response and tolerability in increments of 10 to 20 mg/day at intervals of 1 week.

• Extended-release:

  • Oral: Initial dose: 25 mg once daily; dose may be increased to a maximum of 62.5 mg per day based on response and tolerability in increments of 12.5 mg per day at intervals of about a week.

Paroxetine Dose in the treatment of Obsessive-compulsive disorder:

• Immediate release:

  • Oral: The starting dose is 20 mg once daily. Depending on response and tolerance, the dose may be increased in increments of 10 mg per day at intervals of more than 1 week, up to a suggested dose of 40 to 60 mg/day. The maximum dose is 60 mg per day.
• Note: A sufficient trial for evaluating the impact on obsessive-compulsive disorder

Paroxetine Dose in the treatment of Panic disorder:

• Immediate-release:

  • Oral: Initial dose is 10 mg once day for 3 to 7 days; based on response and tolerability, the dose may be increased in increments of 10 mg per day at intervals of 1 week up to a typical dose of 20 to 40 mg per day; the maximum dose is 60 mg/day.

• Extended-release:

  • Oral: Initial dose: 12.5 mg once daily; dose may be increased up to a maximum of 75 mg/day based on response and tolerability in increments of 12.5 mg per day at intervals of 1 week.

Paroxetine Dose in the treatment of Posttraumatic stress disorder:

• Immediate-release:

  • Oral: Initial dose of 20 mg once day; dose may be increased to 60 mg once daily based on response and tolerance in increments of 10 to 20 mg/day spaced every one to three weeks.

Paroxetine Dose in the treatment of Premature ejaculation (off-label):

• Immediate release:

  • Oral: Initial dose of 10 mg once daily; dose may be increased to the standard dosage of 20 mg once daily based on response and tolerability in increments of 10 mg/day at intervals of 1 week.
  • For the best result, some people may need up to 40 mg/day; some specialists advise using titration intervals of three to four weeks.

Paroxetine Dose in the treatment of Premenstrual dysphoric disorder:

• Note: Other than paroxetine, some specialists favour selective serotonin reuptake inhibitors (SSRIs) for this purpose.

• Continuous daily dosing regimen:

  • Immediate release (off-label):

    • Oral: Start with 10 mg once daily, then increase to the typical effective dose of 20 mg once daily over the course of the first month. For patients, an additional increase to 40 mg once daily may be necessary for the best response during a subsequent menstrual cycle.

  • Extended-release:

    • Oral: Initial dose of 12.5 mg once daily; increase to usual effective dose of 25 mg once daily over the course of the first month; in a subsequent menstrual cycle, a further increase to 50 mg/day (based on equivalent IR dose) may be necessary for some patients in order to achieve an optimal response.

• Intermittent regimens:

  • Luteal phase dosing regimen:

    • Immediate release (off-label):

      • Oral: For the first month, the usual effective dose of 10 mg once daily during the luteal phase of the menstrual cycle only (i.e., starting therapy 14 days before the anticipated start of menstruation and continuing until the onset of menses) may be increased; in a subsequent menstrual cycle, a further increase to 20 mg once daily during the luteal phase may be necessary for some patients for some conditions.

    • Extended-release:

      • Oral: Initial dose is 12.5 mg once daily only during the luteal phase of the menstrual cycle (i.e., starting therapy 14 days prior to the anticipated start of menstruation and continuing until the onset of menses); over the course of the first month, the dose may be increased to the typical effective dose of 25 mg once daily during the luteal phase; in a subsequent menstrual cycle, a further increase to 37.5 mg/day 

  • Symptom-onset dosing regimen (off-label):

    • Instant release: Oral: Initial: 10 mg once day from the day of symptom onset until a few days after the start of menses; during the course of the first month, the dose may be increased based on response and tolerability up to 20 mg/day; in rare cases, the dose may be discontinued entirely.

Paroxetine Dose in the treatment of Social anxiety disorder:

• Immediate-release:

  • Oral: Initial dose: 10 mg once daily; dose may be increased to a maximum of 60 mg per day based on response and tolerability in increments of 10 mg per day at intervals of 1 week.

• Extended-release:

  • Oral: Initial dose of 12.5 mg once day; dose may be increased to a maximum of 37.5 mg/day (manufacturer's labelling) based on response and tolerability in increments of 12.5 mg per day at intervals of 1 week.
  • Note: For the best result, some patients may need doses of up to 75 mg per day (based on the comparable IR dose).

Paroxetine dose as alternative agent in the treatment of Vasomotor symptoms of menopause:

• Note: When a patient is unable or unwilling to take oestrogen, there is a non-hormonal option.

•  Immediate release :

  • Capsule: Orally: 7.5 mg at bedtime each day.
  • Oral: 10 to 20 mg once day at bedtime; tablet (off-label).

• Extended-release (off-label):

  • 12.5 to 25 mg orally, one daily before night.

• Dosing conversions:

  • Immediate-release Extended-release 12.5 mg is similar to 10 mg.

• Discontinuation of therapy:

  • To lessen withdrawal symptoms and spot reemerging problems, lower the dose gradually when stopping antidepressant therapy after more than 21 days, for example over a period of 2 to 4 weeks.
  • The usage of a medication with a half-life of less than 24 hours (such as paroxetine or venlafaxine), a prior history of antidepressant withdrawal symptoms, or large doses of antidepressants are causes for a slower titration (for example, over 4 weeks).
  • Resuming the previously prescribed dose or reducing the dose more gradually are the two options to consider if unbearable withdrawal symptoms arise.

• Switching antidepressants:

  • There isn't much support for the best inter-converting antidepressant strategies, but they include direct switch and cross-titration (which gradually reduces the first antidepressant while gradually increasing the new antidepressant) (abruptly stopping the first antidepressant drug and then starting the new antidepressant at an equivalent dose or at lower dose and increasing it gradually).
  • Cross-titration is common for most switches but is not advised when moving to or from an MAOI (e.g., over 1 to 4 weeks depending on susceptibility to withdrawal symptoms and adverse effects).
  • When switching to a different medication in the same or similar class (for example, when switching between two SSRIs), when the antidepressant to be discontinued has been used for 1 week, or when the antidepressant is to be stopped suddenly, a direct changeover may be the best course of action.
  • Consider the likelihood of discontinuation symptoms, the possibility of medication interactions, additional antidepressant features (such as half-life, adverse effects, and pharmacodynamics), and the desired level of symptom management when deciding on the switch approach.

• Switching to or from an MAOI:

  • When starting paroxetine after stopping an MAOI, give yourself 14 days.
  • 14 days should pass between stopping paroxetine and starting an MAOI.

Paroxetine Dose in Children

Paroxetine dose in the treatment of Obsessive-compulsive disorder (OCD):

• Children and Adolescents 7 to 17 years:

  • Oral: The starting dose is 10 mg once day; the dose is increased by 10 mg every 7 to 14 days. The daily maximum is 60 mg.

Paroxetine Dose in the treatment of Social anxiety disorder:

• Children and Adolescents 8 to 17 years:

  • Oral: The starting dose is 10 mg once daily; the maximum daily dose is 50 mg per day. Titrate at intervals of at least 7 days.

• Discontinuation of therapy:

  • When stopping antidepressant therapy, lower the dosage gradually to reduce the likelihood of withdrawal symptoms and make it possible to spot any that reappear. There is little data to support appropriate taper rates.
  • According to APA and NICE recommendations, therapy should be tapered over at least a few weeks while taking the antidepressant's half-life into account; antidepressants having a shorter half-life may need to be tapered more gradually.
  • In addition to patients receiving long-term treatment, WFSBP guidelines suggest tapering over a period of 4 to 6 months.
  • If unpleasant withdrawal symptoms appear after a dose reduction, think about going back to the initial dosage or decreasing the dose more gradually.

Paroxetine use with an MAO inhibitor - recommendations:

• Switching to or from an MAO inhibitor intended to treat psychiatric disorders:

  • You should wait 14 days before starting paroxetine after stopping an MAO inhibitor used to treat psychiatric problems.
  • Paroxetine should be stopped 14 days before starting an MAO inhibitor used to treat psychiatric illnesses.

• Use with other MAO inhibitors (linezolid or IV methylene blue):

  • Consider alternate psychiatric treatments before starting paroxetine in patients receiving linezolid or IV methylene blue.
  • If a patient who is already getting paxil needs urgent therapy and the advantages outweigh the dangers, stop taking the paroxetine right away and start giving them linezolid or IV methylene blue.
  • For two weeks or until 24 hours after the final dosage of linezolid or IV methylene blue, whichever comes first, keep an eye out for serotonin syndrome.
  • 24 hours after the previous dose of linezolid, paroxetine may be taken again.

Pregnancy Risk Factor D/X

• Effects of Pregnancy Prilosec crosses the placenta.
• The use of paroxetine and other SSRIs during pregnancy may increase the risk of teratogenic consequences, including cardiovascular abnormalities. There is, however, little data available.
• The newborn may experience nonteratogenic effects from SSRI/SNRI late in the third trimester.
• These include respiratory distress, seizures, temperature instability and feeding difficulties, as well as hypoglycemia or hypotonia, hypo-, hypertonia, hyperreflexia and jitteriness.
• Symptoms could be caused by toxicity of SSRIs/SNRIs, or a discontinuation syndrome. This may also be consistent with serotonin syndrome that is associated with SSRI treatment.
• SSRIs have also been linked to persistent pulmonary hypertension in the newborn (PPHN).
• We don't know the long-term effects of in utero SSRIs on infant behavior and development.
• Some pharmacokinetic parameters for paroxetine could be affected by pregnancy-induced physiological changes
• The maternal CYP2D6 gene also has an impact on paroxetine plasma levels during pregnancy.
• If the benefits of treatment are not justified, discontinue paroxetine treatment or switch to an antidepressant. Women who plan to become pregnant should consider other options.
• ACOG recommends that treatment with SSRIs and SNRIs during pregnancy is individualized.
• Treatment of depression during pregnancy should include the clinical expertise of the mental healthcare provider, obstetrician and primary care provider.
• If at all possible, ACOG advises against paroxetine medication during pregnancy and advises having any foetuses who have been exposed to it in the first trimester of pregnancy assessed using foetal echocardiography.
• According to other recommendations, pregnant women should never be given paroxetine.
• The American Psychiatric Association advises weighing the hazards of drug use against those of alternative therapies.
• For pregnant women, paroxetine shouldn't be the first course of treatment.
• People who have stopped taking antidepressant medication during pregnancy or who are at high risk of postpartum depression can resume their medications after delivery.
• The ACOG and APA have developed treatment algorithms for women with depression before and during pregnancy.
• Paroxetine is not recommended for pregnant women because it does not treat menopausal vasomotor signs.

Use of paroxetine while breastfeeding

• Breast milk contains paroxetine.
• Paroxetine's relative infant dose (RID) is 5.6%. This was computed using the maximum amount of breast milk concentration and compared to a dose of 50 mg/day that was weight-adjusted for the mother.
• When the RID is less than 10%, breastfeeding is generally acceptable.
• Some sources mention that breastfeeding is only recommended if the RID for psychotropic drugs is less than 5%.
• When determining the RID for paroxetine, a milk content of 255.3ng/mL is used. Infants receive an estimated daily dose of 0.04 mg/kg/day from this.
• After giving the mother paroxetine at a dosage of 50 mg per day, this milk concentration was attained.
• Linear correlation exists between milk and maternal plasma concentrations.
• Some infants breastfed with paroxetine had serum levels that were detectable.
• Breastfed infants who were exposed to SSRIs, including paroxetine, have shown constant crying, insomnia, poor weight gain, restlessness, lethargy and lethargy.
• Mothers who use psychotropic medication should monitor their infants daily for any changes in sleep, feeding, behavior, or neurodevelopment.
• Pregnancy may be delayed if a mother uses an SSRI.
• If the product is to be administered to a nursing woman, it is recommended that caution be taken.
• An antidepressant medication can be started in a breastfeeding woman using paroxetine. However, if the lady requires ongoing therapy or wants to have another child, alternative treatments may be available.
• If there are no contraindications, women who have been successfully treated with paroxetine in pregnancy can continue to breastfeed if they have not had any other complications.

Paroxetine Dose in Kidney disease:

• CrCl 30 to 60 mL/minute:

  • The manufacturer of the medicine does not recommend changing the dosage, but the plasma concentration may be twice what is typical for normal function.

• Severe impairment (CrCl <30 mL/minute):

  • The average plasma concentration is almost four times that of normal function.

• Immediate-release:

  • Initial dose: 10 mg/day; dose increases up to a maximum of 40 mg/day if necessary in increments of 10 mg/day spaced at least a week apart.

• Extended-release:

  • Initial dose: 12.5 mg/day; dose increases by increments of 12.5 mg/day if necessary, spaced by at least 1 week; maximum dose: 50 mg/day.

Paroxetine Dose in Liver disease:

Note: In hepatic dysfunction, plasma concentration maybe 2 times that seen in normal function.

• Mild to moderate impairment:

  • There are no dosage adjustments provided in the drug manufacturer's labeling.

• Severe impairment:

  • Immediate-release:
    • Initial: 10 mg/day; increase if needed by 10 mg/day increments at intervals of at least 1 week;
    • The maximum dose: 40 mg/day.
  • Extended-release:
    • Initial: 12.5 mg/day; increase if needed by 12.5 mg/day increments at intervals of at least 1 week;
    • The maximum dose: 50 mg/day.

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Frequency varies by dose and indication. Adverse reactions reported as a composite of all indications.

Common Side Effects of Paroxetine:

• Central Nervous System:

  • Drowsiness
  • Insomnia
  • Headache
  • Dizziness

• Dermatologic:

  • Diaphoresis

• Endocrine & Metabolic:

  • Decreased Libido

• Gastrointestinal:

  • Nausea
  • Xerostomia
  • Constipation
  • Diarrhea

• Genitourinary:

  • Ejaculatory Disorder

• Neuromuscular & Skeletal:

  • Weakness
  • Tremor

Less Common Side Effects Of Paroxetine:

• Cardiovascular:

  • Vasodilation
  • Chest Pain
  • Palpitations
  • Hypertension
  • Tachycardia

• Central Nervous System:

  • Nervousness
  • Anxiety
  • Fatigue
  • Agitation
  • Paresthesia
  • Abnormal Dreams
  • Lack Of Concentration
  • Yawning
  • Depersonalization
  • Myoclonus
  • Amnesia
  • Chills
  • Emotional Lability
  • Vertigo
  • Confusion
  • Myasthenia

• Dermatologic:

  • Skin Rash
  • Pruritus

• Endocrine & Metabolic:

  • Weight Gain

• Gastrointestinal:

  • Decreased Appetite
  • Dyspepsia
  • Flatulence
  • Abdominal Pain
  • Nausea And Vomiting
  • Increased Appetite
  • Vomiting
  • Dysgeusia

• Genitourinary:

  • Male Genital Disease
  • Female Genital Tract Disease
  • Impotence
  • Orgasm Disturbance
  • Dysmenorrhea
  • Urinary Frequency
  • Urinary Tract Infection

• Infection:

  • Infection

• Neuromuscular & Skeletal:

  • Myalgia
  • Back Pain
  • Myopathy
  • Arthralgia

• Ophthalmic:

  • Blurred Vision
  • Visual Disturbance

• Otic:

  • Tinnitus

• Respiratory:

  • Dyspnea
  • Pharyngitis
  • Sinusitis
  • Rhinitis

Contraindications to Paroxetine:

• Use within 14 days of or simultaneously with MAOIs while treating psychiatric disorders.
• the start of patients' IV treatments with methylene blue or linezolid;
• Hypersensitivity to paroxetine and any ingredient in the formulation should be treated with pimozide and thioridazine together.
• Pregnancy

Warnings and precautions

• Akathisia

  • Paroxetine and other SSRIs have the potential to make users agitated or restless, which makes it difficult to sit still.

• Anticholinergic effects

  • Compared to cyclic antidepressants, less chance of sedation or anticholinergic effects. However, the SSRI groups are more likely to have adverse symptoms.

• Bleeding Risk:

  • Use of aspirin, NSAIDs or warfarin together with other anticoagulants may cause platelet aggregation to be impaired. This can increase the risk of bleeding.
  • Bleeding due to SSRI usage has been reported in a variety of situations, from minor bruising to epistaxis to life-threatening hemorhage.

• Depression in the CNS:

  • This can lead to central nervous system depression which may in turn affect mental or physical abilities.
  • Patients should be counseled when they are required to perform tasks such as operating machinery or driving.

• Fractures

  • Antidepressant treatment has been shown to be associated with bone fractures.
  • If an antidepressant-treated person experiences unresolved bone pain, tenderness, swelling or bruising, it is worth looking into the possibility of a fragility injury.

• Ocular effects

  • Mild pupillary dilatation may happen, and in individuals who are vulnerable, this could cause a brief episode of narrow-angle vision.
  • Patients who have narrow-angle glaucoma risk factors who have not undergone an irisectomy should be assessed.

• Serotonin syndrome

  • Serotonin syndrome (SS), which can be life-threatening, has been reported with serotonergic drugs (eg SSRIs, SNRIs), especially when combined with other serotonergic medications (eg triptans TCAs, fentanyls, lithium, tramadol and buspirone), or drugs that interfere in the metabolism of serotonin.
  • Pay attention to signs of SS in patients.
    • Mental status changes (eg: agitation, hallucinations and delirium, coma).
    • autonomic instability (eg tachycardia or labile blood pressure, diaphoresis)
    • Neuromuscular changes (eg, tremors, rigidity and myoclonus);
    • GI symptoms (eg nausea, vomiting, diarrhea)
    • Seizure
  • If you notice signs/symptoms of serotonin disorder, stop taking any serotonergic agents and discontinue all treatment immediately.

• Sexual dysfunction

  • This may lead to or exacerbate sexual dysfunction.

• SIADH and Hyponatremia

  • SIADH has been developed in association with SSRIs as well as SNRIs.
  • Hyponatremia is a rare condition, especially in elderly people.
  • Risk is likely to increase if volume depletion or concurrent use of diuretics occurs.

• Cardiovascular disease

  • Patients with heart disease should be cautious.
  • Patients with unstable heart disease or recent MI have not had their paroxetine systemically evaluated.

• Hepatic impairment

  • Patients with hepatic impairment should be cautious; plasma concentrations and clearance are decreased, so a lower dose may be necessary.

• Hypomania and mania:

  • This may lead to psychosis in some patients, or a shift towards mania or hypomania among patients with bipolar disorder.
  • Patients with bipolar disorder must be treated in a multi-disciplinary team. Patients with depressive symptoms need to be evaluated for bipolar disorder.
  • For the treatment of bipolar disorder, Paroxetine has not been approved by the FDA.

• Renal impairment

  • Patients with impaired renal function should be cautious. Plasma concentrations and clearance are decreased, so a lower dose may be necessary.

• Seizure disorder

  • Patients with a history of seizure disorders or conditions that predispose to seizures, such as brain damage or addiction, should be cautious.

Paroxetine: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy)
Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.)	May enhance the antiplatelet effect of other Agents with Antiplatelet Properties.
Ajmaline	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Ajmaline	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Ajmaline.
Amphetamines	Amphetamine serum concentrations may rise in the presence of strong CYP2D6 inhibitors.
Anticoagulants	The anticoagulant impact of anticoagulants may be strengthened by agents with antiplatelet properties. Exceptions: Heparin, Bemiparin, and Enoxaparin.
Antiemetics (5HT3 Antagonists)	Could make serotonin modulators' serotonergic effects stronger. Serotonin syndrome might occur from this.
Antipsychotic Agents	Serotonin modulators might make antipsychotic drugs more harmful or toxic. Serotonin modulators, in particular, may enhance dopamine blockade, potentially raising the risk for neuroleptic malignant syndrome. Serotonin modulators' serotonergic effects may be strengthened by antipsychotic drugs. Serotonin syndrome might occur from this.
Apixaban	Antiplatelet agents may intensify the toxic/unfavorable effects of apixaban. In particular, there may be an elevated risk of bleeding. Management: Carefully weigh the advantages and disadvantages of this pairing, and keep a tight eye on things.
Aprepitant	Aprepitant's serum levels may drop when PARoxetine is used. The serum concentration could be lowered using aprepitant.
Aspirin	Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of Aspirin.
Benzhydrocodone	CYP2D6 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of Benzhydrocodone.
Beta-Blockers	Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Beta-Blockers. Exceptions: Acebutolol; Atenolol; Betaxolol (Ophthalmic); Betaxolol (Systemic); Bisoprolol; Carteolol (Ophthalmic); Esmolol; Labetalol; Levobunolol; Metipranolol; Nadolol; Sotalol.
Blood Glucose Lowering Agents	Selective Serotonin Reuptake Inhibitors may enhance the hypoglycemic effect of Blood Glucose Lowering Agents.
Brexanolone	Selective Serotonin Reuptake Inhibitors may enhance the CNS depressant effect of Brexanolone.
BuPROPion	Could make PARoxetine's harmful or toxic effects worse. Serotonin syndrome and seizures in particular may be at higher risk.
Cephalothin	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased.
Cimetidine	May increase the serum concentration of PARoxetine.
Clarithromycin	May enhance the adverse/toxic effect of PARoxetine. Clarithromycin may enhance the QTc-prolonging effect of PARoxetine.
CloBAZam	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
CloZAPine	CYP2D6 Inhibitors (Strong) may increase the serum concentration of CloZAPine.
CNS Depressants	May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.
Cobicistat	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Collagenase (Systemic)	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and/or bleeding may be increased.
CYP2D6 Inhibitors (Moderate)	CYP2D6 substrate metabolism may be decreased (High risk with Inhibitors).
Cyproheptadine	May diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors.
Dabigatran Etexilate	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Dabigatran Etexilate. Agents with Antiplatelet Properties may increase the serum concentration of Dabigatran Etexilate. This mechanism applies specifically to clopidogrel. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling recommends avoiding prasugrel or ticagrelor.
Darunavir	May decrease the serum concentration of PARoxetine.
Dasatinib	May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Deoxycholic Acid	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased.
Desmopressin	Selective Serotonin Reuptake Inhibitors may enhance the adverse/toxic effect of Desmopressin.
Edoxaban	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased.
Fat Emulsion (Fish Oil Based)	Agents with poisonous or harmful effects may intensify their negative or hazardous effects.
Fesoterodine	The active metabolite(s) of fesoterodine may be present in higher serum quantities when taking CYP2D6 inhibitors.
Fosamprenavir	May lower the level of PARoxetine in the serum. It is most likely amprenavir, the active metabolite, that causes this effect.
Fosaprepitant	The active metabolite(s) of fosaprepitant's serum concentrations may be lowered by paroxetine. Fosaprepitant may lower the level of PARoxetine in the serum.
Galantamine	Galantamine's serum levels may rise in response to CYP2D6 Inhibitors (Strong).
Glucosamine	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
HYDROcodone	CYP2D6 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of HYDROcodone. Specifically, concentrations of hydromorphone may be decreased.
Ibritumomab Tiuxetan	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Both agents may contribute to impaired platelet function and an increased risk of bleeding.
Ibrutinib	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.
Imatinib	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Indoramin	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Indoramin.
Inotersen	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Ioflupane I 123	Selective Serotonin Reuptake Inhibitors may diminish the diagnostic effect of Ioflupane I 123.
Limaprost	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Lofexidine	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Lofexidine.
Lumefantrine	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Metaxalone	May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Methylphenidate	May enhance the adverse/toxic effect of Serotonin Modulators. Specifically, the risk of serotonin syndrome or serotonin toxicity may be increased.
Metoprolol	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Metoprolol.
MetyroSINE	May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors.
Multivitamins/Fluoride (with ADE)	Agents with antiplatelet properties may have an enhanced antiplatelet impact.
Multivitamins/Minerals (with ADEK, Folate, Iron)	Agents with antiplatelet properties may have an enhanced antiplatelet impact.
Multivitamins/Minerals (with AE, No Iron)	Agents with antiplatelet properties may have an enhanced antiplatelet impact.
Nebivolol	Nebivolol's serum levels may rise in response to CYP2D6 Inhibitors (Strong).
Nicergoline	The active metabolite(s) of nigroline may be present in higher serum quantities when CYP2D6 Inhibitors (Strong) are used. More specifically, levels of the MMDL metabolite may rise. The active metabolite(s) of nigroline may have lower serum concentrations when taken with CYP2D6 Inhibitors (Strong). More specifically, levels of the MDL metabolite may drop.
Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective)	Nonsteroidal Anti-Inflammatory Drugs may have a stronger antiplatelet impact when used with Selective Serotonin Reuptake Inhibitors (COX-2 Selective). Selective COX-2 anti-inflammatory drugs may lessen the therapeutic benefit of selective serotonin reuptake inhibitors.
Nonsteroidal Anti-Inflammatory Agents (Topical)	The antiplatelet action of selective serotonin reuptake inhibitors might be improved.
Obinutuzumab	Agents with antiplatelet properties may intensify Obinutuzumab's toxic/unfavorable effects. In particular, there may be an increased risk of life-threatening bleeding-related incidents.
Omega-3 Fatty Acids	Agents with antiplatelet properties may have an enhanced antiplatelet impact.
Opioid Agonists	Could make serotonin modulators' serotonergic effects stronger. Serotonin syndrome might occur from this.
Panobinostat	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Peginterferon Alfa-2b	May lower the serum level of CYP2D6 substrates (High risk with Inhibitors). The concentration of CYP2D6 Substrates in the serum may rise when using Peginterferon Alfa-2b (High risk with Inhibitors).
Pentosan Polysulfate Sodium	Agents with poisonous or harmful effects may intensify their negative or hazardous effects. In particular, the concurrent use of several drugs may raise the risk of bleeding.
Pentoxifylline	Agents with antiplatelet properties may have an enhanced antiplatelet impact.
Pravastatin	Could make PARoxetine's harmful or toxic effects worse. In particular, the combination may cause blood sugar levels to rise.
Propafenone	Propafenone's serum levels may rise in response to PARoxetine.
Prostacyclin Analogues	Agents with antiplatelet properties may have an enhanced antiplatelet impact.
QuiNINE	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Rivaroxaban	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Rivaroxaban. Management: Carefully consider risks and benefits of this combination and monitor closely; Canadian labeling recommends avoiding prasugrel or ticagrelor.
Salicylates	Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result.
Serotonin Modulators	May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Exceptions: Nicergoline; Tedizolid.
Tamsulosin	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Tamsulosin.
Tedizolid	May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Thiazide and Thiazide-Like Diuretics	Selective Serotonin Reuptake Inhibitors may enhance the hyponatremic effect of Thiazide and Thiazide-Like Diuretics.
Thrombolytic Agents	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents.
Thyroid Products	Selective Serotonin Reuptake Inhibitors may diminish the therapeutic effect of Thyroid Products. Thyroid product dose requirements may be increased.
Timolol (Ophthalmic)	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Timolol (Ophthalmic).
TraMADol	CYP2D6 Inhibitors (Strong) may diminish the therapeutic effect of TraMADol. CYP2D6 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of TraMADol. CYP2D6 Inhibitors (Strong) may increase the serum concentration of TraMADol.
TraMADol	Serotonin Modulators may enhance the adverse/toxic effect of TraMADol. The risk of seizures may be increased. TraMADol may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Tricyclic Antidepressants	Tricyclic antidepressants' serotonergic effects may be strengthened by paroxetine. Tricyclic Antidepressants' serum levels may rise when PARoxetine is used. Management: If these medications are combined, keep an eye out for elevated TCA concentrations and side effects, as well as signs and symptoms of serotonin syndrome and serotonin toxicity (such as hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, and changes in mental status).
Tropisetron	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Tropisetron.
Valbenazine	CYP2D6 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Valbenazine.
Vitamin E (Systemic)	May enhance the antiplatelet effect of Agents with Antiplatelet Properties.
Vitamin K Antagonists (eg, warfarin)	Selective Serotonin Reuptake Inhibitors may enhance the anticoagulant effect of Vitamin K Antagonists.
Risk Factor D (Consider therapy modification)
Abiraterone Acetate	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible. When concurrent use is not avoidable, monitor patients closely for signs/symptoms of toxicity.
Alcohol (Ethyl)	May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Management: Patients receiving selective serotonin reuptake inhibitors should be advised to avoid alcohol. Monitor for increased psychomotor impairment in patients who consume alcohol during treatment with selective serotonin reuptake inhibitors.
ARIPiprazole	The negative or toxic effects of ARIPiprazole may be exacerbated by PARoxetine. In particular, there may be an elevated risk of neuroleptic malignant syndrome. The serotonergic action of paroxetine may be enhanced by aripiprazole. Serotonin syndrome might occur from this. ARIPiprazole's serum levels may rise in response to paroxetine. Management: Aripiprazole dose adjustment is suggested, except when given adjunctively for depression. For detailed information, refer to the aripiprazole prescribing information or the entire interaction monograph.
ARIPiprazole Lauroxil	The blood concentrations of the active metabolite(s) of ARIPiprazole Lauroxil may rise in response to CYP2D6 Inhibitors (Strong). Management: For further information on the suggested dose modifications, please see the complete interaction monograph.
Asenapine	Asenapine's ability to extend QTc may be enhanced by paroxetine. The serum content of PARoxetine could rise as a result of asenapine.
Asunaprevir	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
AtoMOXetine	CYP2D6 Inhibitors (Strong) may increase the serum concentration of AtoMOXetine. Management: Initiate atomoxetine at a reduced dose (adult doses -- patients up to 70kg: 0.5mg/kg/day; patients 70kg or more: 40mg/day) in patients receiving a strong CYP2D6 inhibitor.
Bemiparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding.
Brexpiprazole	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Brexpiprazole. Management: Reduce brexpiprazole dose to 50% of usual with a strong CYP2D6 inhibitor, reduce to 25% of usual if used with both a strong CYP2D6 inhibitor and a CYP3A4 inhibitor; these recommendations do not apply if treating major depressive disorder.
BusPIRone	May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. Selective Serotonin Reuptake Inhibitors may decrease the metabolism of BusPIRone. Management: The combination of a selective serotonin reuptake inhibitor and buspirone should be undertaken with great caution. When combined treatment is clinically indicated, monitor closely for signs of serotonin toxicity/serotonin syndrome.
Codeine	CYP2D6 Inhibitors (Strong) may diminish the therapeutic effect of Codeine. These CYP2D6 inhibitors may prevent the metabolic conversion of codeine to its active metabolite morphine.
CYP2D6 Inhibitors (Strong)	May decrease the metabolism of CYP2D6 Substrates (High risk with Inhibitors).
CYP2D6 Substrates (High risk with Inhibitors)	CYP2D6 Inhibitors (Strong) may decrease the metabolism of CYP2D6 Substrates (High risk with Inhibitors). Exceptions: Ajmaline; Dapoxetine; Indoramin; Metoprolol; Tamoxifen; Timolol (Ophthalmic); Tropisetron.
Dacomitinib	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Avoid concurrent use of dacomitinib with CYP2D6 subtrates that have a narrow therapeutic index.
Deutetrabenazine	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Deutetrabenazine. Management: The total daily dose of deutetrabenazine should not exceed 36 mg, and the maximum single dose of deutetrabenazine should not exceed 18 mg with concurrent use of a strong CYP2D6 inhibitor.
Dextromethorphan	Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Dextromethorphan. Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Dextromethorphan. Management: Avoid the concurrent use of dextromethorphan and SSRIs, particularly fluoxetine and paroxetine, when possible. The risk for this interaction may persist for several weeks following discontinuation of fluoxetine or paroxetine.
DOXOrubicin (Conventional)	CYP2D6 Inhibitors (Strong) may increase the serum concentration of DOXOrubicin (Conventional). Management: Seek alternatives to strong CYP2D6 inhibitors in patients treated with doxorubicin whenever possible. One U.S. manufacturer (Pfizer Inc.) recommends that these combinations be avoided.
DULoxetine	May improve PARoxetine's serotonergic effects. Serotonin syndrome might occur from this. The serum levels of DULoxetine may rise in response to PARoxetine. Management: Use cautious when administering. If duloxetine and paroxetine are taken together, keep an eye out for any hazardous side effects of duloxetine as well as any indications of serotonin poisoning or the serotonin syndrome.
Eliglustat	Eliglustat's serum levels may rise in response to CYP2D6 Inhibitors (Strong). Management: Lower the daily dose of eliglustat to 84 mg. A strong CYP2D6 inhibitor and a moderate or strong CYP3A4 inhibitor should not be used together when taking eliglustat.
Enoxaparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue antiplatelet agents prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding.
Gilteritinib	May diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Avoid use of this combination if possible. If the combination cannot be avoided, monitor closely for evidence of reduced response to the selective serotonin reuptake inhibitor.
Heparin	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or agents with antiplatelet properties if coadministration is required.
Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)	May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Management: Avoid combination when possible. If used, monitor more closely for evidence of bleeding. Discontinue herbal products with anticoagulant or antiplatelet actions 2 weeks prior to surgical, dental, or invasive procedures.
Iloperidone	CYP2D6 Inhibitors (Strong) may increase serum concentrations of the active metabolite(s) of Iloperidone. Specifically, concentrations of the metabolite P88 may be increased. CYP2D6 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of Iloperidone. Specifically, concentrations of the metabolite P95 may be decreased. CYP2D6 Inhibitors (Strong) may increase the serum concentration of Iloperidone. Management: Reduce iloperidone dose by half when administered with a strong CYP2D6 inhibitor.
Linezolid	May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This could result in serotonin syndrome. Management: Consider alternatives to this combination whenever possible. If clinically acceptable, wait at least 2 weeks (5 weeks for fluoxetine) after SSRI discontinuation to initiate linezolid.
Linezolid	May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Management: Due to a risk of serotonin syndrome/serotonin toxicity, discontinue serotonin modulators 2 weeks prior to the administration of linezolid. If urgent initiation of linezolid is needed, discontinue serotonin modulators immediately and monitor closely.
Lithium	May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This could increase the risk of serotonin toxicity/serotonin syndrome. Management: This combination should be undertaken with great caution. When combined treatment is clinically indicated, monitor closely for signs of serotonin toxicity/serotonin syndrome.
Metoclopramide	May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Management: Seek alternatives to this combination when possible. Monitor patients receiving metoclopramide with selective serotonin reuptake inhibitors for signs of extrapyramidal symptoms, neuroleptic malignant syndrome, and serotonin syndrome.
Metoclopramide	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Metoclopramide. Management: Reduce metoclopramide dose to 5 mg 4 times daily (30 minutes before each meal and at bedtime) and limit the maximum daily dose to 20 mg if combined with strong CYP2D6 inhibitors.
Nonsteroidal Anti-Inflammatory Agents (Nonselective)	Selective Serotonin Reuptake Inhibitors may enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Consider alternatives to NSAIDs. Monitor for evidence of bleeding and diminished antidepressant effects. It is unclear whether COX-2selective NSAIDs reduce risk. Exceptions: Diclofenac (Topical); Ibuprofen (Topical); Piroxicam (Topical).
Perhexiline	CYP2D6 Inhibitors may increase the serum concentration of Perhexiline. Management: Consider alternatives to this combination if possible. If combined, monitor for increased perhexiline serum concentrations and toxicities (eg, hypoglycemia, neuropathy, liver dysfunction). Perhexiline dose reductions will likely be required.
Pitolisant	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Pitolisant. Management: Reduce the pitolisant dose by 50% if a strong CYP2D6 inhibitor is initiated. For patients receiving strong CYP2D6 inhibitors, initiate pitolisant at 8.9 mg once daily and increase after 7 days to a maximum of 17.8 mg once daily.
Primaquine	CYP2D6 Inhibitors (Strong) may diminish the therapeutic effect of Primaquine. Management: Monitor for signs and symptoms of possible treatment failure with primaquine in patients who are taking strong CYP2D6 inhibitors. If efficacy of primaquine is compromised, may consider adjusting therapies.
Serotonin Reuptake Inhibitor/Antagonists	Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Serotonin Reuptake Inhibitor/Antagonists. This may cause serotonin syndrome. Management: Consider alternatives, and use conservative initial dosing. Monitor patients receiving these combinations for signs/symptoms of serotonin toxicity.
Tetrabenazine	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Tetrabenazine. Specifically, concentrations of the active alpha- and beta-dihydrotetrabenazine metabolites may be increased. Management: Tetrabenazine adult dose should be reduced by 50% when starting a strong CYP2D6 inhibitor. Maximum tetrabenazine adult dose is 50 mg/day when used with a strong CYP2D6 inhibitor.
Vortioxetine	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Vortioxetine. Management: The vortioxetine dose should be reduced by 50% when used together with a strong CYP2D6 inhibitor. Following cessation of the strong CYP2D6 inhibitor, the vortioxetine dose should be returned to the normal level.
Risk Factor X (Avoid combination)
Bromopride	May enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors.
Dapoxetine	May enhance the adverse/toxic effect of Serotonin Modulators.
Dothiepin	Selective Serotonin Reuptake Inhibitors may increase the serum concentration of Dothiepin.
Mequitazine	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Mequitazine.
Methylene Blue	Selective Serotonin Reuptake Inhibitors may enhance the serotonergic effect of Methylene Blue. This could result in serotonin syndrome.
Methylene Blue	May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome.
Monoamine Oxidase Inhibitors	May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome. While methylene blue and linezolid are expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to monographs specific to those agents for details. Exceptions: Linezolid; Methylene Blue; Tedizolid.
Pimozide	Pimozide's negative or hazardous effects may be exacerbated by selective serotonin reuptake inhibitors. Management: When necessary, additional information on the medications listed as exceptions to this article can be found in separate monographs on drug interactions.
Pimozide	CYP2D6 Inhibitors (Strong) may increase the serum concentration of Pimozide.
Tamoxifen	CYP2D6 Inhibitors (Strong) may decrease serum concentrations of the active metabolite(s) of Tamoxifen. Specifically, strong CYP2D6 inhibitors may decrease the metabolic formation of highly potent active metabolites.
Thioridazine	CYP2D6 Inhibitors may increase the serum concentration of Thioridazine.
Tryptophan	May enhance the serotonergic effect of Selective Serotonin Reuptake Inhibitors. This may cause serotonin syndrome.
Urokinase	Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase.

Monitoring parameters:

• Liver and renal function tests 
• serum sodium
• CBC 
• suicidal ideation 

How to administer Paroxetine (Seroxat)?

• Oral: Can be given regardless of mealtime. If used for menopause-related vasomotor symptoms, administer preferably in the morning; otherwise, administer at bedtime.
• Film-coated ER or IR tablets should not be broken, chewed, or crushed.

Mechanism of action of Paroxetine (Seroxat):

• Paroxetine, a selective serotonin reuptake inhibitor, differs chemically from tricyclic, tripetracyclic, and other antidepressants in its mechanism of action.
• Serotonin synthesis may have been increased by the brain's suppression of serotonin metabolism at the brain synapse.

The onset of action:

• Depression:
  • The effects start within a week, although each person's response varies widely, and a full recovery may not be evident for 8 to 12 weeks after treatment begins;
• anti-obsessional and anti-panic effects:
  • Up to several weeks

Absorption:

• Following oral delivery, fully absorbed

Protein binding:

• 93% to 95%

Metabolism:

• Primary metabolites are created by oxidising and methylating the parent drug, followed by glucuronide/sulfate conjugation. Nonlinear pharmacokinetics (through 2D6 saturation) may be observed at higher doses and longer treatment durations. Extensively hepatic via CYP2D6 enzymes.
• Metabolites only retain 2% of the parent compound's effectiveness.
• In comparison to patients who are not aged, Cmin concentrations are 70% to 80% higher in the elderly, and clearance is similarly lowered.

Bioavailability:

• Equal bioavailability exists for oral suspension and immediate release tablets.

Half-life elimination:

• Paxil: 21 hours;
• Paxil CR: 15 to 20 hours;
• Pexeva: 33.2 hours

Time to peak:

• Capsules: Median: 6 hours (range: 3 to 8 hours)
• Immediate-release Tablets and oral suspension: Mean: 5.2 to 8.1 hours
• Controlled release Tablets: 6 to 10 hours

Excretion:

• Urine (64%, 2% as unchanged drug);
• feces (36% primarily via bile, <1% as unchanged drug)

International Brands of Paroxetine:

• Brisdelle
• Paxil
• Paxil CR
• Pexeva
• ACT PARoxetine
• AG-Paroxetine
• APO-PARoxetine
• Auro-PARoxetine
• BIO-PARoxetine
• DOMPARoxetine
• JAMP-PARoxetine
• M-Paroxetine
• Mar-PARoxetine
• MINT-Paroxetine
• MYLANPARoxetine
• NRA-Paroxetine
• NU-PARoxetine
• PARoxetine-10
• PARoxetine-20
• PARoxetine-30
• Paxil
• Paxil CR
• PMS-PARoxetine
• Priva-PARoxetine
• RIVA-PARoxetine
• SANDOZ PARoxetine
• TARO-PARoxetine
• TEVA-PARoxetine
• A-Xat CR
• Afentan
• Arapaxel
• Arketis
• Aropax
• Aropax 20
• Aroxat
• Dapagut
• Daparox
• Depanx
• Deprox
• Deroxat
• Divarius
• Ennos
• Euplix
• Extine
• Harotin 10
• Harotin 20
• Harotin 40
• Loxamine
• Melev
• Olane
• Oxat
• Paluxon
• Pari
• PARI CR
• Parmite
• Paroket
• Parolex
• Paroser
• Paroten
• Parotin
• Parox
• Paroxat
• Paroxil CR
• Paroxin
• Paxan
• Paxetil
• Paxetin
• Paxil
• Paxil CR
• Paxitab
• Paxtine
• Paxxet
• Rexsetin
• Roxet
• Seretran
• Seretran CR
• Seroxat
• Seroxat CR
• Seroxate
• Setine
• Sumiko
• Tagonis
• Tiarix
• Unirox
• Xalexa
• Xandol
• XET
• Xet 20
• Xetanor
• Xetine-P

Paroxetine Brand Names in Pakistan:

Paroxetine 20 mg Tablets
Aiz	Avital Pharma
Aptipar	Aptcure Private Limited
Aroxitin	Everest Pharmaceuticals
Depin	Selmore Agencies
Discerox	Crest Pharmaceuticals
Euopram	Healers Laboratories
Froxtin	Friends Pharma (Pvt) Ltd
Gerox	Glitz Pharma
Harmony	Wilsons Pharmaceuticals
Impika	Wilshire Laboratories (Pvt) Ltd.
Medoxetine	Medera Pharmaceuticals (Pvt) Ltd.
Merit	Xenon Pharmaceuticals (Pvt) Ltd.
Myroxit	Welmark Pharmaceuticals
Nubliss Dispersible	Crest Pharmaceuticals
Obexil	Popular Chemical Works (Pvt) Ltd.
Paraxyl	Consolidated Chemical Laboratories (Pvt) Ltd.
Parinom	Cellgene Pharmaceuticals International
Paromax	Genetics Pharmaceuticals
Parotin	Schazoo Zaka
Parotine	Mediate Pharmaceuticals (Pvt) Ltd
Parotine	Fassgen Pharmaceuticals
Parowin	Orta Labs. (Pvt) Ltd.
Paroxetol	Caraway Pharmaceuticals
Paroxin	Amarant Pharmaceuticals (Pvt)
Paroxin	Amarant Pharmaceuticals (Pvt)
Paroxin	Amarant Pharmaceuticals (Pvt)
Paroxit	Gray`S Pharmaceuticals
Paroxten	Medizan Labs (Pvt) Ltd
Paroxywin	Wns Field Pharmaceuticals
Partin	Alliance Pharmaceuticals (Pvt) Ltd.
Parxet	Bio Labs (Pvt) Ltd.
Parxet	Bio Labs (Pvt) Ltd.
Paxetin	Ferroza International Pharmaceuticals (Pvt) Ltd.
Paxil	Aries Pharmaceuticals (Pvt) Ltd
Peroxa	Organic Pharmaceuticals.
Peroxit	Libra Pharmaceuticals (Pvt) Ltd
Pexeva	Shrooq Pharmaceuticals
Pexot	Helix Pharma (Private) Limited
Pexta	Tg Pharma
Pexus	Nexus Pharma (Pvt) Ltd
Plasare	S.J. & G. Fazul Ellahie (Pvt) Ltd.
Poxet	Medisure Laboratories Pakistan (Pvt.) Ltd.
Progra	Gray`S Pharmaceuticals
Proxetol	Linear Pharma
Pyrotin	Olive Laboratories
Quixet	Albro Pharma
Relenza	Meditech Pharmaceuticals
Roxet	Medicure Laboratories
Rozitin	Pulse Pharmaceuticals
Scots Paroxetine	Scotmann Pharmaceuticals
Seroless	Pharma Health Pakistan (Pvt) Ltd
Seroxat	Glaxosmithkline
Smooth Tabs	Werrick Pharmaceuticals
Taxopar	Mass Pharma (Private) Limited
Twinks	Cherwel Pharmaceuticals (Pvt) Ltd
U-Saprox	Usawa Pharmaceuticals
Unexetin	Tg Pharma
Wixetine	Wilsons Pharmaceuticals
Xintin	Genera Pharmaceuticals
Zaprotin	Swan Pharmaceuticals(Pvt) Ltd

 

Paroxetine 25 mg Tablets
Appease Cr	Everest Pharmaceuticals
Deroxat Cr	Global Pharmaceuticals
Paroxin Cr	Amarant Pharmaceuticals (Pvt)
Raxil	Adamjee Pharmaceuticals (Pvt) Ltd.
Roxet Cr	Medicure Laboratories
Seroxat Cr	Glaxosmithkline
Zara	Shrooq Pharmaceuticals

 

Paroxetine 50 mg Tablets
Tretol	Friends Pharma (Pvt) Ltd

 

Paroxetine 12.5 mg Tablets
Deroxat Cr	Global Pharmaceuticals
Paraxyl Cr	Consolidated Chemical Laboratories (Pvt) Ltd.
Paroxin Cr	Amarant Pharmaceuticals (Pvt)
Pexeva Cr	Shrooq Pharmaceuticals
Raxil	Adamjee Pharmaceuticals (Pvt) Ltd.
Seroxat Cr	Glaxosmithkline

 

Paroxetine 37.5 mg Tablets
Deroxat Cr	Global Pharmaceuticals