Paroxetine Foods

The prototypical serotonin reuptake inhibitor (SRI) medication is the non-selective agent clomipramine, a tricyclic antidepressant (TCA). The Selective SRIs (SSRIs) include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and citalo-pram (Celexa). The Food and Drug Administration (FDA) approved clinical indications for these medications are described in Table 22.1. 

Clinically important, potentially hazardous interactions with amitriptyline, amoxapine, amphetamines, bupropion, citalopram, clomipramine, cyproheptadine, desipramine, dextroamphetamine, dextromethorphan, diethylpropion, dopamine, doxepin, entacapone, ephedrine, epinephrine, fluoxetine, fluvoxamine, imipramine, levodopa, mazindol, meperidine, methamphetamine, nefazodone, nortriptyline, paroxetine, phendimetrazine, phentermine, phenylephrine, phenylpropanolamine, pizotifen, protriptyline, pseudoephedrine, rizatriptan, sertraline, sibutramine, sumatriptan, sympathomimetics, tramadol, tricyclic antidepressants, trimipramine, tryptophan, tyramine-containing foods, venlafaxine, zolmitriptan... 

The antidepressants can be dosed once a day (see Table 69-7). The initial dose of venlafaxine extended-release is 75 mg once a day 37.5 mg can be used in some patients. The dose can be increased every 4 days up to a maximum of 225 mg once daily, although a dose-response relationship has not been established. Paroxetine is administered in a single daily dose (with or without food) of 20 mg. Doses greater than 20 mg/day have not been found to be more effective, but it can be increased by 10 mg/day every week. Escitalopram dosing begins with 10 mg daily. ... 

Dosing and Administration. SSRIs should be initiated at doses similar to those used for the treatment of depression and administered as a single daily dose with or without food (except for fluvoxamine). If the patient suffers from comorbid panic disorder, the SSRI dose should be started at one-fourth or one-half of the normal antidepressant dose. Patients should receive the starting dose for 2 to 4 weeks before it is increased slowly (i.e., paroxetine 10 mg/day and sertraline 50 mg/day) in weekly intervals as necessary to obtain a response. Safety for paroxetine in SAD was demonstrated in doses up to 60 mg/day, but additional therapeutic benefits above 20 mg/day were not shown. The maximum dosage of sertraline used in patients with SAD was 200 mg/day. ... 

The Food and Drug Administration (FDA) has approved five antidepressants for the management of OCD clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline. In adolescents with OCD, CBT is generally selected first for mild OCD, but CBT plus an SSRI (e.g., fluoxetine, fluvoxamine, sertraline, or paroxetine) are used for more severe OCD. In adults, CBT is the initial choice for mild OCD, and CBT plus an SSRI or an SSRI alone is selected for more severe OCD. Figure 70-2 is an algorithm for the treatment of OCD. 

Paroxetine appears to be slowly but well absorbed from the Gl tract following oral administration with an oral bioavailability of approximately 50%, suggesting first-pass metabolism (Table 21.8), reaching peak plasma concentrations in 2 to 8 hours. Food does not substantially affect the absorption of paroxetine. Paroxetine is distributed into breast milk. Approximately 80% of an oral dose of paroxetine is oxidized by CYP2D6 to a catechol intermediate, which is then either 0-methylated or 0-glucuronidated. These conjugates are then eliminated in the urine. 

Paroxetine (Paxil, Seroxat, Pexeva) is an SSRI that increases synaptic 5-HT levels in the treatment of depression. Approved by the Food and Drug Administration (FDA) in 1992, by 2006 there were nearly 20 million prescriptions. 

The manufacturers of sertindole contraindicate the concurrent use of cimetidine, diltiazem, erythromycin, itraconazole, ketoco-nazole, terfenadine and verapamil because of an increased risk of cardiac arrhythmias. Carbamazepine and phenytoin reduce plasma sertindole levels whereas fluoxetine and paroxetine increase them. No clinically relevant interactions occur with alprazolam, antacids, food or tobacco smoking. 

Paroxetine appears not to interact to a clinically important extent with aluminium hydroxide or food, although absorption may be reduced by large quantities of milk. Concurrent use of paroxetine and aprepitant may slightly reduce the plasma levels of both drugs, but this is probably not clinically significant. 

A study in healthy subjeets found that the absorption of paroxetine was not markedly changed by food. A 40% reduction in absorption was seen when paroxetine was taken with one litre of milk, but few people are likely to drink such a large amount regularly, and so this interaction is unlikely to... 

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