Paroxetine (Paxil)

Approved for major depressive disorder, OCD, panic disorder, social anxiety disorder, premenstrual dysphoric disorder, generalized anxiety disorder, and posttraumatic stress disorder.

A selective serotonin reuptake inhibitor.

Decreases CYP2D6 activity resulting in drug interactions and had potent P-glycoprotein inhibitory activity.

Initially metabolized through cytochrome P450 (CYP) 2D6 which is subject to genetic variation and inhibition.

As a CYP2D6 inhibitor it decreases the conversion of tamoxifen to an active metabolite, endoxifen, and is not recommended for women taking that drug.

Co-administration with digoxin can lead to digitalis intoxication as a result of P-glycoprotein inhibition.

Among 527 fetuses exposed to this selective serotonin reuptake inhibitor (SSRI) drug in the first trimester, 23 were born with major congenital malformations.

The most common congenital malformations among fetuses exposed to this drug in the first trimester were cardiovascular and primarily ventricular septal defects, with an absolute magnitude of risk of heart defects approximately 2% (compared to unexposed infants at 1%).

A Canadian study revealed an association between cardiac malformations and a daily dose that was greater than 25 mg during pregnancy.

Approved for the treatment of moderate to severe vasomotor symptoms associated with menopause.

Induces hyponatremia in 12% of elderly patients with a median duration of 9 days (Fabian).

Warnings for treatment emergent suicidality, particularly in adolescents and young adults.

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