Paxil is an international nonproprietary name. Paxil antidepressant

Release form Paxil

Coated tablets

Packing Paxil

Pharmacological action Paxil

Paxil is an antidepressant. It selectively blocks the reuptake of serotonin, increases its concentration in the synaptic cleft and causes an antidepressant effect. It has a low affinity for muscarinic cholinergic receptors, for alpha-1, alpha-2, beta-adrenergic receptors, as well as 5-HT_1-like, 5-HT_2-like and histamine (H_1) receptors. It does not violate psychomotor functions and does not potentiate the inhibitory effect of ethanol on them. The antidepressant effect appears after 7-14 days of systematic use. Against the background of treatment, there is a decrease in anxiety, depression, normalization of sleep.

Paxil Indications

Depression of all types, including reactive depression, severe endogenous depression and depression accompanied by anxiety (the results of studies in which patients received the drug for 1 year show that it is effective in preventing relapse of depression).
- Treatment (including maintenance and preventive therapy) of obsessive-compulsive disorder (OCD) in adults, as well as in children and adolescents aged 7-17 years (it has been proven that the drug has been effective in the treatment of OCD for at least 1 year and prevention of OCD relapses).
- Treatment (including maintenance and preventive therapy) of panic disorder with and without agoraphobia (the effectiveness of the drug is maintained for 1 year, preventing relapse of panic disorder).
- Treatment (including maintenance and preventive therapy) of social phobia in adults, as well as in children and adolescents aged 8-17 years (the effectiveness of the drug is maintained when long-term treatment this disorder).
- Treatment (including maintenance and preventive therapy) of generalized anxiety disorder (the effectiveness of the drug is maintained during long-term treatment of this disorder, preventing relapse of this disorder).
- Treatment of post-traumatic stress disorder.

Contraindications Paxil

Simultaneous administration of MAO inhibitors and a period of 14 days after their withdrawal (MAO inhibitors cannot be prescribed within 14 days after the end of treatment with paroxetine).
- Simultaneous reception of thioridazine.
- Hypersensitivity to paroxetine and other components of the drug.

Use during pregnancy and lactation Paxil

AT experimental studies no teratogenic or embryotoxic effects of paroxetine were detected. Data from a small number of women who took paroxetine during pregnancy suggest no increased risk of congenital anomalies in newborns. There are reports of premature birth in women who received paroxetine during pregnancy, but a causal relationship with the drug has not been established. Paxil should not be used during pregnancy unless the potential benefit of treatment outweighs the possible risk associated with taking the drug.
It is necessary to monitor the health of newborns whose mothers took paroxetine for later dates pregnancy, since there are reports of complications in children (however, a causal relationship with taking the drug has not been established). Respiratory distress syndrome, cyanosis, apnea, convulsive seizures, temperature instability, feeding difficulties, vomiting, hypoglycemia, arterial hyper- or hypotension, hyperreflexia, tremor, irritability, lethargy, constant crying, drowsiness are described. In some reports, the symptoms have been described as neonatal manifestations of the withdrawal syndrome. In most cases, the described complications occurred immediately after childbirth or shortly after them (within 24 hours). Paroxetine is excreted in small amounts in breast milk. Therefore, the drug should not be used during lactation, unless the potential benefit of treatment outweighs the possible risk associated with taking the drug.

Dosage and administration of Paxil

Inside, in the morning - 20 mg. With insufficient effect, it is possible to increase the dose by 10 mg / day with an interval of at least 1 week (maximum dose - 50 mg / day). In elderly, malnourished patients, as well as in violation of the function of the kidneys and liver, the initial dose is 10 mg / day, the maximum is 40 mg / day.

Paxil side effects

Drowsiness or insomnia, tremor, nervousness, increased excitability of the central nervous system, impaired concentration, emotional lability, amnesia, dizziness, accommodation paresis, pupil dilation, eye pain, noise and pain in the ears, increase or decrease in blood pressure, fainting, tachycardia or bradycardia, violation of cardiac conduction and peripheral circulation, cough, rhinitis, dipnea, tachypnea, nausea, loss of appetite, dyspepsia, increased activity of hepatic transaminases, stomatitis, arthralgia, arthritis, dysuria, polyuria, urinary incontinence, urinary retention, amenorrhea, dysmenorrhea, miscarriage, mastitis , violation of ejaculation, decreased libido and potency, peripheral edema, decrease or increase in body weight, anemia, leukopenia, allergic reactions(itching, urticaria, chills). Rarely - thinking disorders, akinesia, ataxia, convulsions, hallucinations, hyperkinesia, manic or paranoid reactions, delirium, euphoria, grand mal seizures, aggressiveness, nystagmus, stupor, autism, decreased visual acuity, cataracts, conjunctivitis, glaucoma, exophthalmos, angina pectoris, myocardial infarction, disorders cerebral circulation, cardiac arrhythmias, eosinophilia, leukocytosis, lymphocytosis, monocytosis, hematuria, nephrourolithiasis, impaired renal function, dermatitis, erythema nodosum, depigmentation.

Special instructions Paxil

It should be taken with caution in renal and hepatic insufficiency, angle-closure glaucoma, prostatic hyperplasia, mania, cardiac pathology, epilepsy, convulsive conditions, in combination with electrical impulse therapy, in patients receiving drugs that increase the risk of bleeding, with risk factors for increased bleeding. During treatment, you must refrain from taking alcoholic beverages. Use with caution while driving Vehicle and people whose profession is associated with increased concentration of attention. With abrupt cancellation - dizziness, sensory disturbances, sleep disturbance, agitation, anxiety, nausea, sweating. Care should be taken when prescribing in combination with lithium preparations. At the time of treatment should refrain from drinking ethanol.

Paxil drug interactions

Inducers of microsomal oxidation (phenobarbital, phenytoin) reduce blood concentration and activity, inhibitors (cimetidine) - increase. Increases the level of procyclidine in plasma. Incompatible with MAO inhibitors. Co-administration with indirect anticoagulants can cause increased bleeding with an unchanged prothrombin time. Enhances the effect of alcohol.

Paxil overdose

Available information on paroxetine overdose suggests a wide range of safety.
Symptoms: amplification of the above side effects, vomiting, dilated pupils, fever, changes in blood pressure, involuntary muscle contractions, agitation, anxiety, tachycardia.
Patients usually do not develop serious complications even with a single dose of up to 2 g of paroxetine. In some cases, coma and EEG changes develop, and very rarely death occurs when paroxetine is combined with psychotropic drugs or alcohol.
Treatment: standard measures used for an overdose of antidepressants (gastric lavage through artificial vomiting, the appointment of 20-30 mg of activated charcoal every 4-6 hours during the first day after an overdose). The specific antidote is unknown. Supportive therapy and control of vital body functions are shown.

Paxil storage conditions

Store in a dry place at a temperature not exceeding 30°.

In an online pharmacy Paxil can be purchased with home delivery. The quality of all products in our online pharmacy, including Paxil, undergo quality control of goods by our trusted suppliers. You can buy Paxil on our website by clicking on the "Buy" button. We will be happy to deliver Paxil to you absolutely free of charge to any address within our delivery area.

Paxil - medicinal product, antidepressant action.

Release form and composition

Paxil is available in the form of film-coated tablets: white, oval-shaped, biconvex, engraved "20" on one side and with a break line on the other (10 pieces each in a PVC / aluminum foil or PVC / PVDC / aluminum foil; in a cardboard bundle 1, 3 or 10 blisters).

Composition of 1 tablet:

Active substance: paroxetine hydrochloride hemihydrate - 22.8 mg (corresponding to 20 mg of paroxetine base);
Additional components: magnesium stearate, sodium carboxymethyl starch type A, calcium hydrogen phosphate dihydrate;
Shell composition: polysorbate 80, macrogol 400, titanium dioxide, hypromellose.

Indications for use

Paxil is recommended for the treatment of depression of all types, including severe and reactive, as well as depression accompanied by anxiety. There is evidence confirming the good performance of the drug in cases of ineffectiveness of standard antidepressant therapy. The use of the product in the morning does not adversely affect the duration and quality of sleep. Within a few weeks of drug therapy, the symptoms of depression decrease, and the appearance of suicidal thoughts decreases. According to research results, the drug is also effective in preventing relapses of depression.

Paxil is also indicated for use in the treatment the following diseases(including as a means of preventive and maintenance therapy):

Obsessive-compulsive disorder (including relapse prevention);
Panic disorder with and without agoraphobia and relapse prevention (combination of CBT and paroxetine found to be significantly more effective than CBT alone)
social phobia;
Generalized anxiety disorder (including relapse prevention).

The tool is also used to treat post-traumatic stress disorder.

Contraindications

Simultaneous administration with monoamine oxidase inhibitors (MAOIs), as well as a period of 2 weeks after their withdrawal (MAO inhibitors are prohibited from taking for 2 weeks after completion of paroxetine therapy);
Simultaneous reception with thioridazine (because paroxetine increases the content of thioridazine in plasma, which can lead to a prolongation of the QT interval and the appearance of associated arrhythmia of the "pirouette" type, and sudden death);
Simultaneous reception with pimozide (due to possible prolongation of the QT interval);
Age up to 18 years (the effectiveness and safety of using the drug in children under 7 years of age have not been studied; in children and adolescents 7-18 years old, according to research results, the effectiveness of paroxetine has not been proven);
Hypersensitivity to the components of the drug.

In experimental studies on animals, the embryotoxic and teratogenic effects of Paxil have not been identified. However, in the course of recent epidemiological studies of pregnancy outcomes with the use of antidepressants in the first trimester, an increased risk of congenital anomalies has been established, in particular, of cardio-vascular system. As a result, before prescribing the remedy, it is necessary to consider the possibility of alternative therapy during pregnancy, and in women planning a pregnancy. Paroxetine should only be taken if the expected benefit outweighs the possible risk of complications.

Particular attention should be paid to the health status of those newborns whose mothers used paroxetine in late pregnancy, since there are reports of the development of complications in newborns. These effects include: seizures, apnea, cyanosis, respiratory distress syndrome, temperature instability, vomiting, feeding difficulties, hypotension, arterial hypertension, hypoglycemia, lethargy, irritability, nervous irritability, trembling, tremor, hyperreflexia, drowsiness and constant crying. In most cases, these reactions were observed almost immediately after childbirth or shortly after them.

Paxil penetrates into breast milk in small quantities, but, nevertheless, it is not recommended to use it during lactation.

Method of application and dosage

The drug should be taken 1 time per day during breakfast, without breaking or chewing, the tablet is swallowed whole.

Depression. The daily dose is 20 mg, in the absence of the desired effect, a weekly dose increase of 10 mg per day is possible. The maximum allowable daily dose should not exceed 50 mg. It is required to adjust the dose and evaluate the effectiveness of treatment 2-3 weeks after the start of the course, and in the future, depending on the clinical indications. To prevent relapse and to relieve symptoms of depression, it is necessary to observe an adequate duration of maintenance and relief therapy. The recommended course duration is up to several months;
Obsessive-compulsive disorder. The daily dose is 40 mg, at the beginning of therapy, take 20 mg per day. If necessary, the daily dose can be increased every week by 10 mg, but not more than 60 mg per day. The course can last several months or longer;
panic disorder. The recommended dose is 40 mg per day. The initial dose is 10 mg per day, in the absence of therapeutic effect the dose can be increased weekly by 10 mg to a maximum daily dose of 60 mg. A low initial dose is necessary to minimize the possible aggravation of the symptoms of panic disorder that occurs at the beginning of therapy. Duration of treatment from several months or more;
Social phobia, generalized anxiety disorder, post-traumatic stress disorder. The drug is taken at 20 mg per day. If necessary, taking into account clinical effect, the daily dose is increased every week by 10 mg to the maximum allowable 50 mg per day.

It is necessary to stop taking Paxil gradually, avoiding abrupt withdrawal, it is recommended to reduce the daily dose by 10 mg every week. After reaching a dose of 20 mg per day, it should be taken for 7 days, and only then completely stop taking it.

If withdrawal symptoms occur during the period of dose reduction or after discontinuation of therapy, it is advisable to resume the use of the drug at the previously prescribed dose and consult a specialist.

Patients with severe functional disorders kidneys and / or liver, the drug is prescribed in doses that are in the lower part of the therapeutic range.

Side effects

Hematopoietic system: infrequent - abnormal bleeding, mainly hemorrhage into the mucous membranes and skin (most often - bruising); very rare - thrombocytopenia;
Immune system: very rare - allergic reactions (angioneurotic edema, urticaria);
Endocrine system: extremely rare - syndrome of impaired secretion of antidiuretic hormone;
Metabolic and nutritional disorders: frequent - increased cholesterol levels, decreased appetite; rare - hyponatremia (mainly in elderly patients, possibly caused by a syndrome of impaired secretion of antidiuretic hormone);
Mental disorders: frequent - agitation, insomnia, drowsiness, unusual dreams (including nightmares); infrequent - hallucinations, confusion; rare - manic disorders (may be due to the disease itself);
Nervous system: frequent - headache, tremor, dizziness; infrequent - extrapyramidal disorders; rare - restless legs syndrome, akathisia, convulsions; very rare - serotonin syndrome, especially when combined with neuroleptics and / or other serotonergic drugs (may include tremor, tachycardia with trembling, myoclonus, hyperreflexia, hallucinations, increased sweating, confusion, agitation); the development of extrapyramidal symptoms (including orofacial dystonia) - in patients with impaired motor function or taking antipsychotics;
Organ of vision: frequent - blurred vision; infrequent - mydriasis; very rare - acute glaucoma;
Respiratory system: frequent - yawning;
Cardiovascular system: infrequent - postural hypotension, sinus tachycardia;
Digestive system: very common - nausea; frequent - dry mouth, vomiting, diarrhea, constipation; very rare - gastrointestinal bleeding;
Hepatobiliary disorders: rare - increased levels of liver enzymes; very rare - hepatitis, accompanied by liver failure and / or jaundice;
Skin and subcutaneous tissues: frequent - sweating; infrequent - skin rash; extremely rare - photosensitivity, erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome;
Urinary system: rare - urinary incontinence, urinary retention;
Reproductive system and mammary glands: very frequent - sexual dysfunction; rare - galactorrhea / hyperprolactinemia;
Others: frequent - weight gain, asthenia; extremely rare - peripheral edema;
Symptoms observed upon discontinuation of the drug (especially with abrupt withdrawal): frequent - headache, anxiety, sleep disturbances, sensory disturbances, dizziness; infrequent - diarrhea, sweating, confusion, tremor, nausea, agitation (in most patients, these effects are mild or moderate and disappear spontaneously).

During clinical trials in children, the appearance of the following adverse reactions: agitation, hyperkinesia, sweating, tremor, decreased appetite, hostility, mood swings, tearfulness, suicidal thoughts and attempts, and self-harm.

special instructions

During Paxil therapy in patients aged 18-24 years (especially in those suffering from depressive disorder) may increase the risk of suicidal behavior. The presence of this risk may be observed until a pronounced remission is achieved. As a result, in the first weeks of therapy until improvement is achieved, it is necessary to carefully monitor young patients for the timely detection of suicidality and clinical exacerbation.

Particular attention should also be given to individuals of any age with a history of suicidal attempts or suicidal thoughts. In the event of signs of clinical deterioration and / or suicidal thoughts / behavior (especially if they suddenly appear or are severe), it is recommended to reconsider the treatment regimen up to the withdrawal of the drug.

In the first weeks of therapy, there is a possibility of developing akathisia, manifested by psychomotor agitation and a feeling of inner restlessness.

In the presence of epilepsy, Paxil must be used with extreme caution; in the event of a convulsive seizure, it must be discontinued.

At the beginning of the course of treatment, the possible risk of bone fractures should be considered.

The drug can lead to the appearance of mydriasis, as a result, it must be taken with caution in angle-closure glaucoma.

The drug is not intended for the treatment of a depressive episode in the context of bipolar disorder. Before starting the course, a thorough screening (which includes data on the presence of bipolar disorder, depression and suicide in the family) is necessary to assess the risk of its occurrence in the patient.

Paxil should be used with extreme caution in patients with a history of mania, in combination with electrical impulse therapy, and in combination with drugs that increase the risk of bleeding, especially in patients with a predisposition to bleeding.

Paroxetine may affect the quality of seminal fluid, an effect that is reversible after discontinuation of the drug.

During the period of therapy, care must be taken when driving vehicles and other complex mechanisms.

drug interaction

Possible interaction reactions when paroxetine is combined with other drugs:

Lithium, fentanyl, selective serotonin reuptake inhibitors (SSRIs), tramadol, triptans, L-tryptophan - serotonin syndrome may occur;
Inhibitors of enzymes involved in the metabolism of drugs - it is possible to change the metabolism and pharmacokinetics of paroxetine;
Fosamprenavir and ritonavir - significantly reduces the level of paroxetine in the blood plasma;
Procyclidine - its concentration in blood plasma increases;
Metoprolol, some class 1 C antiarrhythmics (eg, flecainide and propafenone), atomoxetine, risperidone, phenothiazine antipsychotics (thioridazine and perphenazine), tricyclic antidepressants (desipramine, imipramine, nortriptyline, amitriptyline) - may increase the plasma concentration of these drugs (due to inhibition of paroxetine of the liver enzyme CYP2D6);
Sodium valproate, phenytoin, carbamazepine (anticonvulsants) - there is no change in their pharmacokinetics and pharmacodynamics in patients with epilepsy;
Tamoxifen - may reduce its effectiveness.

According to clinical studies, the pharmacokinetics and absorption of paroxetine are practically independent (i.e., no change in its dose is required) from propranolol, digoxin, antacids, ethanol and food. Although paroxetine does not increase the negative effect of alcohol on psychomotor functions, it is not recommended to take them at the same time.

Terms and conditions of storage

Store at a temperature not exceeding 30 ° C, out of the reach of children.

Shelf life - 3 years.

It is necessary to eliminate at the very first stage of their occurrence. You can get rid of them with the help of antidepressants.

These drugs include the drug Paxil (Paxil), which has a sedative effect and quickly restores the central nervous system, but this medicine has numerous contraindications and side effects and therefore must be used with extreme caution.

Release form and composition

it medicine It is produced in the form of tablets with a biconvex shape, which are placed in blisters of 10 pieces, which in turn are placed in a pack of cardboard base. One pack may contain one, three or nine blisters.

The composition includes:

active element- paroxetine hydrochloride hemihydrate in the amount of 22.8 milligrams;
additional components- calcium dihydrogen phosphate dihydrate, sodium carboxymethyl starch type A, magnesium;
stearin shell composition— Opadry white color YS - 1R - 7003 (macrogol 400, titanium dioxide, hypromellose, polysorbate 80).

Pharmacological properties

Paxil belongs to the group. The mechanism of action of this medication is to suppress the reuptake of the mediator serotonin by brain neurons.

The main component has a slight affinity for muscarinic-type cholinergic receptors, for this reason the agent has minor anticholinergic effects.

Due to the fact that Paxil has an anticholinergic effect, the main component causes a rapid reduction, eliminates insomnia, and has a weak initial activation result. In rare cases, it can cause diarrhea and vomiting.

But in connection with this, this drug has an anticholinergic effect, often during its administration there is a decrease in libido, constipation appears, and body weight increases.

Paxil has little effect on the uptake of norepinephrine, dopamine. In addition, it has an antidepressant, thymoleptic, anxiolytic effect, and also has a sedative effect.

Pharmacokinetics and pharmacodynamics

After oral administration, the active substance is absorbed and metabolized immediately during the first passage through the liver. Therefore, a small dose of proxetin enters the bloodstream than that absorbed in the gastrointestinal tract.

An increase in the dosage of the active component occurs due to a slight saturation of the metabolic pathway and a decrease in the clearance of plasma paroxetine. As a result, an uneven increase in the level of concentration occurs. It follows that the pharmacokinetic data are unstable and the kinetics are non-linear.

But the non-linearity of this agent is rather weak, it is mainly manifested in patients who take low dosages. An equilibrium reaction in the structure of the blood plasma during the use of this drug occurs only after 7-14 days of use.

The active substance Paxil is distributed mainly through the tissues. According to pharmacokinetic data, about 1% of the main element can remain in the blood. At therapeutic-type concentrations, up to 95% of paroxetine in plasma may be protein-bound.

The half-life is from 16 to 24 hours. About 64% is excreted in the urine as metabolites, about 2% unchanged, the rest along with stool in the form of metabolites and 1% unchanged.

When to apply and when to refuse

According to the instructions, Paxil should be used for the following indications:

depression with varying degrees severity, as well as their relapses;
at various;
for elimination ;
with social phobias;
with a post-traumatic nature;
at .

adolescents and children under 18;
women during pregnancy;
during breastfeeding;
if there is an individual intolerance to the constituent components;
allergic reactions to the medicine;
if patients are taking medicines such as Nialamide, Selegiline and Thioridazine.

How to take the drug

The pills are taken by oral route, during the reception they are swallowed as a whole. When taking, do not break the tablets, grind in the form of a powder or chew. To facilitate swallowing, drink a small amount of water. One tablet is taken per day. It should be taken in the morning during breakfast.

In depression, you need to take 20 mg per day. If suddenly required, then the dosage level can be increased by 10 mg, but the highest dose should not exceed 50 mg. Changes in dosage should be made at least 14-21 days after the start of use.

The dosage during an obsessive-compulsive type disorder should be 40 mg per 24 hours. The initial dose level is 20 mg per day, then every 7 days it is added by 10 mg. The highest dose in 24 hours should not exceed 60 mg.

For panic disorders in adults, the dose per 24 hours should be 40 mg. The dosage should be 10 mg per day at the beginning of the intake and slowly increase by 10 mg every 7 days. The highest dosage level should not exceed 60 mg per 24 hours.

With social phobias, generalized anxiety disorders ah, it is recommended to take 20 mg of the drug per day. It starts with 10 mg per day and gradually increases the dose by 10 mg every 7 days. The maximum dose per day should not exceed 50 mg.

Taking the drug during pregnancy and lactation

The use of the drug during pregnancy is contraindicated, especially in the late

term. There have been cases when mothers who took Paxil in the last term had children with such disorders as apnea, convulsions, cyanosis, irritability, unstable temperature, and pressure.

Taking the medicine during breastfeeding is not recommended, because the constituent components enter the milk.

Side effects and overdose

During the use of Paxil tablets, the following side effects may occur:

Paxil withdrawal syndrome is manifested by the following unpleasant symptoms:

dizziness;
the occurrence of hyperhidrosis;
the appearance of nausea;
occurrence of anxiety.

These symptoms go away on their own over time. But it is still recommended to do the withdrawal of the medication smoothly, gradually reducing the dose to a minimum.

When taking an overdose, the following overdose symptoms may appear:

gagging;
the occurrence of dilated pupils;
the appearance of fever;
state of anxiety;
change blood pressure- increase or decrease;
the occurrence of involuntary muscle contractions;
the appearance of agitation;
state of tachycardia.

If this symptom occurs, gastric lavage is performed, the patient is given Activated carbon 20-30 mg every 4-6 hours during the day. This is followed by maintenance therapy.

From the practice of application

Review of the doctor and reviews of patients who have experienced the action of Paxil on themselves.

Paxil is an antidepressant that has thymoleptic, anxiolytic and sedative effects. Its use allows you to restore the state nervous system. This medicine eliminates various mental disorders - depression, social phobias, post-traumatic stress disorders, anxiety, fears.

It should be taken according to the instructions and not more than the recommended dosage. It is worth remembering that a single dose should not exceed 50-60 mg, otherwise side effects. It is better to consult a doctor before taking this drug, he will be able to determine the violation and prescribe dosages.

psychiatrist

When I had a big trouble, namely, I broke up with my soulmate, I just fell into depression. Not at that moment I just did not want to live. Since I had few friends, I had no one to discuss it with and my condition only worsened.

As a result, I had to turn to a psychotherapist. The doctor examined me and prescribed me to take Paxil. I took it for a long time, but stubbornly. After 3 months of use, I felt much better, everything negative thoughts passed, there was a desire to live!

Lyudmila, 28 years old

After the death of my mother, I was very sick! She was the closest and dearest person to me and then she was gone. At the same time, no one could help me at that time, neither the children, nor the husband. As a result, I fell into a depression, from which I could not get out on my own. My husband took me to a psychiatrist.

After the examination, Paxil was prescribed to me. I took it for six months. As a result, I felt better, I began to enjoy life.

Oksana, 35 years old

Issue price

The price of a package of Paxil No. 10 is about 650-700 rubles, package No. 30 costs about 1700-1800 rubles, analogues of the product are also available for purchase:

Paxil is an antidepressant that selectively reduces the neuronal reuptake of 5-hydroxytryptamine.

It has an impact on the pathogenetic link in the occurrence of a depressive state, removes the lack of serotonin deficiency in the synapses of brain neurons. Paxil has weak anticholinergic properties due to the slight similarity of the active substance of the drug with muscarinic cholinergic receptors.

In this article, we will look at why doctors prescribe Paxil, including instructions for use, analogues and prices for this drug in pharmacies. Real REVIEWS of people who have already used Paxil can be read in the comments.

Composition and form of release

Dosage form Paxil - film-coated tablets containing:

20 mg paroxetine (as hemihydrate hydrochloride);
auxiliary components: 317.75 mg of calcium hydrogen phosphate dihydrate, 5.95 mg of sodium carboxymethyl starch (type A), 3.5 mg of magnesium stearate;

Clinico-pharmacological group: antidepressant.

What helps Paxil?

According to the instructions for Paxil, the drug is used in such situations:

Panic disorder with and without agoraphobia;
obsessive-compulsive disorder (OCD);
Generalized anxiety disorders;
social phobia;
Post-traumatic stress disorder.

Also used for depression of all types, including severe and reactive depression, incl. depression accompanied by anxiety.

pharmachologic effect

The main active ingredient of Paxil paroxetine tablets selectively (selectively) inhibits the reuptake of 5-hydroxytryptamine (serotonin) in the structures of the cerebral cortex.

Through this mechanism, the drug reduces panic fear a person, depression (prolonged depression of mood) with obsessive-compulsive disorder (OCD) and panic disorder. Paroxetine does not affect the functional activity of the cerebral cortex, and also does not enhance the inhibitory effect of ethanol.

In healthy individuals, Paxil tablets after administration do not cause changes in the indicators of the functional activity of the cardiovascular system (level of systemic arterial pressure, heart rate and electrocardiogram indicators).

Instructions for use

According to the instructions for use, Paroxetine is recommended to be taken 1 time / day in the morning with meals. The tablet should be swallowed whole without chewing.

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 any antidepressant treatment, 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 thereafter depending on clinical indications. To stop depressive symptoms and prevent relapses, it is necessary to observe an adequate duration of stopping and maintenance therapy. This period may be several months.
With obsessive-compulsive and panic disorder, the optimal therapeutic dosage of Paxil for adults is 40 mg per day, and the maximum allowable is 60 mg. However, the drug is started with 20 mg per day, bringing the daily dosage to 40 mg, adding 10 mg every week for this. For example, in the first week they take 20 mg (1 tablet) of Paxil, in the second - 30 mg (1.5 tablets), and from the third week and during the entire subsequent course of therapy they drink 40 mg (2 tablets) per day. If within two weeks the person's condition does not improve, then the dosage of Paxil can be increased to 60 mg (3 tablets) per day, adding 10 mg every week.
Panic disorder - the initial dosage is 10 mg, as needed over several weeks, it can be gradually increased to 40 mg. The maximum daily dose should not exceed 60 mg. Adequate duration of therapy should not be less than several months.
Social phobias: for adults 20 mg per day, if necessary, the dose is increased every week by 10 mg per day up to 50 mg per day. Treatment of children aged 7 to 17 years is prescribed with a dose of 10 mg per day and then a weekly increase by 10 mg per day, the maximum allowable daily dose is 50 mg per day.
Generalized anxiety disorder and post-traumatic stress syndrome - the initial dosage is 10 mg, the average therapeutic dose is 20 mg, it can be increased to 50 mg.

After the end of therapy, in order to reduce the likelihood of a withdrawal syndrome, the dose of the drug should be reduced in stages to reach 20 mg - 10 mg per week. Paxil can be completely canceled after 7 days. If withdrawal symptoms occur when the dose is reduced or after discontinuation of the drug, it is advisable to resume therapy at the previously prescribed dose, and then reduce the dose more slowly.

Elderly patients should begin therapy at the recommended starting dose, which can be gradually increased to 40 mg per day. Patients with severe renal impairment (creatinine clearance - less than 30 ml per minute) should be given reduced doses (in the lower part of the therapeutic range).

Contraindications

Paxil is contraindicated for:

Patients under 18;
During lactation;
Patients receiving treatment with MAO inhibitors, pimozide, tryptophan, thioridazine;
With hypersensitivity to paroxetine, excipients of the drug.

The decision on the possibility of Paxil therapy for a pregnant woman is made by the attending physician. Paxil is not prescribed to pregnant women in the later stages, since complications in the form of distress syndrome, apnea, convulsive reactions, cyanosis, vomiting, irritability, drowsiness, tremors, temperature instability, pressure were observed in newborns, while taking Paxil by mothers.

Adverse reactions

Paxil can cause disorders of the immune, endocrine, cardiovascular, digestive, reproductive, respiratory system, as well as mental disorders, metabolic disorders.

The most commonly reported were blurred vision, headache, yawning, tremors, dizziness, drowsiness, agitation, sleep disturbances, decreased appetite, nausea, stool disorders, dry mouth, sweating, sexual dysfunction, asthenia, and weight gain.
When Paxil treatment was stopped, the most common complaints were dizziness, sensory disturbances, anxiety, headache, and sleep disturbances.

Paxil's analogs

Structural analogues for the active substance:

Adepress;
Actaparoxetine;
Apo Paroxetine;
paroxetine;
Pleased;
Rexetin;
Sirestill.

Attention: the use of analogues must be agreed with the attending physician.

Paxil is an antidepressant that belongs to the group of SSRIs (Selective Serotonin Reuptake Inhibitors).

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

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

Clinical and pharmacological group

Antidepressant.

Terms of dispensing from pharmacies

Released by 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

Dosage form Paxil - film-coated tablets containing:

20 mg paroxetine (as hemihydrate hydrochloride);
Auxiliary components: 317.75 mg of calcium hydrogen phosphate 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 cardboard box.

Pharmacological effect

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

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

Paxil has little effect on the uptake of norepinephrine, dopamine. In addition, it has an antidepressant, thymoleptic, anxiolytic effect, and also has a sedative effect.

Indications for use

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

reactive depression;
severe depression;
depression accompanied by anxiety.

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

post-traumatic stress disorder;
generalized anxiety disorders - in this case, the drug can be used during long-term maintenance and preventive treatment;
the drug is used both in the treatment and prevention of the development of obsessive-compulsive disorders;
treatment of panic disorders accompanied by agoraphobia: tablets can be used during maintenance as well as preventive therapy; the use of the drug helps to prevent recurrence of panic disorders;
used to treat and prevent social phobias.

During the first few weeks of using the tablets, there is a decrease in the symptoms of depressive states, suicidal thoughts disappear.

Contraindications

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

Individual intolerance active substance or auxiliary components of the drug.
Concomitant use with thioridazine, which can lead to significant arrhythmia (rhythm and heart rate disturbances), which increases the risk of death.
Combined use of Paxil tablets 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.
Children's and adolescence under 18 years of age - treatment of depression with Paxil tablets in children and adolescents is ineffective, there is currently 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 experiments on animals, no negative effects of the drug on the growth and development of the fetus, as well as on the course of pregnancy and childbirth, were revealed.

However, clinical observations of women taking Paxil during the first trimester of pregnancy (up to and including the 12th week) showed that the drug doubles the risk of developing congenital anomalies, such as ventricular and atrial septal defects. In addition, some newborns whose mothers took Paxil during the third trimester of pregnancy (weeks 26 to 40) have experienced complications such as:

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

These complications in children whose mothers took Paxil in the third trimester of pregnancy occur 4 to 5 times more often than the average in the population. Thus, given all these facts, women during pregnancy can use Paxil only if the intended benefit outweighs all possible risks. But it is better not to use the drug during pregnancy.

Paxil passes into breast milk, so it is also not recommended to use the drug during breastfeeding. At the time of therapy with Paxil, it is better to stop breastfeeding and transfer the child to artificial mixtures. In addition, Paxil reduces the quality of sperm in men, therefore, against the background of drug therapy, you should not plan to conceive a child. However, changes in the quality of sperm are reversible, and some time after Paxil is canceled, it returns to its normal state again. Therefore, pregnancy should be planned some time after the cancellation of Paxil.

Dosage and method of application

The instructions for use indicate that Paxil is recommended to be taken 1 time / day in the morning with 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. It is necessary to observe an adequate duration of therapy (several months or longer).

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 any antidepressant treatment, 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 thereafter depending on clinical indications. To stop depressive symptoms and prevent relapses, it is necessary to observe an adequate duration of stopping and maintenance therapy. This period may be several months.

The recommended dose is 40 mg/day. Patients should be treated at a dose of 10 mg/day and increased weekly by 10 mg/day based on clinical response. If necessary, the dose can be increased to 60 mg / day. A low initial dose is recommended to minimize the possible increase in panic disorder symptoms that may occur at the start of treatment with any antidepressant. It is necessary to observe adequate terms of therapy (several months and longer).

Post Traumatic Stress Disorder:

Generalized Anxiety Disorder:

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

Separate groups of patients

In elderly patients, plasma concentrations of paroxetine may be increased, but the range of its plasma concentrations is similar to that 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 paroxetine concentrations are elevated in patients with severe violation kidney 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 therapeutic dose range.

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

Cancellation of the drug

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

The following withdrawal regimen may be recommended: reduce the daily dose by 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 completely canceled. 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

A decrease in the frequency and intensity of individual side effects of paroxetine occurs as the course of treatment progresses, therefore, do not require discontinuation of the appointment. 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), учитывая отдельные случаи.

Frequent and very frequent occurrence is determined on the basis of generalized data on 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 rare or very rare side effects of Paxil is based on post-marketing information on the frequency of reports, and not the true frequency of these effects.

Side effect rates are stratified by organ and frequency:

Endocrine system: very rarely - a violation of the secretion of ADH.
Urinary system: Urinary retention was rarely recorded.
Respiratory organs, chest and mediastinum: "often" yawning was noted.
Vision: very rarely there is an exacerbation of glaucoma, but "often" - blurred vision.
Immune system: very rarely allergic reactions such as urticaria and angioedema occur.
Reproductive system: very often - cases of sexual dysfunction; rarely - hyperprolactinemia and galactorrhea.
Cardiovascular system: “rarely” sinus tachycardia was noted, as well as a transient decrease or increase in blood pressure.
Metabolism: "often" cases of loss of appetite, sometimes in elderly patients with impaired secretion of ADH - hyponatremia.
Epidermis: Sweating was often recorded; rare cases of skin rashes and very rare photosensitivity reactions.
Gastrointestinal: "very often" nausea is fixed; often - constipation or diarrhea with dry mouth; gastrointestinal bleeding is very rarely recorded.
Blood and lymphatic system: Abnormal bleeding (bleeding into the skin and mucous membranes) rarely occurs. Very rarely, thrombocytopenia is possible.
Hepatobiliary system: quite "rarely" there was an increase in the level of production of liver enzymes; very rare cases of hepatitis, accompanied by jaundice and / or liver failure.
CNS: often there is drowsiness or insomnia, convulsive seizures; rarely - clouding of consciousness, hallucinations, manic reactions as possible symptoms of the disease itself.
Among the general disorders: asthenia is often fixed, and very rarely - peripheral edema.

An approximate list of symptoms that may occur after completing a course of paroxetine has been established: “often” noted dizziness and other sensory disturbances, sleep disturbances, the presence of anxiety, headaches; sometimes - strong emotional arousal, nausea, tremor, sweating, and diarrhea. Most often, these symptoms in patients are mild and mild, disappear without intervention.

Patient groups at increased risk of side effects have not been registered, but if there is no greater need for treatment with paroxetine, the dose is gradually reduced until complete withdrawal.

Overdose

With an overdose of Paxil, it is possible to increase unwanted side reactions, as well as the development of fever, blood pressure disorders, tachycardia, anxiety, involuntary muscle contraction. In most cases, the patient's well-being returns to normal without serious complications.

Rarely, there was information about cases of coma and ECG changes, and sporadically about lethal outcomes. In most cases, such conditions were provoked by the combination of Paxil with alcohol or other psychotropic substances.

Overdose therapy can be carried out in accordance with its manifestations, as well as the instructions of the national poison control center. There is no specific antidote. Therapy includes general measures that are required in case of an overdose of an antidepressant. In addition, the main physiological parameters of the body should be monitored and supportive treatment should be carried out.

special instructions

In young patients, especially during treatment for major depressive disorder, Paxil may increase the risk of suicidal behavior.

Exacerbation of symptoms in depression and / or the emergence of suicidal thoughts and suicidal behavior can occur regardless of whether the patient receives antidepressants. The probability of their development remains until the onset of a pronounced remission. Due to the fact that the improvement in the condition of patients, as a rule, occurs after a few weeks of taking Paxil, during this period they need to ensure careful monitoring of the condition, especially at the beginning of the treatment course.

It should be borne in mind that with other mental disorders in which Paxil is indicated, there is also a high 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 occurrence of akathisia (manifested as internal restlessness and psychomotor agitation, when the patient cannot be in a calm state - sit or stand).

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

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

Major depressive episodes are in some cases the initial manifestation of bipolar disorder. It is believed that monotherapy with Paxil may increase the likelihood of an 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 carried out, including a detailed psychiatric family history with data on cases of depression, suicide and bipolar disorder. For the treatment of a depressive episode in the framework of bipolar disorder, Paxil is not intended. It should be used with caution in patients with a history of mania. Also, the appointment of the drug requires caution against the background of epilepsy, angle-closure glaucoma, diseases predisposing to bleeding, 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 swings, nausea, tearfulness, nervousness, dizziness, abdominal pain) does not mean that Paxil is addictive or that it is being abused.

If convulsive seizures develop during treatment, Paxil is canceled.

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

drug interaction

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

Pimozide: an increase in its level in the blood, a prolongation of the QT interval (the combination is contraindicated, if necessary, joint use requires caution and careful monitoring of the condition);
Serotonergic drugs (including fentanyl, L-tryptophan, tramadol, triptans, SSRIs, lithium and herbal remedies containing St. ;
Fosamprenavir/ritonavir: Significant reduction in plasma concentrations of paroxetine;
Enzymes and inhibitors involved in the metabolism of drugs: changes in the metabolism and pharmacokinetics of paroxetine;
Drugs that are metabolized by the hepatic enzyme CYP2D6 (antipsychotics of the phenothiazine series, tricyclic antidepressants, atomoxetine, risperidone, some class 1 C antiarrhythmics): an increase in their plasma concentration;
Procyclidine: an increase in its concentration in the blood plasma (in the case of the development of anticholinergic effects, its dose should be reduced).

The pharmacokinetics and absorption of Paxil does not depend on 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 dose changes) on diet and alcohol. It has not been established that paroxetine enhances the negative effect of ethanol on psychomotor, however, it is not recommended to take it together with alcohol, since alcohol mainly suppresses the effect of the drug - reducing the effectiveness of treatment.