Indications and Dosage

Major Depression, Social Anxiety Disorder, Post-traumatic Stress Disorder, Generalized Anxiety Disorder

• • By Mouth (Adults): 20 mg daily, taken in the morning. No evidence of greater efficacy at higher doses; maximum dose 50 mg per day.
  • By Mouth (Elderly): Same as adults, with a maximum dose of 40 mg per day.

Obsessive-Compulsive Disorder

• • By Mouth (Adults): Start with 20 mg daily in the morning. Dose may be increased gradually in steps of 10 mg up to a maximum of 40 mg daily.
  • By Mouth (Elderly): Start with 20 mg daily. Increase gradually with the same steps, maximum dose 40 mg per day.

Panic Disorder

• • By Mouth (Adults): Initially 10 mg daily, taken in the morning. Increase in steps of 10 mg gradually up to a maximum of 40 mg daily.
  • By Mouth (Elderly): Start with 10 mg daily. Increase gradually in steps of 10 mg, maximum dose 40 mg per day.

Menopausal Symptoms in Women with Breast Cancer (Unlicensed Use)

• • By Mouth (Adults): 10 mg once daily. Not licensed for this indication but used clinically.

Special Considerations

• Cautions: Reduced absorption with achlorhydria or high gastric pH.
• Interactions: Refer to Appendix 1 for details on interactions with SSRIs.
• Side Effects:

• • Common/Very Common: Blurred vision.
  • Uncommon: Impaired diabetic control.
  • Rare/Very Rare: Acute glaucoma, hepatic disorders, peripheral edema.

Reproductive Health

• Pregnancy: Increased risk of congenital malformations, especially if used in the first trimester.
• Breastfeeding: Present in milk but considered too small to be harmful.

Impairments

• Hepatic: Dose adjustments are advised at the lower end of the dosing range.
• Renal: Use with caution if creatinine clearance is less than 30 mL/minute.

Treatment Cessation

• Withdrawal: High risk of withdrawal reactions. Preferably reduce the dose gradually over about 4 weeks, or longer if withdrawal symptoms emerge (up to 6 months for long-term maintenance treatment).

Patient and Carer Advice

• Driving and Skilled Tasks: Patients should be counseled about potential effects on driving and performing skilled tasks.

Medicinal Forms

Oral Suspension

• Available forms may vary depending on the manufacturer. Check labeling for specific advisory details.

Tablets

• Paroxetine (Non-proprietary):

• • Paroxetine Hydrochloride 10 mg Tablets
  • Paroxetine Hydrochloride 20 mg Tablets
  • Paroxetine Hydrochloride 30 mg Tablets
  • Paroxetine Hydrochloride 40 mg Tablets

• Seroxat (GlaxoSmithKline UK Ltd):

• • Paroxetine Hydrochloride 10 mg Tablets
  • Paroxetine Hydrochloride 20 mg Tablets
  • Paroxetine Hydrochloride 30 mg Tablets