Paroxetine has been demonstrated to be an effective treatment for several psychiatric disorders, including major depression and virtually all of the anxiety disorders. It is well tolerated with convenient once-daily dosing and is available in both IR and CR formulations. Most patients can expect symptomatic relief within 4 weeks, and some patients as early as 2 weeks. Concern for pharmacokinetic interactions with other drugs is minimal, although concomitant MAOI use is contraindicated. Overdosage rarely results in significant toxicity, rendering paroxetine a judicious choice among available psychotropics for the impulsive or suicidal patient. Paroxetine should be used cautiously in the treatment of pediatric anxiety disorders and sparingly in child and adolescent patients with depression. Its use in pregnancy remains controversial and requires more data to resolve safety concerns. In the postpartum setting, however, nursing very likely poses a negligible exposure risk to infants of mothers receiving treatment with paroxetine.
Paroxetine, with its wide application and favorable safety profile, represents an important member of the SRI class of drugs, although it appears to behave as an SNRI at higher doses. It continues to be evaluated for efficacy in the treatment of other psychiatric and nonpsychiatric disorders.
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