Paroxetine

Paroxetine

[1 tablet 20 cents]

ADMINISTRATION ROUTES:

  • PO, NG

ALTERNATIVE NAMES:

  • Aropax, Loxamine

ICU INDICATIONS:

  1. Antidepressant
  • Note: it is rare for antidepressants to be commenced in patients in the ICU. Most ICU patients have ‘situational depression’ and the risks of medication often outweigh the benefits. (see WARNINGS)

PRESENTATION AND ADMINISTRATION:

  • PO:
    Tablets:
    Aropax 20mg tablets (white), Loxamine 20mg tablets (white)
  • NG: Tablets can be crushed for administration via NG tube

DOSAGE:

  • PO:
    20mg-60mg daily

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose in renal impairment [GFR (ml/min)]
    <10: 20mg daily
    10-30: 20mg daily
    >30-50: 20mg daily
  • Dose in renal replacement therapy
    CAPD: 20mg daily
    HD: 20mg daily
    CVVHDF: dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • 0.4mg/kg daily, increase to maximum of 1mg/kg daily

CLINICAL PHARMACOLOGY:

  • Paroxetine is a serotonin specific reuptake inhibitor antidepressant

CONTRAINDICATIONS:

  1. hypersensitivity to paroxetine or other SSRIs

WARNINGS

  • Use in Patients With Concomitant Illness:
    Clinical experience with SSRIs in patients with concomitant systemic illness is limited. Caution is advisable in using SSRIs in patients with diseases or conditions that could affect metabolism or hemodynamic responses.
  • Suicidality:
    Patients with major depressive disorder (MDD), both adult and paediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behaviour (suicidality) or unusual changes in behaviour, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs.
  • Hyponatremia:
    Cases of hyponatremia (some with serum sodium lower than 110 mmol/L) have been reported. The hyponatremia appeared to be reversible when SSRI was discontinued.

PRECAUTIONS

  • General:
    Anaphylactoid events, including bronchospasm, angioedema, laryngospasm, and urticaria alone and in combination, have been reported. Pulmonary events, including inflammatory processes of varying histopathology and/or fibrosis, have been reported rarely. These events have occurred with dyspnea as the only preceding symptom.
    Published case reports have documented the occurrence of bleeding episodes in patients treated with psychotropic drugs that interfere with serotonin reuptake. Subsequent epidemiological studies, both of the case-control and cohort design, have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding.
  • Laboratory Tests:
    No tests in addition to routine ICU tests are required.
  • Drug/Laboratory Test Interactions:
    None noted.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • The combination of Tramadol and SSRIs should be used with caution due to the increased risk of serotonin syndrome with concomitant use. Patients on stable doses of phenytoin and carbamazepine have developed elevated plasma anticonvulsant concentrations and clinical anticonvulsant toxicity following initiation of concomitant fluoxetine treatment. Serotonin release by platelets plays an important role in haemostasis. Epidemiological studies of the case-control and cohort design that have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding have also shown that concurrent use of an NSAID or aspirin potentiated the risk of bleeding.

ADVERSE REACTIONS

  • Body as a Whole:
    Flu syndrome
  • Cardiovascular System:
    Vasodilatation
  • Digestive System:
    Nausea, diarrhoea, anorexia, dry mouth, dyspepsia
  • Nervous System:
    Insomnia, anxiety, nervousness, somnolence, tremor
  • Respiratory System: Pharyngitis, sinusitis
  • Skin and Appendages Sweating, rash

Critical Care Drug Manual

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