paroxetine, low dose
paroxetine, low dose
(par-ox-e-teen),Brisdelle
(trade name)Classification
Therapeutic: antidepressantsPharmacologic: selective serotonin reuptake inhibitors ssris
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (improvement in VMS)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | within 4 wk | unk | unk |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- Neuroleptic malignant syndrome (life-threatening)
- seizures (life-threatening)
- suicidal ideation
- fatigue
- headache
Ear, Eye, Nose, Throat
- angle closure glaucoma
Gastrointestinal
- nausea
- vomiting
Fluid and Electrolyte
- hyponatremia (associated with syndrome of inappropriate antidiuretic hormone secretion
Hematologic
- bleeding
Musculoskeletal
- bone fractures
Neurologic
- akisthesia
Miscellaneous
- serotonin syndrome (life-threatening)
Interactions
Drug-Drug interaction
Serious, potentially fatal reactions (hyperthermia, rigidity, myoclonus, autonomic instability, with fluctuating vital signs and extreme agitation, which may proceed to delirium and coma) may occur with concurrent MAO inhibitor therapy (including linezolid and methylene blue. MAO inhibitors should be stopped at least 14 days prior to paroxetine therapy. Paroxetine should be stopped at least 14 days prior to MAO inhibitor therapy.May ↓ metabolism and ↑ effects of certain drugs that are metabolized by the liver, including other antidepressants, phenothiazines, class ICantiarrhythmics, risperidone, atomoxetine, theophylline, procyclidine, and quinidine. Concurrent use should be undertaken with caution.Concurrent use with pimozide or thioridazine may ↑ risk of QT interval prolongation and torsades de pointes; concurrent use contraindicated.Cimetidine ↑ blood levels.Phenobarbital and phenytoin may ↓ effectiveness.Concurrent use with alcohol is not recommended.May ↓ the effectiveness of digoxin and tamoxifen.May ↑ risk of bleeding with warfarin, aspirin, or NSAIDS.Concurrent use with 5-HT1 agonists (frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan ), fentanyl, lithium, or tramadol may result in ↑ serotonin levels and lead to serotonin syndrome.↑ risk of serotonergic side effects including serotonin syndrome with St. John’s wort, SAMe, and tryptophan.Route/Dosage
Availability
Nursing implications
Nursing assessment
- Used only for vasomotor symptoms, not depression or bipolar disorder. Assess patient for signs and symptom of bipolar disorder with detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression prior to starting therapy.
- Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient. Risk may be increased in children, adolescents, and adults ≤24 yr.
- Assess for serotonin syndrome (mental changes [agitation, hallucinations, coma], autonomic instability [tachycardia, labile BP, hyperthermia], neuromuscular aberations [hyper reflexia, incoordination], and/or GI symptoms [nausea, vomiting, diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, triptans, St. John's Wort, librium).
- Lab Test Considerations: May cause hyponatremia. Monitor serum sodium levels if signs and symptoms occur.
Potential Nursing Diagnoses
Deficient knowledge, related to medication regimen (Patient/Family Teaching)Implementation
- Oral: Administer at bedtime with or without food.
Patient/Family Teaching
- Instruct patient to take paroxetine as directed. Take missed doses as soon as possible, unless almost time for next dose; do not double doses. Advise patient to read Medication Guide before starting and with each Rx refill in case of changes.
- May cause drowsiness or dizziness. Caution patient to avoid driving and other activities requiring alertness until response to the drug is known.
- Inform patient of risk of increased fractures with paroxetine.
- Advise patient, family and caregivers to look for suicidality, especially during early therapy or dose changes. Notify health care professional immediately if thoughts about suicide or dying, attempts to commit suicide, new or worse depression or anxiety, agitation or restlessness, panic attacks, insomnia, new or worse irritability, aggressiveness, acting on dangerous impulses, mania, or other changes in mood or behavior or if symptoms of serotonin syndrome or neuroleptic malignant syndrome occur.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications and to avoid alcohol or other CNS-depressant drugs during therapy.
- Advise patient to notify health care professional if signs and symptoms of hyponatremia (difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness) or restlessness (inner restlessness, agitation, nervousness, or inability to sit still or stand still, especially at beginning of therapy) occur or if headache, fatigue, nausea, and vomiting persists.
- Instruct female patient to inform health care professional if pregnancy is planned or suspected or if breastfeeding.
Evaluation/Desired Outcomes
- Reduction of moderate to severe hot flashes associated with menopause