Paroxetine

CLINICAL USE

Antidepressant:Panic disorders Obsessive compulsive disorder Social anxiety Post traumatic stress disorder

DOSE IN NORMAL RENAL FUNCTION

10–60 mg daily depending on indication

PHARMACOKINETICS

Molecular weight :329.4

%Protein binding :95

%Excreted unchanged in urine : <2

Volume of distribution (L/kg) :13

half-life – normal/ESRD (hrs) :24/30

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

30–50 Dose as in normal renal function10–30 20 mg daily and titrate slowly

<10 : 20 mg daily and titrate slowly

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Dose as in GFR <10 mL/min

HD :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :Unknown dialysability. Dose as for GFR=10–30 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Analgesics: increased risk of bleeding with aspirin and NSAIDs; increased risk of CNS toxicity with tramadol

Anti-arrhythmics: possibly inhibits propafenone metabolism (increased risk of toxicity)

Anticoagulants: effect of coumarins possibly enhanced

Antidepressants: avoid concomitant use with MAOIs and moclobemide (increased risk of toxicity); avoid concomitant use with St John’s wort; possibly enhanced serotonergic effects with duloxetine; can increase tricyclics antidepressant concentration; increased agitation and nausea with tryptophan

Anti-epileptics: antagonism (lowered convulsive threshold); concentration reduced by carbamazepine, phenytoin and primidone

Antimalarials: avoid concomitant use with artemether/lumefantrine

Antipsychotics: concentration of clozapine, sertindole and possibly risperidone increased; metabolism of perphenazine inhibited, reduce dose of perphenazine; possibly inhibit aripiprazole metabolism, reduce aripiprazole dose

Antivirals: concentration increased by ritonavir

Dopaminergics: use entacapone with caution; increased risk of hypertension and CNS excitation with selegiline – avoid concomitant use; increased risk of CNS toxicity with rasagiline – avoid concomitant use5HT 1 agonist: risk of CNS toxicity increased by sumatriptan – avoid concomitant use; possibly increased risk of serotonergic effects with frovatriptan

Lithium: increased risk of CNS effects – monitor levels

Sibutramine: increased risk of CNS toxicity – avoid concomitant use

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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