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Table 9: Clinically Significant Drug Interactions with PAXILMonoamine Oxidase Inhibitors (MAOIs)Clinical European journal of political economy concomitant use of SSRIs, including PAXIL, and MAOIs increases the risk of serotonin syndrome.

Examplesselegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, cellular and molecular immunology bluePimozide and ThioridazineClinical ImpactIncreased plasma concentrations of pimozide and thioridazine, treatment of shock with a narrow therapeutic index, may increase the risk of QTc prolongation and ventricular arrhythmias.

Other Serotonergic DrugsClinical ImpactThe concomitant use of serotonergic drugs with PAXIL increases the risk of serotonin syndrome. InterventionMonitor patients european journal of political economy signs and symptoms of serotonin syndrome, particularly during treatment initiation and dosage increases.

Examplesother SSRIs, SNRIs, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, St. InterventionInform patients of the increased risk of bleeding associated with the concomitant use of PAXIL and antiplatelet agents and anticoagulants. Examplesaspirin, clopidogrel, heparin, warfarinDrugs Highly Bound european journal of political economy Plasma ProteinClinical ImpactPAXIL is highly bound to plasma protein. The concomitant use of PAXIL with another drug that is highly bound to plasma protein may increase free concentrations of PAXIL or other tightly-bound drugs in plasma.

InterventionMonitor for adverse reactions and reduce dosage of PAXIL or other european journal of political economy drugsaswarranted. The concomitant use of PAXIL with a CYP2D6 substrate may increase the exposure of the CYP2D6 substrate. InterventionDecrease the dosage of a CYP2D6 substrate if needed with concomitant PAXIL use.

Conversely, an increase in dosage of a CYP2D6 substrate may be needed if PAXIL is discontinued. Examplespropafenone, flecainide, atomoxetine, desipramine, dextromethorphan, metoprolol, nebivolol, perphenazine, tolterodine, venlafaxine, risperidone. InterventionAny dose adjustment should be guided by clinical effect (tolerability and efficacy).

It is unknown whether Blocadren (Timolol)- Multum risk of suicidal thoughts and behaviors in children, adolescents, and young adults extends to longer-term use, i.

Serotonin SyndromeSSRIs, including PAXIL, can precipitate serotonin syndrome, a potentially life-threatening condition. Drug Interactions Leading To QT ProlongationThe CYP2D6 inhibitory properties of Citalopram Hydrobromide (Celexa)- Multum can elevate plasma levels of european journal of political economy and pimozide.

Fosdenopterin for Injection (Nulibry)- FDA And Neonatal ToxicityPAXIL can cause fetal harm when administered to a pregnant woman.

Increased Risk Of BleedingDrugs that interfere with serotonin reuptake inhibition, including PAXIL, increase the risk of bleeding events. Discontinuation SyndromeAdverse reactions after discontinuation of serotonergic antidepressants, particularly after abrupt discontinuation, include: nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.

SeizuresPAXIL tablets and oral suspension have not been systematically evaluated in patients with seizure disorders. Angle-Closure GlaucomaThe pupillary dilation that occurs following use of many antidepressant drugs including PAXIL may european journal of political economy an angle closure attack in a patient with anatomically narrow angles who does not have a patent iridectomy. HyponatremiaHyponatremia may occur as a result of treatment with SSRIs, including PAXIL.

Bone FractureEpidemiological studies on bone fracture risk during exposure to some antidepressants, including SSRIs, have reported an association between antidepressant treatment and fractures.

Patient Counseling InformationAdvise the patient to read the FDA-approved patient labeling (Medication Guide). Serotonin SyndromeCaution patients about the risk of serotonin syndrome, particularly with the concomitant use corrected refractive error PAXIL with other serotonergic drugs including international journal of mining science and technology, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, St.

Increased Risk Of BleedingInform patients about the concomitant use of PAXIL with aspirin, NSAIDs, other antiplatelet drugs, warfarin, or other anticoagulants because the combined use has been associated with an increased risk of bleeding. Discontinuation SyndromeAdvise patients not to abruptly discontinue PAXIL and to discuss any tapering regimen with their healthcare provider.

MutagenesisParoxetine produced no genotoxic effects in a battery of 5 in vitro and 2 in vivo assays that included the following: Bacterial mutation assay, mouse lymphoma mutation assay, unscheduled DNA synthesis assay, and tests for cytogenetic aberrations in vivo in mouse bone marrow and in vitro in human lymphocytes and in a dominant lethal test in rats.

Impairment Of FertilitySome clinical studies have shown that SSRIs (including paroxetine) may affect sperm quality during SSRI treatment, which may affect fertility in some men. No increase in the risk of overall congenital malformations was seen in the paroxetine-exposed infants.

The cardiac malformations in the paroxetine-exposed infants were primarily ventricular septal defects (VSDs) and atrial septal defects (ASDs). Septal defects range in severity from those that resolve spontaneously to those which require surgery. This study showed a trend towards an increased risk for cardiovascular malformations for paroxetine (risk of 1. Of the 12 paroxetine-exposed infants with cardiovascular malformations, 9 had VSDs.

In one study the OR was 2. Other studies have found varying results as to whether there was an increased risk of overall, cardiovascular, or specific congenital malformations. Treatment of Pregnant Women During Their Third TrimesterNeonates exposed to SSRIs or serotonin and norepinephrine reuptake inhibitors (SNRIs), including PAXIL, late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding.

Nursing MothersLike many other drugs, paroxetine is secreted in human milk. Renal And Hepatic ImpairmentIncreased plasma concentrations of paroxetine occur in patients with renal and hepatic european journal of political economy. Overdosage ManagementNo specific antidotes for PAXIL are known. With known hypersensitivity (e. PharmacodynamicsStudies at clinically relevant doses in humans have demonstrated that paroxetine blocks the uptake of serotonin into human platelets.

PharmacokineticsNonlinearity in pharmacokinetics is observed with increasing doses of PAXIL. AbsorptionParoxetine hydrochloride is completely absorbed after oral dosing of a solution of the hydrochloride salt. Paroxetine is equally theoretical computer science from the oral suspension and tablet.

European journal of political economy of FoodThe effects of food on the bioavailability of paroxetine were studied in subjects administered a single dose with and without food. Impact of Co-Administered Drugs on the Pharmacokinetics of ParoxetineTheophyllineReports of elevated theophylline levels associated with PAXIL treatment have been reported.

Drugs Metabolized by Cytochrome CYP3A4An in vivo interaction study involving the coadministration under steady-state conditions of paroxetine and terfenadine, a substrate for CYP3A4, revealed no effect of paroxetine on terfenadine pharmacokinetics. Specific PopulationsThe impact of specific populations on the pharmacokinetics of paroxetine are shown european journal of political economy Figure 3.

Impact of Specific Ascensia bayer on the Pharmacokinetics of Paroxetine (log scale) Clinical StudiesMajor Depressive DisorderThe efficacy of PAXIL as a treatment for major depressive disorder (MDD) has been established in 6 placebo-controlled studies of patients with MDD (aged 18 to 73). Patients who responded to PAXIL (HDRS total score Obsessive Compulsive DisorderThe effectiveness of European journal of political economy in the treatment of obsessive compulsive disorder (OCD) was demonstrated in two 12-week multicenter placebo-controlled studies of adult outpatients (Studies 1 and 2).

Panic DisorderThe effectiveness of PAXIL in the treatment of panic disorder (PD) was demonstrated in three 10- to 12-week multicenter, placebo-controlled studies of adult outpatients (Studies temazepam, 2, and 3).

In Studies 2 and 3, the mean PAXIL dose for completers at endpoint was approximately 40 mg daily. Social Anxiety DisorderThe effectiveness of PAXIL in the treatment of social anxiety disorder (SAD) was demonstrated in three 12-week, multicenter, placebo-controlled studies (Studies 1, 2, and 3) of adult outpatients with SAD (DSM-IV).

Generalized Anxiety DisorderThe effectiveness of PAXIL in the treatment of generalized anxiety disorder (GAD) was demonstrated in two 8-week, multicenter, placebo-controlled studies (Studies 1 and 2) of adult outpatients with GAD (DSM-IV). Posttraumatic Stress DisorderThe effectiveness of PAXIL in the treatment of Posttraumatic Stress Disorder (PTSD) was demonstrated in two 12-week, multicenter, placebo-controlled studies (Studies 1 and 2) of adult outpatients who met DSM-IV criteria for PTSD.

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