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Paxil - instructions for use, analogs, reviews and release forms (20 mg tablets) antidepressant drug for the treatment of depression and phobia in adults, children and pregnancy. Composition and interaction with alcohol

Paxil - instructions for use, analogs, reviews and release forms (20 mg tablets) antidepressant drug for the treatment of depression and phobia in adults, children and pregnancy. Composition and interaction with alcohol

In this article, you can read the instructions for using the drug Paxil. Comments of visitors of the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Paxil in their practice are presented. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Paxil in the presence of existing structural analogues. Use to treat depression and phobia in adults, children, as well as during pregnancy and lactation. Composition and interaction of the drug with alcohol.

 

Paxil is a potent and selective inhibitor of 5-hydroxytryptamine re-uptake (5-HT, serotonin). It is believed that its antidepressant activity and effectiveness in the treatment of obsessive-compulsive (OCD) and panic disorder is due to the specific inhibition of reuptake of serotonin in neurons of the brain.

 

In terms of its chemical structure, Paroxetine (the active substance of Paxil) is different from tricyclic, tetracyclic and other known antidepressants.

 

Paroxetine has a weak affinity for muscarinic cholinergic receptors, and studies in animals have shown that it has only weak anticholinergic properties.

 

In accordance with the selective effect of paroxetine, studies have shown that, unlike tricyclic antidepressants, it has a weak affinity for alpha1, alpha2 and beta adrenoreceptors, as well as for dopamine (D2), 5-HT1-like, 5HT2- and histamine (H1) receptors. This lack of interaction with postsynaptic receptors is confirmed by the results of studies that demonstrated the lack of paroxetine's ability to oppress the central nervous system and cause arterial hypotension.

Pharmacodynamic effects

 

Paxil does not impair psychomotor functions and does not enhance the depressant effect of ethanol (alcohol) on the central nervous system.

 

Like other selective serotonin reuptake inhibitors, paroxetine causes symptoms of excessive stimulation of 5-HT receptors when administered to animals that previously received MAO inhibitors or tryptophan. Studies of EEG behavior and changes have demonstrated that paroxetine causes mild activating effects at doses in excess of those required to inhibit serotonin reuptake. By its very nature, its activating properties are not "amphetamine-like".

 

Studies in animals have shown that paroxetine does not affect the cardiovascular system.

 

In healthy subjects paroxetine does not cause clinically significant changes in blood pressure, heart rate and ECG.

 

Studies have shown that, unlike antidepressants that inhibit norepinephrine reuptake, Paxil has a much lower ability to inhibit the antihypertensive effects of guanethidine.

 

Composition

 

Paroxetine hydrochloride hemihydrate (Paroxetine) + auxiliary substances.

 

Pharmacokinetics

 

After oral administration, Paxil is well absorbed and is metabolized on the first pass. Due to the metabolism of the first passage, less paroxetine is delivered to the systemic bloodstream than that absorbed from the digestive tract. As the amount of paroxetine increases in the body with a single intake of large doses or with repeated intake of usual doses, the partial metabolism of the first passage occurs and the clearance of paroxetine from the plasma decreases. This leads to a disproportionate increase in the concentrations of paroxetine in the plasma. Therefore, its pharmacokinetic parameters are not stable, resulting in nonlinear kinetics. It should be noted, however, that the nonlinearity is usually poorly expressed and is observed only in those patients who, when taking low doses of the drug in the plasma, achieve low levels of paroxetine. Stable concentrations in the plasma are achieved 7-14 days after the start of treatment with paroxetine. its pharmacokinetic parameters, most likely, do not change during prolonged therapy.

 

Paroxetine is widely distributed in tissues, and pharmacokinetic calculations show that only 1% of the total amount of paroxetine present in the body remains in the plasma.At therapeutic concentrations, approximately 95% of paroxetine in the plasma is associated with proteins.

 

It was found that paroxetine penetrates into breast milk of women in small amounts, as well as in embryos and fruits of laboratory animals.

 

The main metabolites of paroxetine are polar and conjugated oxidation and methylation products, which are easily eliminated from the body. Given the relative lack of pharmacological activity in these metabolites, it can be argued that they do not affect the therapeutic effects of paroxetine.

 

Metabolism does not impair the ability of paroxetine to selectively inhibit the reuptake of serotonin.

 

With urine in the form of unchanged paroxetine excreted less than 2% of the dose, while excretion of metabolites reaches 64% of the dose. About 36% of the dose is excreted with feces, probably getting into it with bile; Excretion with feces of unchanged paroxetine is less than 1% of the dose. Thus, paroxetine is eliminated almost entirely through metabolism.

 

Excretion of metabolites is biphasic: first it is the result of metabolism of the first passage, then it is controlled by systemic elimination of paroxetine.

 

Indications

  • depression (all types, including reactive and severe depression, as well as depression, accompanied by anxiety);
  • recurrent depressive disorder;
  • obsessive-compulsive disorder;
  • panic disorder;
  • agoraphobia;
  • social phobia;
  • generalized anxiety disorder;
  • post-traumatic stress disorder.

 

Forms of release

 

The tablets covered with a cover of 20 mg.

 

Instructions for use and dosing regimen

 

Paxil is recommended 1 time a day in the morning during a meal. The tablet should be swallowed whole, without chewing.

 

Depression

 

The recommended dose for adults is 20 mg per day. If necessary, depending on the therapeutic effect, the daily dose may increase weekly by 10 mg per day to a maximum dose of 50 mg per 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 in the future, depending on the clinical indications.

 

To relieve depressive symptoms and prevent relapses, adequate duration of stopping and maintenance therapy should be observed.This period can be several months.

 

Obsessive-compulsive disorder

 

The recommended dose is 40 mg per day. Treatment begins with a dose of 20 mg per day, which can be increased weekly by 10 mg per day. If necessary, the dose can be increased to 60 mg per day. It is necessary to observe adequate duration of therapy (several months and longer).

 

Panic disorder

 

The recommended dose is 40 mg per day. Treatment of patients should begin with a dose of 10 mg per day and weekly increase the dose by 10 mg per day, focusing on the clinical effect. If necessary, the dose may be increased to 60 mg per day. A low initial dose is recommended to minimize the possible increase in symptoms of panic disorder, which can occur at the beginning of treatment with any antidepressant. It is necessary to observe adequate periods of therapy (several months and longer).

 

Social phobia

 

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

 

Generalized anxiety disorder

 

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

 

Post-Traumatic Stress Disorder

 

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

 

Canceling Paxil

 

As in the treatment of other psychotropic drugs, avoid abrupt withdrawal of paroxetine.

 

The following cancellation schedule can be recommended: reduction of the daily dose by 10 mg per week; after reaching a dose of 20 mg per day. patients continue to take this dose for 1 week, and only then the drug is canceled completely. If withdrawal symptoms develop during dose reduction or after drug withdrawal, it is advisable to resume taking the previously prescribed dose. In the future, the doctor may continue to reduce the dose, but more slowly.

 

Individual patient groups

 

In elderly patients, paroxetine concentrations in plasma can be increased, but the range of its plasma concentrations coincides with those in younger patients.In this category of patients, therapy should be started with a dose recommended for adults, which can be increased to 40 mg per day.

 

The concentrations of paroxetine in plasma are increased in patients with severe renal dysfunction (KC less than 30 ml / min) and in patients with impaired liver function. Such patients should be given doses of the drug that are in the lower part of the therapeutic dose range.

 

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

 

Side effect

  • abnormal bleeding, mainly hemorrhage into the skin and mucous membranes (most often - bruising);
  • thrombocytopenia;
  • allergic reactions (including hives and angioedema);
  • syndrome of impaired secretion of antidiuretic hormone;
  • decreased appetite;
  • increased cholesterol;
  • drowsiness;
  • insomnia;
  • unusual dreams (including nightmares);
  • confusion of consciousness;
  • hallucinations;
  • manic reactions;
  • dizziness;
  • tremor;
  • headache;
  • convulsions;
  • serotonin syndrome (symptoms may include agitation, confusion, increased sweating, hallucinations, hyperreflexia, myoclonus,tachycardia with tremors and tremors);
  • blurred vision;
  • acute glaucoma;
  • sinus tachycardia;
  • postural hypotension;
  • yawn;
  • nausea, vomiting;
  • constipation;
  • diarrhea;
  • dry mouth;
  • gastrointestinal bleeding;
  • hepatitis;
  • sweating;
  • skin rashes;
  • photosensitivity reaction;
  • severe skin reactions (including polymorphic erythema, Stevens-Johnson syndrome and toxic epidermal necrolysis);
  • retention of urination;
  • urinary incontinence;
  • sexual dysfunction;
  • hyperprolactinaemia / galactorrhea;
  • asthenia;
  • increase in body weight;
  • peripheral edema.

 

Contraindications

  • combined use of Paxil with MAO inhibitors and methylene blue. Paroxetine should not be used concomitantly with MAO inhibitors or within 2 weeks after they are discontinued. MAO inhibitors can not be administered within 2 weeks after treatment with paroxetine;
  • combined use with thioridazine. Paroxetine should not be given in combination with thioridazine, as, like other drugs that inhibit the activity of the hepatic enzyme CYP450 2D6, paroxetine can increase the thioridazine concentrations in the plasma, which can lead to prolongation of the QT interval and the associated arrhythmia "pirouette" (torsade de pointes ) and sudden death;
  • combined use with pimozide;
  • use in children and adolescents under 18 years of age. Controlled clinical studies of paroxetine in the treatment of depression in children and adolescents have not proven its effectiveness, so the drug is not indicated for treatment of this age group. The safety and effectiveness of paroxetine have not been studied in patients younger than 7 years of age;
  • increased sensitivity to paroxetine and other components of the drug.

 

Application in pregnancy and lactation

 

Studies in animals have not revealed in Paxil teratogenic or selective embryotoxic activity.

 

Recent epidemiological studies of pregnancy outcomes with antidepressant medications in the first trimester have shown an increased risk of congenital anomalies, in particular the cardiovascular system (eg, interventricular and atrial septal defects) associated with paroxetine. According to the data, the occurrence of cardiovascular system defects with paroxetine during pregnancy is approximately 1/50, whereas the expected occurrence of such defects in the general population is approximately 1/100 of the newborns.When paroxetine is prescribed, it is necessary to consider the possibility of alternative treatment in pregnant women and pregnant women planning pregnancy. There are reports of premature birth in women who received paroxetine or other SSRIs during pregnancy, but a causal relationship between these drugs and preterm delivery has not been established. Paroxetine should not be used during pregnancy, if its potential benefit does not exceed the possible risk. Particular care should be taken to monitor the health of those newborns whose mothers were taking paroxetine late in pregnancy, since there are reports of complications in newborns exposed to paroxetine or other SSRI drugs in the third trimester of pregnancy. It should be noted, however, that in this case the cause-and-effect relationship between these complications and this drug therapy has not been established. The clinical complications described included: respiratory distress syndrome, cyanosis, apnea, convulsive seizures, temperature instability, feeding difficulties, vomiting, hypoglycaemia,arterial hypertension, hypotension, hyperreflexia, tremor, tremor, nervous excitability, irritability, lethargy, constant crying and drowsiness. In some reports, the symptoms have been described as neonatal manifestations of withdrawal syndrome. In most cases, the described complications occurred immediately after birth or shortly after birth (<24 h). According to epidemiological studies, the intake of SSRIs (including paroxetine) in late pregnancy is associated with an increased risk of developing persistent pulmonary hypertension in newborns. Increased risk is observed in children born to mothers who took SSRIs in late pregnancy, 4-5 times higher than observed in the general population (1-2 per 1000 pregnancies).

 

Insignificant amounts of Paxil enter the breast milk. However, paroxetine should not be taken during breastfeeding, except when its benefit to the mother exceeds the potential risks to the child.

 

Fertility

 

SSRIs (including paroxetine) can affect the quality of semen. This effect is reversible after discontinuation of the drug.Change in semen properties can lead to impaired fertility.

 

Application in elderly patients

 

In elderly patients, treatment should begin with a dose for adults, then the dose can be increased to 40 mg per day.

 

Use in children

 

Treatment with antidepressants for children and adolescents with major depressive disorder and other mental illnesses is associated with an increased risk of suicidal ideation and suicidal behavior.

 

In clinical trials, adverse events associated with suicidal (suicidal attempts and suicidal ideation) and hostility (mainly aggression, deviant behavior and anger) were more common in children and adolescents receiving paroxetine than in those patients of this age group who received a placebo. At present, there is no data on the long-term safety of paroxetine for children and adolescents, which would concern the effect of the drug on growth, maturation, cognitive and behavioral development.

 

As a result of clinical studies in children and adolescents, the incidence of adverse events with the withdrawal of paroxetine was 32%, while the incidence of adverse eventsphenomena in the placebo group was 24%.

 

special instructions

 

Clinical deterioration and suicidal risk in adults

 

Young patients, especially those suffering from major depressive disorder, may be at increased risk of suicidal behavior during paroxetine therapy. An analysis of placebo-controlled studies in adults with mental illnesses indicates an increase in the incidence of suicidal behavior in young patients (aged 18-24 years) when taking paroxetine compared to the placebo group (2.19% to 0.92%, respectively), although this the difference is not considered statistically significant. In patients of older age groups (from 25 to 64 years and older than 65 years), an increase in the incidence of suicidal behavior was observed. In adults of all age groups suffering from major depressive disorder, there was a statistically significant increase in cases of suicidal behavior against paroxetine compared with the placebo group (the occurrence of suicidal attempts: 0.32% to 0.05%, respectively). However, most of these cases, when taking paroxetine (8 of 11), were registered in young patients aged 18-30 years.The data obtained in the study in patients with major depressive disorder may indicate an increase in the incidence of suicidal behavior in patients younger than 24 years with various mental disorders. In patients with depression, the exacerbation of symptoms of this disorder and / or the appearance of suicidal thoughts and suicidal behavior (suicidal) can be observed regardless of whether they receive antidepressants. This risk persists until a pronounced remission is achieved. Improvement of the patient's condition may be absent in the first weeks of treatment or more, and therefore the patient should be closely monitored for the timely detection of clinical exacerbation and suicidality, especially at the beginning of the course of treatment, as well as during periods of dose changes, whether they increase or decrease. Clinical experience with the use of all antidepressants shows that the risk of suicide may increase in the early stages of recovery.

 

Other mental disorders for which paroxetine is used may also be associated with an increased risk of suicidal behavior.In addition, these disorders can be comorbid conditions associated with a major depressive disorder. Therefore, in treating patients suffering from other mental disorders, the same precautions should be followed as in the treatment of major depressive disorder.

 

The greatest risk of suicidal thoughts or suicidal attempts is experienced by patients with a history of suicidal behavior or suicidal ideation, young patients, and patients with severe suicidal thoughts prior to treatment, and therefore all need to be given special attention during treatment. Patients (and those who care for them) need to be warned about the need to monitor their deterioration and / or the appearance of suicidal thoughts / suicidal behavior or thoughts of self-harm during the course of treatment, especially at the beginning of treatment, during a dose change (increase and decrease). If these symptoms occur, seek medical help immediately.

 

It should be remembered that such symptoms as agitation, akathisia or mania may be associated with a major disease or be a consequence of the therapy used.If symptoms of clinical deterioration (including new symptoms) and / or suicidal thoughts / behavior occur, especially if they suddenly appear, the severity of the manifestations increases, or if they are not part of the previous symptom-complex in this patient, withdrawal of the drug.

 

Akathisia

 

Occasionally, treatment with paroxetine or another drug of the group of selective serotonin reuptake inhibitors (SSRIs) is accompanied by the appearance of akathisia, which is manifested by a feeling of internal anxiety and psychomotor agitation, when the patient can not sit or stand still; At akathisia the patient usually experiences subjective discomfort. The likelihood of akathisia is highest in the first few weeks of treatment.

 

Serotonin syndrome / malignant neuroleptic syndrome

 

In rare cases, with paroxetine, serotonin syndrome or symptomatology similar to malignant neuroleptic syndrome may occur, especially if paroxetine is used in combination with other serotonergic drugs and / or antipsychotics.These syndromes present a potential threat to life, and therefore treatment with paroxetine should be discontinued if they occur (they are characterized by groups of symptoms such as hyperthermia, muscle rigidity, myoclonus, autonomic disorders with possible rapid changes in vital signs, changes in mental status, including confusion, irritability, extremely severe agitation, progressing to delirium and coma), and begin supporting symptomatic therapy. Paroxetine should not be given in combination with serotonin precursors (such as L-tryptophan, oxytryptan) due to the risk of developing a serotonergic syndrome.

 

Mania and bipolar disorder

 

A major depressive episode may be the initial manifestation of bipolar disorder. It is generally accepted (although not proven by controlled clinical trials) that treating such an episode with an antidepressant alone may increase the likelihood of an accelerated development of a mixed / manic episode in patients at risk of bipolar disorder.Before starting treatment with an antidepressant, a thorough screening should be performed to assess the risk of a bipolar disorder in the patient; such screening should include the collection of a detailed psychiatric history, including data on the presence in the family of cases of suicide, bipolar disorder and depression. Paroxetine is not registered for the treatment of a depressive episode in the context of bipolar disorder. Paroxetine should be used with caution in patients who have a history of mania.

 

MAO inhibitors

 

Treatment with paroxetine should be started cautiously no earlier than 2 weeks after discontinuation of therapy with MAO inhibitors; The dose of paroxetine should be increased gradually until an optimal therapeutic effect is achieved.

 

Impaired kidney or liver function

 

It is advisable to use caution when treating paroxetine with patients with severe renal dysfunction and patients with impaired hepatic function.

 

Epilepsy

 

Like other antidepressants, paroxetine should be used with caution in patients with epilepsy.

 

Convulsive seizures

 

The frequency of convulsive seizures in patients taking paroxetine is less than 0.1%.In the event of a seizure, paroxetine should be discontinued.

 

Electroconvulsive therapy

 

There is only limited experience in the simultaneous use of paroxetine and electroconvulsive therapy.

 

Glaucoma

 

Like other SSRIs, paroxetine causes mydriasis and should be used with caution in patients with closed-angle glaucoma.

 

Hyponatremia

 

In the treatment of paroxetine, hyponatremia occurs rarely and predominantly in elderly patients and is leveled after the withdrawal of paroxetine.

 

Bleeding

 

Hemorrhages in the skin and mucous membranes (including gastrointestinal bleeding) have been reported in patients with paroxetine. Therefore paroxetine should be used with caution in patients who simultaneously receive drugs that increase the risk of bleeding in patients with a known tendency to bleeding and patients with diseases predisposing to bleeding.

 

Heart Disease

 

In the treatment of patients with heart disease, the usual precautionary measures should be observed.

 

Symptoms that may occur when discontinuing paroxetine treatment in adults

 

As a result of clinical studies in adults, the incidence of adverse events with paroxetine withdrawal was 30%, while the incidence of adverse events in the placebo group was 20%.

 

Describing withdrawal symptoms such as dizziness, sensory disturbances (including paresthesia, electric shock and tinnitus), sleep disorders (including bright dreams), agitation or anxiety, nausea, tremors, confusion, sweating, headaches and diarrhea are described. Usually these symptoms are mild or moderate, but in some patients they can be severe. Usually they occur in the first few days after the drug is discontinued, but in rare cases they occur in patients who accidentally missed only one dose. As a rule, these symptoms pass spontaneously and disappear within 2 weeks, but in some patients they can last much longer (2-3 months or more). It is recommended to reduce the dose of paroxetine gradually, for several weeks or months before its complete cancellation, depending on the needs of the particular patient

 

The onset of withdrawal symptoms does not mean that the drug is abused or addictive, as is the case with drugs and psychotropic substances.

 

Symptoms that may occur when paroxetine is discontinued in children and adolescents

 

As a result of clinical studies in children and adolescents, the incidence of adverse events with paroxetine withdrawal was 32%, while the incidence of adverse events in the placebo group was 24%.

 

Symptoms of paroxetine withdrawal (emotional lability, including suicidal ideation, suicidal attempts, mood changes and tearfulness, as well as nervousness, dizziness, nausea and abdominal pain) were recorded in 2% of patients on the background of a decrease in the dose of paroxetine or after its complete withdrawal and were 2 times more common than in the placebo group.

 

Fractures of bones

 

Based on the results of epidemiological studies of the risk of bone fractures, bone fragility was associated with the intake of antidepressants, including the SSRI group. The risk was observed during the course of treatment with antidepressants and was the maximum at the beginning of the course of therapy. The possibility of bone fractures should be considered when administering paroxetine.

 

Tamoxifen

 

Some studies have shown that the effectiveness of tamoxifen, measured as the ratio of breast cancer recurrence / mortality, decreases with co-administration with Paxil, as a result of irreversible inhibition of CYP2D6.The risk may increase with a joint appointment for a long time. When treating or preventing breast cancer, consideration should be given to the use of alternative antidepressants that do not affect CYP2D6 or less.

 

Impact on the ability to drive vehicles and manage mechanisms

 

Clinical experience with paroxetine indicates that it does not impair cognitive and psychomotor functions. However, as with any other psychotropic medications, patients should be especially cautious when driving a car and working with mechanisms.

 

Despite the fact that paroxetine does not increase the negative effect of alcohol on psychomotor functions, it is not recommended to simultaneously use paroxetine and alcohol.

 

Drug Interactions

 

Serotonergic drugs

 

The use of paroxetine, as well as other SSRI drugs, along with serotonergic drugs (including L-tryptophan, triptans, tramadol, SSRIs, fentanyl, lithium and herbal preparations containing St. John's wort) can cause effects associated with 5-HT (serotonin syndrome).The use of paroxetine with MAO inhibitors (including linezolid, an antibiotic that transforms into a non-selective MAO inhibitor) is contraindicated.

 

Pimozide

 

In a study of the possibility of sharing paroxetine and pimozide at a low dose (2 mg once), an increase in the level of pimozide was recorded. This fact is due to the known property of paroxetine to depress the CYP2D6 system. Due to the narrow therapeutic index of pimozide and its known ability to prolong the QT interval, the combined use of pimozide and paroxetine is contraindicated. When using these drugs in combination with paroxetine, care must be taken and careful clinical monitoring performed.

 

Enzymes involved in the metabolism of drugs

 

Metabolism and pharmacokinetics of paroxetine can change under the influence of induction or inhibition of enzymes that participate in the metabolism of drugs.

 

When paroxetine is used simultaneously as an inhibitor of enzymes involved in the metabolism of drugs, it should be assessed whether it is expedient to use a dose of paroxetine at the bottom of the therapeutic dose range.The initial dose of paroxetine should not be adjusted if it is used concomitantly with a drug that is a known inducer of enzymes involved in the metabolism of drugs (eg, carbamazenin, rifampicin, phenobarbital, phenytoin). Any subsequent adjustment of the dose of paroxetine should be determined by its clinical effects (tolerability and efficacy).

 

Fosamprenavir / ritonavir

 

The combined use of fosamprenavir / ritonavir with Paxil resulted in a significant decrease in paroxetine concentration in the blood plasma.

 

Any subsequent adjustment of the dose of paroxetine should be determined by its clinical effects (tolerability and efficacy).

 

Procyclidine

 

Daily intake of paroxetine significantly increases the concentration of procyclidine in blood plasma. When anticholinergic effects occur, the dose of procyclidine should be reduced.

 

Anticonvulsants: carbamazepine, phenytoin, sodium valproate.

 

Simultaneous use of paroxetine and these drugs does not affect their pharmacokinetics and pharmacodynamics in patients with epilepsy.

 

The ability of paroxetine to inhibit the enzyme CYP2D6

 

Like other antidepressants, including other SSRI drugs, paroxetine inhibits the hepatic enzyme CYP2D6, which belongs to the cytochrome P450 system. The inhibition of the enzyme CYP2D6 can lead to an increase in plasma concentrations of concomitantly used drugs that are metabolized by this enzyme. These drugs include tricyclic antidepressants (for example, amitriptyline, nortriptyline, imipramine and desipramine), neuroleptics of the phenothiazine series (perphenazine and thioridazine), risperidone, atomoxetine, some antiarrhythmic drugs of class 1 C (eg, propafenone and flecainide) and metoprolol.

 

The use of paroxetine, which inhibits the system CYP2D6, can lead to a decrease in the concentration of its active metabolite - endoxifene in the blood plasma, and as a consequence, reduce the effectiveness of tamoxifen.

 

Clinical studies have shown that the absorption and pharmacokinetics of paroxetine is independent or practically independent (ie, the existing dependence does not require dose changes) from food, antacids, digoxin, propranolol, alcohol (paroxetine does not enhance the negative effect of ethanol on psychomotor functions, less,it is not recommended to take paroxetine and alcohol at the same time).

 

Analogues of the drug Paxil

 

Structural analogs for the active substance:

  • Adress;
  • Aktaparoxetine;
  • Apo Paroxetine;
  • Paroxetine;
  • Plizil;
  • Rexetin;
  • Sirestill.

 

Analogues for the pharmacological group (antidepressants):

  • Adress;
  • Azafen;
  • Azona;
  • Alventa;
  • Amizole;
  • Amide;
  • Amirol;
  • Amitriptyline;
  • Velaxin;
  • Velafax;
  • Venlafaxine;
  • Heptor;
  • Heptral;
  • Daplex;
  • Depres;
  • Depenone;
  • Deprim;
  • Doxepine;
  • Duloxetine;
  • Zoloft;
  • Ixelles;
  • Kaliksta;
  • Clominal;
  • Clomipramine;
  • Coaxyl;
  • Life 600;
  • Life 900;
  • Lenuksin;
  • Lerivon;
  • Miansan;
  • Miracitol;
  • Mirzaten;
  • Mirtalan;
  • Nerustin;
  • Neuroplant;
  • Noxibel;
  • Oprah;
  • Pirazidol;
  • Prodep;
  • Prozac;
  • Profluzak;
  • Remeron;
  • Sedopram;
  • Stimuloton;
  • Triptysole;
  • Umorap;
  • Févarine;
  • Fluoxetine;
  • Framex;
  • Fluorocycin;
  • Cipralex;
  • Cipramyl;
  • Citalopram;
  • Elivel;
  • Ephevelone;
  • Epevelon retard.

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Reviews (1):
Guests
Michael
A good antidepressant, though very expensive and import. Somehow, for the sake of economy, I asked for a local Russian paroxetine analog - it's like heaven and earth, a rash, a mood at zero, a word had to be changed quickly back to paxil. Well though doctors understanding at me, and that happen only local bottling sell also all also you will not persuade. angry

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