Antidepressant Paxil

Paxil is an antidepressant that belongs to the group of SSRIs (selective serotonin reuptake inhibitors).

Has a strong anti-anxiety and anxiolytic effect has a bicyclic structure, this distinguishes it from other widespread thymoanaleptics. Timanaleptic effect is due to the fact that the active substance paroxetine is able to selectively block reverse capture 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. The active substance of the drug Paxil is paroxetine hydrochloride in an amount of 20 mg.

Clinical and pharmacological group

Antidepressant.

Conditions of leave from pharmacies

It is released on prescription.

Price list

How much does Paxil cost in pharmacies? The average price in 2018 is at the level of750 rubles.

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Form of issue and composition

Dosage form Paxil - film-coated tablets containing:

• 20 mg of paroxetine (in the form of hemihydrate hydrochloride);
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• Auxiliary components: 31, 5 mg calcium hydrophosphate dihydrate 5 mg sodium carboxymethyl starch (type A), mg magnesium stearate;
• Sheath composition: opadrai white, including polysorbate 80, macrogol 400, titanium dioxide and hypromellose.

Paksil tablets are available for 10 pcs. in a blister, for 1, 3 or 10 blisters in a cardboard bundle.

Pharmacological effect

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

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

Paxil has a negligible effect on the seizure of norepinephrine, dopamine. In addition, it has antidepressant, timoleptic, anxiolytic effect, also has a sedative effect.

Indications for use

Paxil is indicated for use in the treatment of various types of depressive conditions:

• reactive depressions;
• severe depression;
• depressions accompanied by anxiety.

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

• post-traumatic stress disorders;
• generalized anxiety disorders - in this case the drug can be used in the course of prolonged maintenance and preventive treatment;
• the drug is used both for treatment and for the prevention of obsessive-compulsive disorders;
• treatment of panic disorders accompanied by agoraphobia: tablets can be used in the course of supportive, as well as preventive therapy; use of the drug helps prevent recurrences of panic attacks. disorders;
• is used to treat and prevent social phobias.

During the first few weeks of using the tablets, the symptoms of depressive conditions decrease, suicidal thoughts pass.

Contraindications

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

1. Individual intolerance of the active ingredient or auxiliary components of the drug.
2. Combination with thioridazine, which can lead to a significant arrhythmia (violation of the rhythm and frequency of cardiac contractions), which increases the risk of death.
3. Combined use of Paxil tablets with preparations of MAO inhibitors (monoamine oxidase) and methylene blue - the drug should not be taken within 2 weeks after taking MAO inhibitors or using methylene blue.
4. Children and adolescence under the age of 18 - treatment of depression with Paxil tablets in children and adolescents is ineffective, data on the safety of the drug for children younger than 7 years to date no.

Before starting the use of pills, Paxil should be checked to ensure that there are no contraindications.

Use in pregnancy and lactation

During the experiments on animals, there was no negative effect of the drug on the growth and development of the fetus, as well as on the course of pregnancy and childbirth.

However, clinical observations of women taking Paxil during the first trimester of pregnancy (before the 12th week inclusive), showed that the drug doubled the risk of developing congenital anomalies, such as defects of the interventricular and interatrial partitions. In addition, some newborns whose mothers were taking Paxil in the third trimester of pregnancy (from 26 to 40 weeks) had complications, such as:

• hypoglycemia;
• arterial hypertension;
• hypotension;
• strengthened reflexes;
• distress syndrome;
• cyanosis;
• apnea;
• convulsive seizures;
• temperature instability;
• difficulties with feeding;
• vomiting;
• 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, taking into account all the above mentioned facts, women in pregnancy can use Paxil only if the intended benefit exceeds all possible risks. But it is better not to use the drug during pregnancy.

Paxil penetrates into breast milk, so against the background of breast-feeding the drug is also not recommended. For the duration of Paksil therapy, it is better to stop breastfeeding and transfer the baby to artificial mixtures. In addition, Paksil reduces the quality of spermatozoa in men, so against the background of drug therapy, it is not necessary to plan the conception of a child. However, changes in the quality of sperm are reversible, and after a while after Paxil's withdrawal, it again returns to its normal state. Therefore, to plan pregnancy should be some time after the withdrawal of Paxil.

Dosage and route of administration

The instructions for use indicate that Paxil is recommended 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 adequate duration of therapy (several months and longer).

Depression:

• The recommended dose for adults is 20 mg / day. If necessary, depending on the therapeutic effect, the daily dose may increase weekly by 10 mg / day to a maximum dose of 50 mg / day. As with any antidepressant treatment, the effectiveness of therapy and, if necessary, adjust the dose of paroxetine 2-3 weeks after the start of treatment and in the future, depending on the clinical readings. To relieve depressive symptoms and prevent relapses, adequate duration of stopping and maintenance therapy should be observed. This period can be several months.

Social phobia:

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

Panic disorder:

• The recommended dose is 40 mg / day. Treatment of patients should begin with a dose of 10 mg / day and weekly increase the dose by 10 mg / day, focusing on the clinical effect. If necessary, the dose may be increased to 60 mg / 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).

Post-traumatic stress disorder:

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

Generalized anxiety disorder:

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

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

Abolition of the drug

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 20 mg / day patients continue to take this dose for 1 week, and only after that 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.

Side effects

The decrease in the frequency and intensity of certain side effects of paroxetine occurs as the treatment progresses, so do not require the de-assignment. The frequency gradation is as follows:

• very often (≥1 / 10);
• often (≥1 / 100, / / ​​10);
• sometimes happens (≥1 / 1000, / / ​​100);
• rarely (≥1 / 1, 00, / / ​​1000);
• very rarely (/ / 1, 00), taking into account individual cases.

Frequent and very frequent occurrence is determined on the basis of generalized data on the safety of the drug in more than , 00 patients. Clinical trials were conducted to calculate the incidence of side effects in the Paxil group and the second placebo group. Occurrence of side effects Paxil rare or very rare is determined based on post-marketing information on the frequency of messages, rather than the true frequency of these effects.

The indicators of side effects are stratified by organs and frequency:

1. Endocrine system: very rarely - violation of ADH secretion.
2. Urinary system: rarely recorded a delay in urine.
3. Respiratory organs, thorax and mediastinum: "often" yawning was noted.
4. Vision: very rarely there is exacerbation of glaucoma, but "often" - blurred vision.
5. The immune system: allergic reactions such as urticaria and angioedema are very rare.
6. Reproductive system: very often - cases of sexual dysfunction; rarely - hyperprolactinaemia and galactorrhea.
7. Cardiovascular system: "rarely" there was a sinus tachycardia, as well as a transient decrease or increase in blood pressure.
8. Metabolism: "often" cases of decreased appetite, sometimes in elderly patients with violation of ADH secretion - hyponatremia.
9. Epidermis: Sweating was often recorded; rare cases of skin rashes and very rare - photosensitivity reactions.
10. Gastrointestinal: "very often" nausea is fixed; often - constipation or diarrhea if dry in the mouth; very rarely register gastrointestinal bleeding.
11. Blood and lymphatic system: rarely abnormal bleeding occurs (hemorrhage into the skin and mucous membranes). Very rarely, thrombocytopenia is possible.
12. Hepatobiliary system: a "rare" increase in the level of production of hepatic enzymes was noted; Very rare cases of hepatitis, accompanied by jaundice and / or liver failure.
13. CNS: often there is drowsiness or insomnia, convulsive seizures; rarely - confusion, hallucinations, manic reactions as possible symptoms of the actual disease.
14. Among the common disorders: often fixed asthenia, and very rarely - peripheral edema.

An approximate list of symptoms that may appear after completion of the course with paroxetine is established: "often" noted dizziness and other sensory disorders, sleep disorders, the presence of anxiety, headaches; sometimes - a strong emotional arousal, nausea, tremor, sweating, and also diarrhea. Most often, these symptoms in patients are mild and mild, pass without interference.

No groups of patients who are at increased risk of side effects have been registered, but if there is no greater need for paroxetine treatment, the dose is reduced smoothly until complete withdrawal.

Overdose

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

Seldom came information about cases of coma and ECG changes, and single-lethal outcomes. In most cases, such conditions were provoked by combining Paxil with liquor or other psychotropic substances.

Overdose therapy can be carried out in accordance with its manifestations, as well as the instructions of the national toxicology center. There is no specific antidote. Therapy includes general measures that are required when an antidepressant is overdosed. In addition, it is necessary to monitor the basic physiological parameters of the body and conduct supportive treatment.

special instructions

In patients at a young age, especially during the treatment of major depressive disorders, taking Paxil may increase the risk of developing suicidal behavior.

The aggravation of symptoms in depression and / or the appearance of suicidal thoughts and suicidal behavior can occur regardless of whether the patient is receiving antidepressants. The likelihood of their development persists until the onset of severe remission. Due to the fact that the improvement of patients' condition, as a rule, comes in a few weeks of admission Paxila, during this period they need to ensure thorough monitoring of the condition, especially at the beginning of the treatment course.

It should be borne in mind that in other psychiatric disorders in which Paxil is shown, 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 may lead to the appearance of akathisia (manifested in the form of internal anxiety and psychomotor agitation, when the patient can not be in a calm state - sit or stand).

Such disorders as agitation, akathisia or mania may be manifestations of the underlying disease or may develop as a side effect of Paxil. Therefore, in cases where the symptoms are worsening, or when developing new ones, it is necessary to consult a specialist for advice.

Sometimes, most often during combined use with other serotonergic drugs and / or antipsychotics, possibly the development of a serotonin syndrome or symptoms that are similar to a malignant neuroleptic syndrome. If there are symptoms such as autonomic disorders, myoclonus, hyperthermia, muscle rigidity, accompanied by rapid changes in the performance of important functions for life, as well as changes in mental status, including confusion and irritability, treatment cancel.

Major depressive episodes in some cases are the initial manifestation of bipolar disorders. It is believed that Paxil monotherapy may increase the likelihood of an accelerated development of a manic / mixed episode in patients at risk of developing this condition. Before prescribing the drug to assess the risk of bipolar disorder should be carefully screened, including a detailed psychiatric family history with data on cases of depression, suicide and bipolar disorder. For the treatment of a depressive episode within the framework of bipolar disorder, Paxil is not intended. With caution, it should be prescribed to patients with anamnestic data indicating the presence of mania. Also, the appointment of the drug requires caution against the background of epilepsy, angle-closure glaucoma, predisposing to bleeding diseases, including the use of substances / drugs that increase the likelihood of development bleeding.

The development of withdrawal symptoms (in the form of suicidal thoughts and attempts, mood changes, nausea, tearfulness, nervousness, dizziness, abdominal pain) does not mean that Paxil causes addiction or what they are abused.

If seizures develop during treatment, Paxil is canceled.

Because of the existing risk of side effects from the psyche and the nervous system, patients should be especially cautious when working with mechanisms and when driving vehicles.

Drug Interactions

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

• Pimozide: increase in its level in the blood, 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 plant remedies with St. John's wort): development of serotonin syndrome (with monoamine oxidase inhibitors, including an antibiotic transformed into a non-selective MAO inhibitor, and linezolid application contraindicated);
• Fosamprenavir / ritonavir: a significant decrease in the concentration of paroxetine in the blood plasma;
• Enzymes and inhibitors involved in the metabolism of drugs: a change in the metabolism and pharmacokinetics of paroxetine;
• Drugs that are metabolized by the hepatic enzyme CYP2D6 (neuroleptics phenothiazine series, tricyclic antidepressants, atomoxetine, risperidone, some antiarrhythmic drugs of class 1 C): increase in their concentration in plasma;
• Protsiklidin: increase in its concentration in the blood plasma (in the case of development of anticholinergic effects, its dose should be reduced).

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, the dependence does not require changes in the doses) from the diet and alcohol. It has not been established that paroxetine increases the negative effect of ethanol on psychomotor, however, it is not recommended Take it along with alcohol, since alcohol mainly suppresses the effect of the drug - reducing the effectiveness treatment.

Reviews on alcohol consumption in the treatment of Paxil show that if you drink once, then the metabolism medicines drop sharply - without causing negative consequences, but if you drink regularly - he's on the contrary - will accelerate. Patients who suffered from drinking, with an overdose of Paxil usually either get to the hospital in serious condition, or there may be a fatal outcome.

Reviews

We picked up some reviews of people who used the drug Paxil:

1. Marina. The use of Paxil was recommended to me by a psychotherapist during a stressful life situation, after an ineffective treatment with a magnesium preparation. Saw one tablet a day for three weeks, but during this time the level of anxiety only increased, there was insomnia, a convulsive syndrome. After the abolition, I took another drug that helped.
2. Alina. I drink paxil 20 mg per day for 1 month. No side effects at the beginning of the reception did not notice, except that a couple of days there was a lump in the throat, probably this is psychosomatic. At the beginning of the reception, the general anxious condition was preserved, the doctor prescribed symptomatically half of the atarax. Against the background of taking paxil, there is no euphoria, an even normal mood, all emotions are present, I can get angry, and get excited before an important meeting, everything is absolutely like a normal, balanced person, it's easier to concentrate on business, I sleep well. Sometimes I allow myself alcohol, a couple of glasses of wine or a bottle of beer, sometimes, because I do not want to, but if I have a holiday, I can afford it, I do not notice any poboks. As for the appetite, he was not very good before taking me, now he's worse, but it does not bother me, I I eat a little and more because I need to, and not because I want to, it does not bother me at all, a little even has grown thin. Have appointed or nominated poksil for 6 months, now 1proshl, the doctor has told or said after 3 months we will try to lower a dose. The withdrawal syndrome is afraid, some horrors are written. But 10 years ago I drank fluoxetine (Prozac), I did not have withdrawal syndrome.
3. Tatyana. To me 31 year, at me panic attacks from 18 years, and now and with agoraphobia (the chronic form!). In life I panic, therefore it will be very difficult for me to cope with this ailment. For 13 years with me was "probably" already sun, it is connected with the PA with agoraphobia, up to then, I did not leave the house, and at home I was scared alone. In a word, it was hell! I started treatment many times, then I just did not drink, including Paksil. Now I again started a long course of treatment, .k. after severe stress all the horror began again. Paksil has spent on drink 11 months, now has passed to other preparation. There were pobchkk, there was an increase in weight, but this is all tolerable, in comparison with the attack of the PA. With Paksila slazila, problem, but still able to. Many people are afraid to drink it, I will say so, so not so bad to you. When a relapse or you first encounter this, it seems to me I do not care about all the pobochk, it would be gone (well, this is my opinion). Drusya, then a proven drug, it is not suitable for all, for example, I did not fit Selectra-there was a strong allergy, just Elicia - the alarmed state was synchronized, Paksil approached. Do not run, I'm up to the chronic form, get treatment and God bless you all.

Analogues

With the same active substance, preparations are produced: Adapepress, Aktaparoxetine, Apo-Paroxetine, Paroxetine, Plizil, Plizil N, Rexetin, Sirestill.

Before using analogues, consult your doctor.

Storage conditions and shelf life

Keep out of the reach of children at temperatures up to 30 ° C.

Shelf life - 3 years.

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