Social Anxiety Disorder
Premenstrual Dysphoric Disorder
Off-label use for generalized anxiety disorder, obsessive compulsive disorder, and posttraumatic stress disorder.
Selective Serotonin Reuptake Inhibitor (SSRI). Different from Paxil IR because of an enteric-coated “geomatrix,” which delays release of the drug by 4 to 5 hours.
Supplied in 12.5 mg yellow, 25 mg pink, and 37.5 mg blue tablets (not breakable).
Many patients tolerate a starting dose of 25 mg QD.
Start at 12.5 mg QD for the elderly or those most susceptible to side effects. Can be taken QAM or QPM (may be either sedating or activating).
Effective dose 12.5 mg to 62.5 mg QD.
Most common are nausea, fatigue, insomnia, and sexual dysfunction; its cousin, Paxil IR, is considered by most practitioners to cause more weight gain, sexual dysfunction, and fatigue than all of the other SSRIs
Causes less initial nausea and possibly less weight gain than Paxil IR
Black Box Warning: In clinical trials, SSRIs and SNRIs increased the risk of suicidality in children (from 2% to 4%). No actual suicides occurred in these trials, and none of the trials included MAOIs, but all antidepressants are required to carry this warning anyway.
Pregnancy Category D (risk of congenital heart defects, neonatal distress)
Inhibits 2D6; will increase effective serum levels of tricyclics, phenothiazines, type 1C antiarrythmics; contraindicated with mellaril
Highly protein-bound, so monitor dilantin, coumadin, and digoxin levels may be increased
Significant withdrawal syndrome if not gradually tapered; warn patients of dizziness, insomnia, electrical shock sensations.