Antidepressant Paxil

Paxil is an antidepressant, which belongs to the group of SRPIs (selective serotonin reuptake inhibitors).

It has a pronounced anti-anxiety and anxiolytic effect, it has a bicyclic structure, it distinguishes it from other common timoanaleptics. The thymoanaleptic effect is due to the fact that the active substance paroxetine is capable of selectively blocking the reuptake of serotonin, due to which its effect on the central nervous system greatly exceeds the effect of other antidepressants.

The drug is available in the form of tablets for oral administration. The active substance of the drug Paxil is paroxetine hydrochloride in an amount of 20 mg.

Clinical and pharmacological group

Antidepressant.

Pharmacy sales terms

It is released on prescription.

Prices

How much does Paxil cost in pharmacies? The average price in 2018 is at the level of 750 rubles.

Release form and composition

The dosage form of Paxil is a film-coated tablet containing:

  • 20 mg of paroxetine (in the form of hemihydrate hydrochloride);
  • Auxiliary components: 317.75 mg of calcium hydrophosphate dihydrate, 5.95 mg of sodium carboxymethyl starch (type A), 3.5 mg of magnesium stearate;
  • Shell composition: white opadry, including polysorbate 80, macrogol 400, titanium dioxide and hypromellose.

Paxil tablets are sold in 10 pcs. in a blister, 1, 3 or 10 blisters in a carton box.

Pharmacological effect

Paxil is included in the group of antidepressants. The mechanism of action of this medication is to suppress the reuptake of serotonin mediator neurons in the brain.

The main constituent component has a slight affinity for muscarinic-type cholinergic receptors; for this reason, the agent has slight anticholinergic effects. Due to the fact that Paxil has a cholinolytic effect, the main component causes a rapid reduction of anxiety states, eliminates insomnia, and has a weak initial result of activation. In rare cases, it can cause diarrhea and retching. But in connection with the fact that this drug has a cholinolytic effect, often during its reception there is a decrease in libido, there are constipation, increased body weight.

Paxil has a negligible effect on the seizure of norepinephrine, dopamine. In addition, it has antidepressant, thymoleptic, anxiolytic effects, also has a sedative effect.

Indications for use

Paxil is indicated for use in the treatment of various types of depressive states:

  • reactive depression;
  • severe depressions;
  • depression, accompanied by anxiety.

In addition, tablets can be used to identify the following conditions:

  • post-traumatic stress disorders;
  • generalized anxiety disorders - in this case, the drug can be used during prolonged maintenance and prophylactic treatment;
  • the drug is used both in the treatment and prevention of the development of obsessive-compulsive disorders;
  • treatment of panic disorders associated with agoraphobia: tablets can be used in the implementation of maintenance and prophylactic therapy; use of the drug helps to prevent the recurrence of panic disorders;
  • used to treat and prevent social phobias.

During the first few weeks of pill use, a decrease in symptoms of depressive states is observed, suicidal thoughts pass.

Contraindications

Taking Paxil tablets is contraindicated in several situations, which include:

  1. Individual intolerance to the active substance or auxiliary components of the drug.
  2. Combined use with thioridazine, which can lead to significant arrhythmias (arrhythmia and heart rate), which increases the risk of death.
  3. The combined use of tablets Paxil with MAO inhibitors (monoamine oxidase) and methylene blue - the drug should not be taken within 2 weeks after taking MAO inhibitors or using methylene blue.
  4. Children and adolescents under 18 years old - treatment of depression with Paxil pills in children and adolescents is ineffective, and there are no data on the safety of the drug for children under 7 years of age.

Before you start using Paxil tablets, you should make sure that there are no contraindications.

Use during pregnancy and lactation

During animal experiments, no negative effect of the drug on the growth and development of the fetus, as well as on the course of pregnancy and childbirth was detected.

However, clinical observations of women who took Paxil during the first trimester of pregnancy (up to the 12th week, inclusive) showed that the drug doubles the risk of developing congenital anomalies, such as ventricular and interatrial septal defects. In addition, in some newborns whose mothers took Paxil in the third trimester of pregnancy (from 26 to 40 weeks), complications were identified, such as:

  • hypoglycemia;
  • arterial hypertension;
  • hypotension;
  • enhanced reflexes;
  • distress syndrome;
  • cyanosis;
  • apnea;
  • convulsive seizures;
  • temperature instability;
  • feeding difficulties;
  • vomiting;
  • tremor;
  • shiver;
  • excitability;
  • irritability;
  • lethargy;
  • constant crying;
  • drowsiness.

These complications in children whose mothers took Paxil in the third trimester of pregnancy are found 4 to 5 times more often than the average in the population. Thus, taking into account all these facts, Paxil can be applied to women during pregnancy only if the intended benefits outweigh all possible risks. But it is better not to use the drug during pregnancy.

Paksil penetrates into breast milk, therefore, against the background of breastfeeding, the drug is also not recommended. At the time of therapy with Paxil, it is better to refuse breastfeeding and transfer the child to artificial formulas. In addition, Paxil reduces the quality of sperm in men, so the drug should not be conceived during the course of drug therapy. However, changes in sperm quality are reversible, and some time after Paxil is canceled, she returns to her normal state. Therefore, pregnancy should be planned some time after the cancellation of Paxil.

Dosage and method of use

The instructions for use indicate that Paxil is recommended to take 1 time / day in the morning during meals. The tablet should be swallowed whole, without chewing.

Obsessive compulsive disorder:

  • The recommended dose is 40 mg / day. Treatment begins with a dose of 20 mg / day, which can be increased weekly by 10 mg / day. If necessary, the dose can be increased to 60 mg / day. Adequate duration of therapy (several months or longer) must be observed.

Depression:

  • The recommended dose in adults is 20 mg / day. If necessary, depending on the therapeutic effect, the daily dose may be increased weekly by 10 mg / day to a maximum dose of 50 mg / day. As with treatment with any antidepressants, the effectiveness of therapy should be evaluated and, if necessary, the dose of paroxetine should be adjusted 2-3 weeks after the start of treatment and further depending on the clinical indications. To relieve depressive symptoms and prevent recurrence, it is necessary to observe adequate duration of stopping and supporting therapy. This period may be several months.

Social phobia:

  • The recommended dose is 20 mg / day. If necessary, the dose can be increased weekly at 10 mg / day, depending on the clinical effect, up to 50 mg / day.

Panic Disorder:

  • The recommended dose is 40 mg / day. Treatment of patients should begin with a dose of 10 mg / day and weekly increase the dose of 10 mg / day, focusing on the clinical effect. If necessary, the dose can be increased to 60 mg / day. A low initial dose is recommended to minimize the possible increase in symptoms of panic disorder, which may occur at the beginning of treatment with any antidepressants. It is necessary to observe adequate terms of therapy (several months and longer).

Posttraumatic stress disorder:

  • The recommended dose is 20 mg / day. If necessary, the dose can be increased weekly at 10 mg / day, depending on the clinical effect, up to 50 mg / day.

Generalized anxiety disorder:

  • The recommended dose is 20 mg / day. If necessary, the dose can be increased weekly at 10 mg / day, depending on the clinical effect, up to 50 mg / day.

Selected patient groups

In elderly patients, plasma concentrations of paroxetine may be increased, but the range of its plasma concentrations coincides with those in younger patients. In this category of patients, therapy should begin with the dose recommended for adults, which can be increased to 40 mg / day.

Plasma concentrations of paroxetine are increased in patients with severely impaired renal function (CC less than 30 ml / min) and in patients with impaired liver function. Such patients should be prescribed doses of the drug that are in the lower part of the range of therapeutic doses.

The use of paroxetine in children and adolescents (under 18) is contraindicated.

Drug withdrawal

As with other psychotropic drugs, the abrupt withdrawal of paroxetine should be avoided.

The following regimen can be recommended: a daily dose reduction of 10 mg per week; after reaching a dose of 20 mg / day, patients continue to take this dose for 1 week, and only after that the drug is canceled completely. If withdrawal symptoms develop during dose reduction or after discontinuation of the drug, it is advisable to resume taking the previously prescribed dose. Subsequently, the doctor may continue to reduce the dose, but more slowly.

Side effects

Reducing the frequency and intensity of individual side effects of paroxetine occurs as the treatment progresses, and therefore, they do not require abolition of the prescription. The frequency gradation is as follows:

  • very often (≥1 / 10);
  • often (≥1 / 100, <1/10);
  • sometimes happens (≥1 / 1000, <1/100);
  • rarely (≥1 / 10,000, <1/1000);
  • very rarely (<1/10 000), given individual cases.

Frequent and very frequent occurrence is determined on the basis of generalized data about the safety of the drug in more than 8 thousand patients. Clinical trials were conducted to calculate the difference in the incidence of side effects in the Paxil group and the second placebo group. The incidence of Paxil's rare or very rare side effects is determined on the basis of post-marketing information on the frequency of messages, and not on the true frequency of these effects.

Indicators of side effects stratified by organ and frequency:

  1. Endocrine system: very rarely - a violation of the secretion of ADH.
  2. Urinary system: urinary retention is rarely recorded.
  3. Respiratory organs, chest and mediastinum: “often” yawns were noted.
  4. Eyesight: exacerbation of glaucoma very rarely occurs, but "often" - blurred vision.
  5. Immune system: allergic reactions such as urticaria and angioedema are very rare.
  6. Reproductive system: very often - cases of sexual dysfunction; rarely, hyperprolactinemia and galactorrhea.
  7. Cardiovascular system: "rarely" sinus tachycardia was noted, as well as transient decrease or increase in blood pressure.
  8. Metabolism: "often" cases of loss of appetite, sometimes in elderly patients with impaired secretion of ADH - hyponatremia.
  9. Epidermis: often sweating; rare cases of skin rash and very rare photosensitivity reactions.
  10. Gastrointestinal tract: "very often" nausea is fixed; often - constipation or diarrhea with dry mouth; gastrointestinal bleedings are very rarely recorded.
  11. Blood and lymphatic system: rarely abnormal bleeding occurs (hemorrhage in the skin and mucous membranes). Very rarely, thrombocytopenia is possible.
  12. Hepatobiliary system: a rather "rare" there was an increase in the level of production of hepatic enzymes; very rare cases of hepatitis, accompanied by jaundice and / or liver failure.
  13. CNS: drowsiness or insomnia often occurs, seizures; rarely - clouding of consciousness, hallucinations, manic reactions as possible symptoms of the actual disease.
  14. Among the common disorders: asthenia is often fixed, and very rarely - peripheral edema.

An approximate list of symptoms that can occur after completing the course of paroxetine is established: "often" dizziness and other sensory disturbances, disturbances in sleep patterns, the presence of anxiety, headaches; sometimes - strong emotional arousal, nausea, tremor, sweating, as well as diarrhea. Most often, these symptoms in patients are mild and mild, pass without intervention.

There are no registered groups of patients who are at increased risk of side effects, but if there is no greater need for treatment with paroxetine, the dose is reduced smoothly until complete withdrawal.

Overdose

In case of Paxil overdose, it is possible to increase unwanted adverse reactions, as well as the development of fever, arterial pressure disorders, tachycardia, anxiety, involuntary muscle contraction. In most cases, the patient's well-being is normalized without serious complications.

Information about cases of coma and ECG changes was rarely received, and only a few cases of lethal outcomes. In most cases, such conditions were provoked by combining Paxil with alcoholic beverages or other psychotropic substances.

The therapy of overdose can be carried out in accordance with its manifestations, as well as instructions of the National Toxicological Center. The specific antidote is absent. Therapy includes general measures that are required in case of overdose with an antidepressant. In addition, the main physiological indicators of the body should be monitored and supportive treatment should be carried out.

Special instructions

In patients at a young age, especially during the treatment of major depressive disorders, taking Paxil may increase the risk of suicidal behavior.

The worsening of symptoms in depression and / or the appearance of suicidal thoughts and suicidal behavior can occur regardless of whether the patient is receiving antidepressants. The probability of their development is maintained until the onset of severe remission. Due to the fact that the improvement of the patients' condition, as a rule, occurs after a few weeks of taking Paxil, during this period they need to ensure close monitoring of the condition, especially at the beginning of the treatment course.

It should be borne in mind that in other mental disorders in which Paxil is indicated, there is also a high degree of risk of suicidal behavior.

In some cases, most often in the first few weeks of therapy, the use of the drug can lead to the appearance of akathisia (manifested in the form of internal anxiety and psychomotor agitation, when the patient cannot be at rest - to sit or stand).

Disorders such as agitation, akathisia, or mania can be manifestations of the underlying disease or develop as a side effect of Paxil.Therefore, in cases where the existing symptoms worsen, or when new ones develop, it is necessary to consult a specialist for advice.

Sometimes, most often during combined use with other serotonergic drugs and / or neuroleptics, it is possible that serotonin syndrome or symptoms that are similar to the malignant neuroleptic syndrome may develop. If symptoms such as autonomic disorders, myoclonus, hyperthermia, muscular rigidity, accompanied by rapid changes in the indices of vital functions, as well as changes in mental status, including confusion and irritability, appear, the treatment is canceled.

Major depressive episodes in some cases are the initial manifestation of bipolar disorders. It is believed that Paxil monotherapy may increase the likelihood of accelerated development of a manic / mixed episode in patients at risk for this condition. Before prescribing a drug to assess the risk of developing bipolar disorder, a thorough screening should be conducted, including a detailed psychiatric family history with data on cases of depression, suicide and bipolar disorder. Paxil is not intended for the treatment of a depressive episode within bipolar disorder. With care, it should be prescribed to patients with anamnestic data indicating the presence of mania. Also, the purpose of the drug requires caution against the background of epilepsy, angle-closure glaucoma, predisposing to bleeding diseases, including the use of substances / drugs that increase the likelihood of bleeding.

The development of withdrawal symptoms (in the form of suicidal thoughts and attempts, mood variability, nausea, tearfulness, nervousness, dizziness, pain in the abdomen) does not mean that Paxil is addictive or misused.

If convulsive seizures develop during treatment, Paxil is canceled.

Due to the existing risk of side effects on the part of the psyche and the nervous system, patients need to be especially careful when working with mechanisms and when driving vehicles.

Drug interactions

With the combined use of Paxil with some drugs, the following effects may be observed:

  • Pimozide: an increase in its blood level, prolongation of the QT interval (the combination is contraindicated, if necessary, careful use and careful monitoring of the condition are necessary);
  • Serotonergic agents (including fentanyl, L-tryptophan, tramadol, triptans, drugs SSRI, lithium and vegetable products containing Hypericum perforatum): the development of serotonin syndrome (with inhibitors of monoamine oxidase including antibiotic can be transformed into non-selective MAO inhibitor and linezolid is contraindicated) ;
  • Fosamprenavir / ritonavir: a significant decrease in the concentration of paroxetine in the blood plasma;
  • Enzymes and inhibitors involved in drug metabolism: changes in the metabolism and pharmacokinetics of paroxetine;
  • Drugs that are metabolized by the liver enzyme CYP2D6 (phenothiazine neuroleptics, tricyclic antidepressants, atomoxetine, risperidone, some class 1 C antiarrhythmic drugs): an increase in their concentration in plasma;
  • Procyclidine: an increase in its concentration in the blood plasma (if anticholinergic effects develop, the dose should be reduced).

The pharmacokinetics and absorption of Paxil are independent of food, digoxin, antacids, propranolol. Simultaneous use with alcohol is not recommended.

Paxil and alcohol

As a result of clinical studies, data were obtained that the absorption and pharmacokinetics of the active substance - paroxetine does not depend or almost does not depend (that is, dependence does not require changing doses) on diet and alcohol. It has not been established that paroxetine strengthens the negative effect of ethanol on the psychomotor, however, it is not recommended to take it along with alcohol, since it is mainly alcohol that inhibits the effect of the drug - reducing the effectiveness of treatment.

Reviews regarding alcohol use in the treatment of Paxil show that if you drink once, the metabolism of the drug drops sharply - without causing negative consequences, but if you drink regularly - on the contrary - it will speed up. Patients who have had a binge while having an overdose of Paxil usually either go to the hospital in serious condition or can be fatal.

Reviews

We picked up some reviews of people who used the drug Paxil:

  1. Marina. The use of Paxil was recommended to me by a psychotherapist during a stressful life situation, after an ineffective course of treatment with a magnesium drug. Saw one tablet per day for three weeks, but during this time the level of anxiety only increased, appeared insomnia, convulsive syndrome. After the cancellation, she took another drug that helped.
  2. Alina. I drink paksil 20 mg a day for 1 month. I did not notice any side effects at the beginning of the reception, except that there was a lump in my throat for a couple of days, which is probably psychosomatic. At the beginning of the reception, the general anxiety persisted, the doctor prescribed symptomatically half of atarax. Against the background of the Paxil admission, there is no euphoria, an even normal mood, all emotions are present, I can get angry and agitated before an important meeting, everything is absolutely like a normal balanced person, it is easier to concentrate on things, I sleep well. Sometimes I allow myself alcohol, a couple of glasses of wine or a bottle of beer, sometimes because I don’t feel like it, but if I have a holiday for someone, I can afford it, I don’t notice any side effects. As for the appetite, I didn’t have a very good reception, it’s getting worse now, but it doesn’t bother me, I eat a little and more because I need it, not because I want to, it doesn’t bother me at all, I even lost some weight. Paxil was prescribed for 6 months, now I have passed 1, the doctor said after 3 months we will try to reduce the dose. I'm afraid of canceling the syndrome, they write some horrors. But 10 years ago, I drank fluoxetine (Prozac), I did not have withdrawal syndrome.
  3. Tatyana. I am 31 years old, I have panic attacks since I was 18, and now with agoraphobia (chronic form!). I’m an alarmist in life, so it’s very difficult for me to cope with this ailment. For 13 years with me it was “probably” already everything that is connected with the PA with agoraphobia, to the extent that I did not leave the house, and even at home I was scared alone. In a word, it was hell! I started treatment many times, which I just didn’t drink, including Paxil. Now I have again started a long course of treatment, because after a lot of stress, all the horror began again. Paksil has drunk for 11 months, now she has switched to another drug. There were side effects, there was weight gain, but this is all tolerable, compared to the attack of PA. With Paksila, I got stuck, problem, but I still could. Many are afraid to drink it, I will say this, it means that you are not so “bad”. When a relapse or the first time you encounter this, it seems to me to spit on all the side effects, if only to pass (well, this is my opinion). Friends, this is a proven drug, maybe not for everyone, as for example, Selectra didn’t fit me — there was a strong allergy, as well as Elycea –– anxious state was maintained, and Paxil came up. Do not run, as I have to the chronic form, are being treated and God forbid you all recovery.

Analogs

With the same active ingredient the following drugs are available: Adepress, Aktaparoxetine, Apo-Paroxetine, Paroxetine, Plizil, Plizil N, Rexetin, Cyrestill.

Before using analogues consult your doctor.

Storage conditions and shelf life

Keep out of reach of children at temperature up to 30 ° C.

Shelf life - 3 years.

Watch the video: Dr. Jordan Rullo discusses antidepressants and sexual dysfunction (January 2020).

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