paroxetine hydrochloride Nursing Considerations & Management

Drug Name

Generic Name : paroxetine hydrochloride

Brand Name: Apo-Paroxetine (CAN), CO Paroxetine (CAN), Gen-Paroxetine (CAN), Novo-Paroxetine (CAN), Paxil, Paxil CR, Pexeva, ratio-Paroxetine (CAN)

Classification: Antidepressant

Pregnancy Category C

Dosage & Route

Available forms : Tablets—10, 20, 30, 40 mg; CR tablets, 12.5, 25, 37.5 mg; suspension—10 mg/5 mL

  • Depression: 20 mg/day PO as a single daily dose. Range, 20–50 mg/day. Or 25–62.5 mg/day CR tablet.
  • OCD: 20 mg/day PO as a single dose, may increase in 10-mg/day increments; do not exceed 60 mg/day.
  • Panic disorder: 10 mg/day, increase in increments of 10 mg/wk; usual range: 10–60 mg/day. Or 12.5–75 mg/day CR tablet; do not exceed 75 mg/day.
  • Social anxiety disorder: 20 mg/day PO as a single dose in the morning. Or, 12.5 mg/day PO CR form. May increase up to 60 mg/day or 37.5 mg/day CR form.
  • Generalized anxiety disorder: 20 mg/day PO as a single daily dose. Range, 20–50 mg/day.
  • PMDD: 12.5 mg/day PO as a single dose in the morning. Range, 12.5–25 mg/day. May be given daily or just during the luteal phase of the cycle.
  • PTSD: 20 mg/day as a single dose. Range, 20–50 mg/day PO.
  • Switching to or from an MAOI: At least 14 days should elapse between discontinuation of MAOI and initiation of paroxetine therapy; similarly, allow 14 days between discontinuing paroxetine and beginning MAOI.
  • Safety and efficacy not established.
  • 10 mg/day PO; do not exceed 40 mg/day. Or 12.5 mg/day CR tablets; do not exceed 50 mg/day.
Therapeutic actions
  • Paroxetine selectively inhibits the reuptake of serotonin. It has limited direct action at other neurotransmitter sites including muscarinic receptors.
  • Treatment of major depressive disorder
  • Treatment of OCD
  • Treatment of panic disorders
  • Treatment of social anxiety disorder (social phobia)
  • Treatment of generalized anxiety disorder
  • Treatment of posttraumatic stress disorder
  • Treatment of PMDD
  • Unlabeled uses: Treatment of diabetic neuropathy, headaches, hot flashes
Adverse effects
  • Somnolence, insomnia, headache, dizziness; decreased libido; nausea, xerostomia, constipation, diarrhoea; ejaculatory disturbances; weakness, tremor, diaphoresis; vasodilation, chest pain, palpitation, hypertension, tachycardia, nervousness, anxiety , agitation, abnormal dreams, impaired concentration, yawning, depersonalisation, amnesia, emotional lability, vertigo, confusion, chills; rash, pruritus; orgasmic disturbance, dysmenorrhoea; anorexia, decreased appetite, dyspepsia, flatulence, abdominal pain, appetite increased, vomiting, taste perversion, weight gain; impotence, genital disorder, urinary frequency, UTI; paresthesia, myalgia, back pain, myoclonus, myopathy, myasthenia, arthralgia; blurred vision, abnormal vision; tinnitus; respiratory disorder, pharyngitis, sinusitis, rhinitis; infection.
  • Use with or within 14 days of MAOIs; concurrent use with thioridazine or pimozide.
Nursing considerations
  • History: Hypersensitivity to paroxetine, renal or hepatic impairment, seizure disorder; pregnancy, lactation
  • Physical: Orientation, reflexes; P, BP, perfusion; R, adventitious sounds; bowel sounds, normal output; urinary output; liver evaluation; LFTs, renal function tests
  • BLACK BOX WARNING: Be alert for increased suicidality in children and adolescents.
  • Administer once a day in the morning.
  • Shake suspension well before using.
  • Ensure that patient swallows CR tablets whole; do not cut, crush, or chew.
  • Limit amount of drug given to potentially suicidal patients.
  • Abruptly discontinuing the drug may result in discontinuation symptoms (agitation, palpitations); consider tapering.
  • Advise patient to avoid using if pregnant or lactating.
Teaching points
  • Take this drug exactly as directed and as long as directed. Shake suspension well before using. Swallow controlled-release tablets whole; do not cut, crush, or chew.
  • Abruptly stopping the drug without tapering the dose may cause symptoms including agitation and palpitations.
  • This drug should not be taken during pregnancy or when nursing a baby; using barrier contraceptives is advised.
  • You may experience these side effects: Drowsiness, dizziness, tremor (use caution and avoid driving or performing other tasks that require alertness); GI upset (frequent small meals, frequent mouth care may help); alterations in sexual function.
  • Report severe nausea, vomiting; palpitations; blurred vision; excessive sweating; thoughts of suicide.