Paroxetine. An
update of its pharmacology and therapeutic use in depression and a review of
its use in other disorders
by
Gunasekara NS, Noble S, Benfield P
Adis International Limited,
Auckland, New Zealand.
demail@adis.co.nz
Drugs 1998 Jan; 55(1):85-120
ABSTRACT
Paroxetine is a potent and
selective inhibitor of the neuronal reuptake of serotonin
(5-hydroxytryptamine; 5-HT), which was previously reviewed as an
antidepressant in Drugs in 1991. Since then, more comparative trials with
other antidepressants have become available, and its use in the elderly and
as long term maintenance therapy has been investigated. Paroxetine has also
been studied in several other disorders with a presumed serotonergic
component, primarily obsessive compulsive disorder (OCD) and panic disorder.
In short term clinical trials in patients with depression, paroxetine
produced clinical improvements that were significantly greater than those
with placebo and similar to those achieved with other agents including
tricyclic antidepressants (TCAs), maprotiline, nefazodone and the selective
serotonin reuptake inhibitors (SSRIs) fluoxetine, fluvoxamine and sertraline.
Long term data suggest that paroxetine is effective in preventing relapse or
recurrence of depression in patients treated for up to 1 year. In the
elderly, the overall efficacy of paroxetine was at least as good as that of
comparator agents. In short term clinical trials involving patients with OCD
or panic disorder, paroxetine was significantly more effective than placebo
and of similar efficacy to clomipramine. Limited long term data show that
paroxetine is effective in maintaining a therapeutic response over periods
of 1 year (OCD) and up to 6 months (panic disorder). Preliminary data
suggest that paroxetine has potential in the treatment of social phobia,
premenstrual dysphoric disorder and chronic headache. Like the other SSRIs,
paroxetine is better tolerated than the TCAs, causing few anticholinergic
adverse effects. The most commonly reported adverse event associated with
paroxetine treatment is nausea, although this is generally mild and subsides
with continued use. Fewer withdrawals from treatment due to adverse effects
occurred with paroxetine treatment than with TCAs. The adverse events
profile of paroxetine appears to be broadly similar to that of other SSRIs,
although data from comparative trials are limited. Serious adverse effects
associated with paroxetine are very rare. In conclusion, paroxetine is
effective and well tolerated, and suitable as first-line therapy for
depression. It also appears to be a useful alternative to other available
agents for the treatment of patients with OCD or panic disorder.
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