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Indications:

This medication is a selective serotonin reuptake inhibitor (SSRI) used to treat depression, panic attacks, obsessive-compulsive disorder (OCD), social anxiety disorder (social phobia), post-traumatic stress disorder (PTSD), and generalized anxiety disorders (GAD). Paroxetine should not be used in children less than 18 years of age. It has not been shown to be effective for depression in children or teenagers. It may also cause serious side effects in this age group (see Side Effects section). Consult your doctor or pharmacist for more details. SSRI’s work by helping to restore the balance of certain natural substances in the brain (neurotransmitters). OTHER USES: This medication has also been used to treat a severe form of premenstrual syndrome (premenstrual dysphoric disorder- PMDD), sexual function problems in men (premature ejaculation), nerve problems associated with diabetes (diabetic neuropathy), and chronic headaches.

Contraindications:

Use with or within 14 days of MAOIs; concurrent use with thioridazine or pimozide.

Adverse reactions:

Nausea, vomiting, drowsiness, dizziness, diarrhea, trouble sleeping, yawning, constipation, or dry mouth may occur. If any of these effects persist or worsen, notify your doctor promptly. Tell your doctor immediately if any of these serious side effects occur: loss of appetite, unusual or severe mental/mood changes, increased sweating/flushing, unusual fatigue, uncontrolled movements (tremor), decreased interest in sex, changes in sexual ability. Tell your doctor immediately if any of these unlikely but serious side effects occur: black stools, blurred vision, change in amount of urine, "coffee ground" vomit, easy bruising/bleeding. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: fainting, irregular heartbeat, muscle pain, trouble swallowing, unusual swelling, seizures, tingling or numbness of the hands/feet. Paroxetine may infrequently cause suicidal thoughts or self-harm urges in children or teenagers up to 18 years of age. Tell the doctor immediately should this occur (see Uses section). Males: In the very unlikely event you have a painful, prolonged erection, stop using this drug and seek immediate medical attention or permanent problems could occur. A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching, swelling, severe dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

Interactions:

Certain medications taken with this product could result in serious, even fatal, drug interactions. Avoid taking MAO inhibitors (e.g., furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, selegiline, tranylcypromine) within 2 weeks before or after treatment with this medication. Consult your doctor or pharmacist for additional information. This drug should not be used with the following medications because very serious (possibly fatal) interactions may occur: astemizole, terfenadine, thioridazine, weight loss drugs (e.g., sibutramine, phentermine). Ask your doctor or pharmacist for more details. Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: antiarrhythmics (e.g., propafenone, flecainide), cimetidine, clozapine, digoxin, herbal/natural products (e.g., melatonin, ayahuasca, St John’s wort), lithium, nefazodone, procyclidine, other drugs which can cause bleeding/bruising (e.g., thrombolytic drugs such as TPA, anticoagulants such as heparin or warfarin, antiplatelet drugs including NSAIDs such as ibuprofen), other SSRI antidepressants (e.g., citalopram, fluoxetine), theophylline, tramadol, trazodone, tricyclic antidepressants (e.g., amitriptyline, nortriptyline), "triptan" migraine drugs (e.g., sumatriptan, zolmitriptan), tryptophan, venlafaxine. Low-dose aspirin (usually 81-325 mg per day) for heart attack or stroke prevention should be continued unless your doctor instructs you otherwise. Aspirin is similar to NSAID drugs, and can increase the risk of bleeding in combination with this medication (see above). Discuss the risks and benefits with your doctor. Tell your doctor if you take any drugs that cause drowsiness such as: anti-anxiety drugs (e.g., diazepam), certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., carbamazepine), medicine for sleep, muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., phenothiazines such as chlorpromazine), sedatives, tranquilizers. Other drugs besides paroxetine which may affect the heart rhythm (QTc prolongation in the EKG) include dofetilide, pimozide, quinidine, sotalol, procainamide, and sparfloxacin among others. QTc prolongation can infrequently result in serious (rarely fatal) irregular heartbeats. Consult your doctor or pharmacist for details. Ask for instructions about whether you need to stop any other QTc-prolonging drugs you may be using in order to minimize the risk of this effect. Do not start or stop any medicine without doctor or pharmacist approval.

Warnings:

Before taking paroxetine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver problems, kidney problems, seizures, heart problems, stomach ulcers, glaucoma (narrow angle type), other mental/mood disorders (e.g., bipolar disorder), thyroid problems. This drug may make you dizzy or drowsy; use caution engaging in activities requiring alertness such as driving or using machinery. Avoid alcoholic beverages. Though uncommon, depression can lead to thoughts or attempts of suicide. Tell your doctor immediately if you have any suicidal thoughts, worsening depression, or any other mental/mood changes (including new or worsening anxiety, agitation, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, rapid speech). Keep all medical appointments so your healthcare professional can monitor your progress closely and adjust/change your medication if needed. Caution is advised when using this product in the elderly because they may be more sensitive to its effects. The elderly are more likely to develop a type of electrolyte imbalance (hyponatremia), especially if they are also taking "water pills" or diuretics with this medication. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. If this medication is used during the last 3 months of pregnancy, infrequently your newborn may develop symptoms including feeding or breathing difficulties, seizures, muscle stiffness, jitteriness, or constant crying. However, do not stop taking this medication unless your doctor directs you to do so. Report any such symptoms to your doctor promptly. This drug passes into breast milk. Because of the potential risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

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Dr. Samer Al-Jneidy

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