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Analogs of Paxil: Paroxetine.
Other names for this medication:
Aropax, Casbol, Deroxat, Divarius, Eutimil, Frosinor, Motivan, Parotur,  Paroxat, Paroxetina, Paroxetinum, Pexep cr,  Pexeva,  Sereupin,  Seroxat,  Tagonis,  Xet.

Paxil is an antidepressant from the group of selective serotonin reuptake inhibitors (SSRIs), which enhances the effects of serotonin in the structures of the brain.
The drug has antidepressant and anti-anxiety effects, and therefore is used to treat any type of depression (reactive, panic, social phobia, etc.), obsessive-compulsive disorder, panic attacks, social phobia and other anxiety conditions.

Composition, release forms and photos Paxil
Currently, Paxil is available in a single dosage form – it is a tablet for oral administration. Tablets have an oval, biconvex form and are painted white. On one side of the pill Paksila there is a risk, and on the other engraving “20”.
The drug is available in packs of 10, 30 or pieces.

Paxil tablets as an active substance contain 20 mg of paroxetine.

And as auxiliary substances in the preparation includes the following components:
☞ Calcium hydrogen phosphate dihydrate;
☞ Carboxymethyl starch of sodium type A;
☞ Magnesium stearate; Hypromellose;
☞ Titanium dioxide;
☞ Macrogol;
☞ Polysorbate.

Therapeutic effect and scope of application

Therapeutic effects of Paxil

The therapeutic effects of Paxil are determined by its ability to selectively block the reuptake of serotonin, thereby prolonging the pharmacological effects of this substance.
That is, the therapeutic effects of Paxil are determined precisely by the properties of serotonin. The most important and pronounced effects of the drug are antidepressant (timoanaleptic) and anti-anxiety, which determine the scope of Paxil, which consists in the treatment of various types of anxiety and depressive disorders.
The drug is effective in treating obsessive-compulsive disorder in children older than 7 years and adults, since it significantly improves the patient’s condition during the first 1 to 2 weeks of taking Paxil. Also, Paxil during the first weeks of administration significantly improves the condition of people suffering from depression with suicidal thoughts.
The drug is effective in cases when treatment with antidepressants from other classification groups was useless. In addition to treatment Paxil can be used to prevent relapses of depression. In panic states (attacks, phobias, etc.)  Paxil is effective only in combination with nootropic drugs (for example, Pikamilon, Pyracetam, Nootropil, etc.) and tranquilizers.

Paxil moderately stimulates the central nervous system, but does not have amphetamine-like action. Taking the drug in the morning does not impair the quality and duration of sleep, so its reception does not necessitate additional use of sleeping pills or other means.
In most cases, while taking Paxil, sleep even improves. However, if necessary, the drug can be combined with hypnotic drugs of short action, improving only the process of falling asleep and not affecting the structure of sleep. Paxil does not disturb or inhibit the work of the brain, does not affect blood pressure, heart rate and electroencephalogram.

When does Paxil come into play?
Visible and significant effects of Paxil develop and begin to be felt by a person within 1 to 2 weeks after the beginning of the admission. Practitioners on the basis of observations of patients concluded that the first effect of Paxil may be felt as early as one week after the initiation of admission, but a more persistent and noticeable effect that positively affects a person’s quality of life is usually observed after 2 weeks.

Paxil – indications for use
Paxil is indicated for use in the treatment of the following diseases of the human psyche:
◈ Depression of any type (eg, reactive, severe, depressed with anxiety, etc.);
◈ Obsessive-compulsive disorder (painful compulsive thoughts or actions that make a person struggle with some hypothetical possible problems);
◈ Panic disorder with agoraphobia (fear of open space) or without it;
◈ Social phobia is a persistent fear before performing any actions in public, (for example, speaking) or attention from other people (for example, gazing);
◈ Generalized anxiety disorder (excessive daily anxiety about various events or daily activities);
◈ Post-traumatic stress disorder (protracted reaction to any stress).

Paxil can be used for basic, supporting treatment and prevention of relapses of obsessive-compulsive and panic disorders, as well as social phobia and generalized anxiety disorder. With depression and post-traumatic stress disorder, Paxil is used only for treatment.

Instructions for use
General rules for use Paxil
Paxil tablets should be taken once a day in the morning with food. The tablet should be swallowed whole, not chewing and not crushing in other ways, but with a small amount of water.
Paxil must be taken for a long period of time, which will be sufficient to stop all negative symptoms.
Usually effective is the use of Paxil for several months. Specific dosages and duration of drug intake are determined by the disease, for which Paxil is used. When depressed, Paxil is recommended to take 20 mg (1 tablet) per day.
Usually effective is the use of Paxil for several months. Specific dosages and duration of drug intake are determined by the disease, for which Paxil is used. When depressed, Paxil is recommended to take 20 mg (1 tablet) per day.
Moreover, the dosage should be increased gradually, weekly adding 10 additional mg. For example, in the first week another 10 mg are added to 20 mg, and for 30 days (30 mg) (1.5 tablets) of Paxil are taken.
If this dosage has a sufficient clinical effect, then it is no longer increased and Paxil 30 mg is taken throughout the course of therapy. If the clinical effect is still insufficient, then next week the dosage is increased by another 10 mg and taken within 7 days of 40 mg (2 tablets) of Paxil.
Then evaluate the effectiveness of therapy and decide whether to increase or unchanged dosage. The duration of the course of treatment is from 4 to 12 months, after which Paksil is gradually canceled.
*With obsessive-compulsive* and panic disorder, the optimal therapeutic dosage of Paxil for adults is 40 mg per day, and the maximum allowable dosage is 60 mg. However, the drug is taken from 20 mg per day, bringing the daily dosage to 40 mg, adding to this every week for 10 mg.
For example, in the first week, take 20 mg (1 tablet) of Paxil, the second – 30 mg (1.5 tablets), and from the third week and during the subsequent course of therapy, they drink 40 mg (2 tablets) per day. If the human condition does not improve within two weeks, the dosage of Paxil can be increased to 60 mg (3 tablets) per day, adding 10 mg every week.
For children, the optimal dosage of Paxil for treating obsessive-compulsive disorder is 20 to 30 mg per day, and the maximum allowable dose is 50 mg. Start taking the drug should be 10 mg per day, weekly increasing the dosage by 10 mg.
A low initial dosage is necessary in order to minimize the risk of increasing the symptoms of panic disorder, which may develop at the beginning of treatment with antidepressants of any pharmacological group.
Duration of therapy for obsessive-compulsive disorder is up to six months, and panic disorder – from 4 to 8 months.

*With social phobia*, the optimal dosage for adults is 20 mg per day, and for children and adolescents 8 to 17 years, 10 mg. The maximum daily dosage for children and adults is 50 mg. To start taking Paxil at any age should be with 10 mg (0.5 tablets) per day, weekly increasing the dosage by 10 mg. At the end of each week, a person’s condition is recorded and a conclusion is made about the effectiveness of Paxil dosage.
If it was recognized as effective enough, the dosage is no longer increased, but left unchanged until the end of the course of therapy. Duration of therapy is from 4 to 10 months.

*With generalized anxiety disorder*, the optimal dosage of Paxil is 20 mg (1 tablet) per day, and the maximum allowable dosage is 50 mg (2.5 tablets). Begin taking the drug with 20 mg per day and two weeks later evaluate the effectiveness of therapy. If the clinical effect is sufficiently pronounced, the dosage is not increased and left so until the end of the course of treatment. If the effect of Paxil is insufficient, then the dosage is increased weekly by 10 mg until the painful symptoms are effectively suppressed.
The duration of therapy is up to 8 months.

*In the case of posttraumatic stress disorder*, it is recommended to take 20 mg (1 tablet) of Paxil once a day. If the symptom severity did not decrease after two weeks from the beginning of the therapy, the dosage of Paxil can be increased to 50 mg per day, every week adding 10 mg. The duration of therapy is an average of 4 to 7 months.

Reception start
Paxil should start taking one tablet a day, and then after two weeks, evaluate the effect of therapy. If the clinical effect is insufficient, then the dosage is increased by 10 mg every week until it provides the optimal therapeutic effect.
If Paxil is planned after the completion of therapy with drugs from the MAO inhibitor group, then between them should be sure to withstand an interval of at least two weeks.

Canceling Paxil
The drug should be withdrawn gradually to avoid the development of withdrawal and deterioration.

Optimal stop taking Paxil according to the following scheme:
⓵. From the initial dosage, take 10 mg and take Paxil for 7 days in the amount received. For example, a person took a drug of 50 mg, so within a week he needs to drink only 40 mg of the drug.
⓶. Then weekly reduce the dosage of Paxil by 10 mg until it reaches 20 mg.
⓷. Take Paxil 20 mg once a day for a week, then completely stop taking the drug.

If the symptoms of the disorder come back when the dosage is reduced or the drug is completely discarded, that is, the withdrawal syndrome develops, then Paxil should be resumed at the previous dose. After 2 – 3 weeks, the drug is again gradually phased out, reducing the dosage more slowly.
In such cases, the dosage of Paxil is reduced by 10 mg not weekly, but once every 2 to 3 weeks.

Paxil during 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 doubles the risk of developing congenital anomalies, such as defects in the interventricular and atrial septa.
In addition, some newborns whose mothers were taking Paxil in the third trimester of pregnancy (from 26 to 40 weeks) had complications, such as:
☞ distress syndrome;
☞ cyanosis;
☞ apnea;
☞ convulsive seizures;
☞ temperature instability;
☞ difficulties with feeding;
☞ vomiting;
☞ hypoglycemia;
☞ arterial hypertension;
☞ hypotension;
☞ strengthened reflexes;
☞ 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, Paxil reduces the quality of spermatozoa in men, therefore, 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.

Special instructions
In elderly people (over 65 years of age) the concentration of Paxil in blood plasma is usually higher than that of young people. Therefore, the maximum allowable dosage of the drug for the elderly is 40 mg (2 tablets) per day. In addition, in elderly people the drug can cause a decrease in the level of sodium in the blood, which is self-restored after the completion of therapy.
People suffering from severe liver and kidney diseases should take Paxil in a minimally effective dosage equal to 20 mg per day. When using antidepressants in children and adolescents, the risk of developing suicidal behavior, aggression, anger, deviant behavior and hostility to others is very high.
Therefore, before using Paxil in adolescents, you must carefully weigh all possible negative phenomena and positive effects, and only after that make the final decision. Also during the entire period of therapy Paksilom should carefully monitor the condition of the adolescent, and with its significant deterioration, when the negative effects will outweigh the positive, cancel the drug.
The risk of developing suicidal behavior with Paxil taking about depression is much higher in young patients (under 25 years) compared with mature (over 25 years) and elderly (over 65). You can say that the younger a person, the higher the risk of suicidal behavior against the background of taking Paxil.
This circumstance should be considered when prescribing the drug, and carefully monitor the behavior of young people against the background of the entire period of therapy. In addition, a person receiving Paxil should be told to immediately consult a doctor if he sees a suicidal idea or behavior.
The highest risk of development of suicidal thoughts is noted at the initial stages of recovery. Taking Paxil can also provoke akathisia, which is manifested by a feeling of anxiety and psychomotor agitation, when a person feels the need to constantly do something, walk, etc., and can not sit, lie or stand quietly.
The need to constantly do something is painful for a person. Usually akathisia develops during the initial stages of treatment, and after a few weeks passes. In rare cases, Paxil can provoke a serotonin syndrome, which is deadly. Therefore, when the first signs of serotonin syndrome appear, you should immediately stop taking the drug.

This syndrome can be manifested by the following symptoms:
♢ Increased body temperature;
♢ Rigidity of muscles;
♢ Increased muscle tone of extensor muscles;
♢ Vegetative disorders;
♢ Confusion of consciousness;
♢ Irritability;
♢ Agitation (excited state).

The use of Paxil for depression can provoke the accelerated development of mania, since often manic disorders begin precisely with a major depressive episode. In this case, when signs of mania appear, Paksil should be canceled and the person transferred to other psychotropic medications.
Accordingly, people who have been afflicted with mania in the past must take Paxil with caution. Paxil does not increase the risk of convulsive seizures, so it can be used in the therapy of people suffering from epilepsy. However, throughout the course of treatment, one should observe the patient’s condition, and with the development of convulsive seizure, immediately stop taking Paxil.
Also with caution, use Paxil in the presence of glaucoma or a tendency to bleeding. Throughout the course of Paksil therapy, a person has an increased tendency to fracture of bones.

Influence of Paksil reception on the ability to control mechanisms
Paxil does not impair the cognitive and psychomotor functions of the central nervous system, and therefore, against the background of its use, a person can control various mechanisms, including driving a car. However, when performing such actions, you should use reasonable care, stop working, as soon as there are any feelings or symptoms that subjectively interfere with a person.

Overdose Paksilom develops only at a one-stage intake of more than 2000 mg (100 tablets) and is manifested by increased side effects and the following additional symptoms:
◆ Vomiting;
◆ Sharp enlargement of pupils;
◆ Fever;
◆ Blood pressure jumps;
◆ Tachycardia (palpitation);
◆ Involuntary muscle contraction;
◆ Anxiety;
◆ Agitation (strong agitation).

Since there is no specific antidote, in case of an overdose of Paxil, a person should be placed in an intensive care unit, rinsed of the stomach, given a sorbent and maintained the normal functioning of vital organs. In rare cases, Paxil overdoses result in fatalities, but this usually occurs when it is taken concomitantly with other psychotropic drugs or alcohol.

Drug interaction with other drugs
The use of Paxil concurrently with other drugs with serotonin effects (all MAO inhibitors and SSRIs, tryptophan, triptans, tramadol, linezolid, lithium and St. John’s Wort), causes an increase in side effects.
The use of Paxil concurrently with Terfenadine, Alprozalam, Carbamazepine, Phenytoin or sodium valproate is safe and possible without adjusting the dosage.
Paxil increases the concentration in the blood of other antidepressants, neuroleptics, Risperidone, Propafenone, Flecainide, Procyclidine and Metoprolol, so when they are taken simultaneously, you need to reduce the dosage of the latter.

Paxil and alcohol
From the point of view of drug interaction Paxil is compatible with alcohol, therefore theoretically during treatment it is possible to use hot drinks. However, practitioners categorically do not recommend combining alcohol with Paxil, as this can provoke the following negative effects:
⋄ Single use of alcohol on the eve of taking Paxil significantly reduces the effect of the drug;
⋄ The systematic use of alcohol causes excessive strengthening of both the positive effects of Paxil and its side effects.

Side effects
Paxil can provoke the development of the following side effects from various organs and systems:

➀. System of blood and lymph:
✧ Bleeding;
✧ Hemorrhage in the skin or mucous membranes;
✧ Decrease in the total number of platelets.

➁. Immune system: allergic reactions of various types and intensities.

➂. Endocrine system: disruption of the production of antidiuretic hormone (ADH).

➃. Metabolism:
✧ Impairment of appetite;
✧ Reducing the concentration of sodium in the blood (hyponatremia).

➄. Eyes:
✧ Blurred vision;
✧ Exacerbation of glaucoma.

➅. Cardiovascular system:
✧ Tachycardia;
✧ Increase or decrease of pressure.

➆. Central nervous system:
✧ Drowsiness;
✧ Insomnia;
✧ Confusion of consciousness;
✧ Hallucinations;
✧ Manic disorder;
✧ Convulsions.

➇. Respiratory system: yawning.

➈. Alimentary tract:
✧ Nausea;
✧ Constipation;
✧ Diarrhea;
✧ Dry mouth;
✧ Gastrointestinal bleeding;
✧ Increase of activity of transaminases (ASAT, ALAT);
✧ Hepatitis;
✧ Liver failure.

➉. Skin and soft tissues:
✧ Sweating;
✧ Rashes on the skin;
✧ Photosensitivity.

⑪. Genitourinary system:
✧ Delayed urination;
✧ Sexual dysfunction;
✧ Galactorrhea (milk production);
✧ Increased prolactin levels in the blood (hyperprolactemia).

⑫. Common disorders:
✧ Asthenic syndrome;
✧ Edema.

Paxil cancellation syndrome
With the development of withdrawal syndrome, the following symptoms may appear in a person:
✶ Dizziness;
✶ Disturbance of sensitivity, for example, sensation of running creeps or electric shock, and also noise in the ears;
✶ Sleep disturbance;
✶ Agitation (nervous excitation) in combination with anxiety;
✶ Nausea;
✶ Tremor of limbs;
✶ Confusion of consciousness;
✶ Sweating;
✶ Headache;
✶ Diarrhea.

Most often, the above symptoms are mild or moderate and appear in response to the withdrawal of the drug in the first few days. Also can be noted in people who missed taking several Paxil tablets in a row.
The withdrawal syndrome passes independently for two weeks and does not require special treatment. The formation of such a withdrawal syndrome does not mean that Paxil causes addiction like narcotic, it is simply due to the need to change the settings of the mediator exchange in the brain, which takes some time.
Therefore, all psychotropic drugs begin to take and not abolish abruptly, but gradually gaining or decreasing the dosage. In children and adolescents, the withdrawal syndrome of Paxil, in addition to the above symptoms, can manifest itself in the development of suicidal behavior, emotional instability, nervousness, tearfulness and abdominal pain.

Contraindications for use
Paxil is contraindicated in the following cases:
◈ Simultaneous administration with MAO inhibitors, Thioridazine, Pimozide and methylene blue;
◈ Age younger than 18 years in the treatment of depression;
◈ Age younger than 7 years in the treatment of various conditions with the exception of depression;
◈ Hypersensitivity or allergic reactions to the components of the drug.