The Info List - Paroxetine

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Paroxetine, also known by trade names including Paxil and Seroxat among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is used to treat major depressive disorder, obsessive-compulsive disorder, social anxiety disorder, panic disorder, posttraumatic stress disorder, generalized anxiety disorder and premenstrual dysphoric disorder. It has also been used in the treatment of hot flashes and night sweats associated with menopause.[5] It has a similar tolerability profile to other SSRIs.[6] The common side effects include drowsiness, dry mouth, loss of appetite, sweating, trouble sleeping and delayed ejaculation. It may also be associated with a slightly increased risk of birth defects.[7][8] The rate of withdrawal symptoms in young people may be higher with paroxetine and venlafaxine than other SSRIs and SNRIs.[9] Several studies have associated paroxetine with suicidal thinking and behavior in children and adolescents.[10] Marketing of the drug began in 1992 by the pharmaceutical company SmithKline Beecham, known since 2000 as GlaxoSmithKline. Generic formulations have been available since 2003 when the patent expired.[11] The United States Department of Justice
United States Department of Justice
fined GlaxoSmithKline
$3 billion in 2012, including a sum for withholding data on paroxetine, unlawfully promoting it for under-18s and preparing an article, following one of its clinical trials, study 329, that misleadingly reported the drug was effective in treating adolescent depression.[12][13][14]


1 Medical uses

1.1 Depression 1.2 Panic disorder 1.3 Social anxiety disorder 1.4 Obsessive-compulsive disorder 1.5 Menopausal hot flashes

2 Adverse effects

2.1 Suicide 2.2 Sexual dysfunction 2.3 Pregnancy 2.4 Discontinuation syndrome

3 Overdose 4 Interactions 5 Pharmacology

5.1 Pharmacodynamics 5.2 Pharmacokinetics

6 Society and culture

6.1 Withdrawal symptoms 6.2 Off-label marketing 6.3 Marketing 6.4 Sales 6.5 Trade names

7 Research 8 References 9 External links

Medical uses[edit] Paroxetine
is primarily used to treat major depressive disorder, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety disorder, panic disorder, generalized anxiety disorder, premenstrual dysphoric disorder and menopausal hot flashes.[15][16] Depression[edit] A variety of meta analyses have been conducted to evaluate the efficacy of paroxetine in depression. They have variously concluded that paroxetine is superior or equivalent to placebo and that it is equivalent or inferior to other antidepressants.[17][18][19] Despite this, there was no clear evidence that paroxetine was better or worse compared with other antidepressants at increasing response to treatment at any time point.[20] Panic disorder[edit] Paroxetine
was the first antidepressant formally approved in the United States for the treatment of panic disorder.[21][page needed] Several studies have concluded that paroxetine is superior to placebo in the treatment of panic disorder.[22][23] Social anxiety disorder[edit] Paroxetine
has demonstrated efficacy for the treatment of social anxiety disorder in adults and children.[24][25] There was a significant improvement in scores on the Liebowitz Social Anxiety Scale and Social Phobia Inventory compared with placebo.[26] It is also beneficial for people with co-occurring social anxiety disorder and alcohol use disorder.[27] Obsessive-compulsive disorder[edit] Paroxetine
is used in the treatment of obsessive-compulsive disorder.[28] Comparative efficacy of paroxetine is equivalent to that of clomipramine and venlafaxine.[29][30] Paroxetine
is also effective for children with obsessive-compulsive disorder.[31] Menopausal hot flashes[edit] On June 28, 2013, the U.S. Food and Drug Administration
U.S. Food and Drug Administration
approved low-dose paroxetine for the treatment of moderate-to-severe vasomotor symptoms such as hot flashes and night sweats associated with menopause.[5] At the low dose used for menopausal hot flashes, side effects are similar to placebo and dose tapering is not required for discontinuation.[32] Adverse effects[edit] See also: List of adverse effects of paroxetine Paroxetine
shares many of the common adverse effects of SSRIs, including (with the corresponding rates seen in people treated with placebo in parentheses): nausea 26% (9%), diarrhea 12% (8%), constipation 14% (9%), dry mouth 18% (12%), somnolence 23% (9%), insomnia 13% (6%), headache 18% (17%), hypomania 1% (0.3%), blurred vision 4%(1%), loss of appetite 6% (2%), nervousness 5% (3%), paraesthesia 4% (2%), dizziness 13% (6%), asthenia (weakness; 15% (6%)), tremor 8% (2%), sweating 11% (2%), and sexual dysfunction (≥10% incidence).[4] Most of these adverse effects are transient and go away with continued treatment. Central and peripheral 5-HT3 receptor stimulation is believed to result in the gastrointestinal effects observed with SSRI treatment.[33] Compared to other SSRIs, it has a lower incidence of diarrhea, a higher incidence of anticholinergic effects (e.g., dry mouth, constipation, blurred vision, etc.), sedation/somnolence/drowsiness, sexual side effects, and weight gain.[34] Due to reports of adverse withdrawal reactions upon terminating treatment, the Committee for Medicinal Products for Human Use (CHMP) at the European Medicines Agency
European Medicines Agency
recommends gradually reducing over several weeks or months if the decision to withdraw is made.[35] See also Discontinuation syndrome (withdrawal). Mania
or hypomania may occur in 1% of patients with depression and up to 12% of patients with bipolar disorder.[36] This side effect can occur in individuals with no history of mania but it may be more likely to occur in those with bipolar or with a family history of mania.[37] Suicide[edit] Like other antidepressants, paroxetine may increase the risk of suicidal thinking and behaviour in children and adolescents.[38][39] The FDA conducted a statistical analysis of paroxetine clinical trials in children and adolescents in 2004 and found an increase in suicidality and ideation as compared to placebo, which was observed in trials for both depression and anxiety disorders.[40] In 2015 a paper published in The BMJ
that reanalysed the original case notes argued that in Study 329,[41] assessing paroxetine and imipramine against placebo in adolescents with depression, the incidence of suicidal behavior had been under-reported and the efficacy exaggerated for paroxetine.[42] Sexual dysfunction[edit] See also: Selective serotonin reuptake inhibitor
Selective serotonin reuptake inhibitor
§ Sexual dysfunction Sexual dysfunction, including loss of libido, anorgasmia, lack of vaginal lubrication, and erectile dysfunction, is one of the most commonly encountered adverse effects of treatment with paroxetine and other SSRIs. While early clinical trials suggested a relatively low rate of sexual dysfunction, more recent studies in which the investigator actively inquires about sexual problems suggest that the incidence is higher than 70%.[43] Symptoms of sexual dysfunction have been reported to persist after discontinuing SSRIs, although this is thought to be occasional.[44][45][46] Pregnancy[edit] The American College of Obstetricians and Gynecologists
American College of Obstetricians and Gynecologists
recommends that for pregnant women and women planning to become pregnant, "treatment with all SSRIs or selective norepinephrine reuptake inhibitors or both during pregnancy be individualized and paroxetine use among pregnant women or women planning to become pregnant be avoided, if possible".[7] According to the prescribing information, "epidemiological studies have shown that infants born to women who had first trimester paroxetine exposure had an increased risk of cardiovascular malformations, primarily ventricular and atrial septal defects (VSDs and ASDs). In general, septal defects range from those that are symptomatic and may require surgery to those that are asymptomatic and may resolve spontaneously. If a patient becomes pregnant while taking paroxetine, she should be advised of the potential harm to the fetus. Unless the benefits of paroxetine to the mother justify continuing treatment, consideration should be given to either discontinuing paroxetine therapy or switching to another antidepressant."[47] These conclusions are supported by multiple systematic reviews and meta-analyses that found that, on average, the use of paroxetine during pregnancy is associated with about 1.5–1.7-fold increase in congenital birth defects, in particular, heart defects.[48][49][50][51][52] Discontinuation syndrome[edit] See also: SSRI discontinuation syndrome Many psychoactive medications can cause withdrawal symptoms upon discontinuation from administration. Evidence has shown that paroxetine has among the highest incidence rates and severity of withdrawal syndrome of any medication of its class.[53][medical citation needed] Common withdrawal symptoms for paroxetine include nausea, dizziness, lightheadedness and vertigo; insomnia, nightmares and vivid dreams; feelings of electricity in the body, as well as crying and anxiety.[medical citation needed] Liquid formulation of paroxetine is available and allows a very gradual decrease of the dose, which may prevent discontinuation syndrome. Another recommendation is to temporarily switch to fluoxetine, which has a longer half-life and thus decreases the severity of discontinuation syndrome.[54][55][56][unreliable medical source?] Overdose[edit] Acute overdosage is often manifested by emesis, lethargy, ataxia, tachycardia, and seizures. Plasma, serum, or blood concentrations of paroxetine may be measured to monitor therapeutic administration, confirm a diagnosis of poisoning in hospitalized patients or to aid in the medicolegal investigation of fatalities. Plasma paroxetine concentrations are generally in a range of 40–400 μg/L in persons receiving daily therapeutic doses and 200–2,000 μg/L in poisoned patients. Postmortem blood levels have ranged from 1–4 mg/L in acute lethal overdose situations.[57][58] Along with the other SSRIs, sertraline and fluoxetine, paroxetine is considered a low-risk drug in cases of overdose.[59] Interactions[edit] Interactions with other drugs acting on the serotonin system or impairing the metabolism of serotonin may increase the risk of Serotonin Syndrome
Serotonin Syndrome
or Neuroleptic Malignant Syndrome
Neuroleptic Malignant Syndrome
(NMS)-like reaction. Such reactions have been observed with SNRIs and SSRIs alone, but particularly with concurrent use of triptans, MAO inhibitors, antipsychotics, or other dopamine antagonists. Paroxetine
might interact with statins, resulting in increased blood glucose levels. This was demonstrated in a small retrospective study and needs confirmation in a prospective study.[60] The prescribing information states that paroxetine should "not be used in combination with an MAOI (including linezolid, an antibiotic which is a reversible non-selective MAOI), or within 14 days of discontinuing treatment with an MAOI", and should not be used in combination with pimozide, thioridazine, tryptophan, or warfarin.[47] Paroxetine
interacts with the following cytochrome P450 enzymes:[34][61]

for which it is both a substrate and a potent inhibitor.[1][34] CYP2B6
(strong) inhibitor. CYP3A4
(weak) inhibitor. CYP1A2
(weak) inhibitor. CYP2C9
(weak) inhibitor. CYP2C19
(weak) inhibitor.


Mechanism of paroxetine inhibition of CYP2D6.[62]

Pharmacodynamics[edit] Paroxetine
is the most potent and one of the most specific selective serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibitors (SSRIs).[63] It also binds to the allosteric site of the serotonin transporter, similarly, but less potently, than escitalopram.[64] Paroxetine
also inhibits the reuptake of norepinephrine to a lesser extent (<50 nmol/L).[65] Based on evidence from four weeks of administration in rats, the equivalent of 20 mg paroxetine taken once daily occupies approximately 88% of serotonin transporters in the prefrontal cortex.[61]

Binding profile[66][67][33][61]

Receptor Ki (nM)

SERT 0.34

NET 156

DAT 7,700

D2 963

5-HT1A 21,200

5-HT2A 6,300

5-HT2C 9,034

α1 2,741

α2 3,900

M1 72

M2 340

M3 80

M4 320

M5 650

H1 >10,000

Pharmacokinetics[edit] Paroxetine
is well-absorbed following oral administration.[61] It has an absolute bioavailability of about 50%, with evidence of a saturable first-pass effect.[68] When taken orally, it achieves maximum concentration in about 6–10 hours[61] and reaches steady-state in 7–14 days.[68] Paroxetine
exhibits significant interindividual variations in volume of distribution and clearance.[68] Less than 2% of an oral dose is excreted in urine unchanged.[68] Paroxetine
is a mechanism-based inhibitor of CYP2D6.[62][69]

Metabolism of paroxetine in humans.[69]

Society and culture[edit] GlaxoSmithKline
has paid substantial fines, paid settlements in class-action lawsuits, and become the subject of several highly critical books about its marketing of paroxetine, in particular the off-label marketing of paroxetine for children, the suppression of negative research results relating to its use in children, and allegations that it failed to warn consumers of substantial withdrawal effects associated with use of the drug.[12][13][14] Withdrawal symptoms[edit] In 2002 the U.S. FDA published a warning regarding "severe" discontinuation symptoms among those terminating paroxetine treatment, including paraesthesia, bad dreams, and dizziness. The Agency also warned of case reports describing agitation, sweating, and nausea. In connection with a Glaxo spokesperson's statement that withdrawal reactions occur only in 0.2% of patients and are "mild and short-lived", the International Federation of Pharmaceutical Manufacturers Associations said GSK had breached two of the Federation's codes of practice.[70] Paroxetine
prescribing information posted at GlaxoSmithKline
now acknowledges the occurrence of a discontinuation syndrome, including serious discontinuation symptoms.[47] Off-label marketing[edit] See also: Study 329 In early 2004, GSK agreed to settle charges of consumer fraud for $2.5 million.[71] The legal discovery process also uncovered evidence of deliberate, systematic suppression of unfavorable Paxil research results. One of GSK's internal documents read, "It would be commercially unacceptable to include a statement that efficacy [in children] had not been demonstrated, as this would undermine the profile of paroxetine".[72] In 2012 the U.S. Justice Department
U.S. Justice Department
announced that GSK had agreed to plead guilty and pay a $3 billion fine, in part for promoting the use of Paxil for children.[14] Marketing[edit] On 12 February 2016, the UK Competition and Markets Authority
Competition and Markets Authority
imposed record fines of £45 million on companies which were found to have infringed European Union
European Union
and UK Competition law by entering into agreements to delay the market entry of generic versions of the drug in the UK. GlaxoSmithKline
received the bulk of the fines, being fined £37,600,757. Other companies, which produce generics, were issued fines which collectively total £7,384,146. UK public health services are likely to claim damages for being overcharged in the period where the generic versions of the drug were illegally blocked from the market, as the generics are over 70% less expensive. GlaxoSmithKline may also face actions from other generics manufacturers who incurred loss as a result of the anticompetitive conduct.[73] On 18 April 2016, appeals were lodged with the Competition Appeal Tribunal by the companies which were fined.[74][75][76][77][78] Sales[edit] In 2007, paroxetine was ranked 94th on the list of bestselling drugs, with over $1 billion in sales. In 2006, paroxetine was the fifth-most prescribed antidepressant in the U.S. retail market, with more than 19.7 million prescriptions.[79] In 2007, sales had dropped slightly to 18.1 million but paroxetine remained the fifth-most prescribed antidepressant in the U.S.[80][81] Trade names[edit] Trade names include Aropax, Brisdelle, Deroxat, Paxil,[82] Pexeva, Paxtine, Paxetin, Paroxat, Paraxyl,[83] Sereupin, and Seroxat. Research[edit] Several studies have suggested that paroxetine can be used in the treatment of premature ejaculation. In particular, intravaginal ejaculation latency time (IELT) was found to increase with 6–13-fold, which was somewhat longer than the delay achieved by the treatment with other SSRIs (fluvoxamine, fluoxetine, sertraline, and citalopram).[84][85][86] However, paroxetine taken acutely ("on demand") 3–10 hours before coitus resulted only in a "clinically irrelevant and sexually unsatisfactory" 1.5-fold delay of ejaculation and was inferior to clomipramine, which induced a fourfold delay.[86] There is also evidence that paroxetine may be effective in the treatment of compulsive gambling[87] and hot flashes.[88] Benefits of paroxetine prescription for diabetic neuropathy[89] or chronic tension headache[90] are uncertain. Although the evidence is conflicting, paroxetine may be effective for the treatment of dysthymia, a chronic disorder involving depressive symptoms for most days of the year.[91] References[edit]

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and congenital malformations: meta-Analysis and consideration of potential confounding factors". Clin Ther. 29 (5): 918–26. doi:10.1016/j.clinthera.2007.05.003. PMID 17697910.  ^ "Anti-depressant addiction warning". BBC News. 2001-06-11. Retrieved 2010-05-21.  ^ Haddad PM (March 2001). " Antidepressant
discontinuation syndromes". Drug Saf. 24 (3): 183–97. doi:10.2165/00002018-200124030-00003. PMID 11347722. (Subscription required (help)).  ^ Haddad PM, Anderson IM (November 2007). "Recognising and managing antidepressant discontinuation symptoms". Advances in Psychiatric Treatment. 13 (6): 447–457. doi:10.1192/apt.bp.105.001966 .  ^ Healy, David. "Dependence on Antidepressants & Halting SSRIs". benzo.org.uk. Retrieved 2013-04-23.  ^ Goeringer KE, Raymon L, Christian GD, Logan BK (May 2000). "Postmortem forensic toxicology of selective serotonin reuptake inhibitors: a review of pharmacology and report of 168 cases". J. Forensic Sci. 45 (3): 633–48. PMID 10855970.  ^ R. Baselt,Disposition of Toxic Drugs and Chemicals in Man, 8th edition, Biomedical Publications, Foster City, CA, 2008, pp. 1190–1193. ^ White N, Litovitz T, Clancy C (December 2008). "Suicidal antidepressant overdoses: a comparative analysis by antidepressant type". Journal of Medical Toxicology. 4 (4): 238–250. doi:10.1007/BF03161207. PMC 3550116 . PMID 19031375.  ^ Andrade, C (February 2014). "Selective serotonin reuptake inhibitor drug interactions in patients receiving statins". The Journal of Clinical Psychiatry. 75 (2): e95–9. doi:10.4088/jcp.13f08941. PMID 24602259.  ^ a b c d e Sanchez, C; Reines, EH; Montgomery, SA (July 2014). "A comparative review of escitalopram, paroxetine, and sertraline: Are they all alike?". International clinical psychopharmacology. 29 (4): 185–96. doi:10.1097/YIC.0000000000000023. PMC 4047306 . PMID 24424469.  ^ a b Stepan, Antonia F.; Mascitti, Vincent; Beaumont, Kevin; Kalgutkar, Amit S. (2013). "Metabolism-guided drug design". MedChemComm. 4 (4): 631. doi:10.1039/C2MD20317K.  ^ Mellerup ET, Plenge P (July 1986). "High affinity binding of 3H-paroxetine and 3H-imipramine to rat neuronal membranes". Psychopharmacology. 89 (4): 436–9. doi:10.1007/BF02412117. PMID 2944152.  ^ Mansari ME, Wiborg O, Mnie-Filali O, Benturquia N, Sánchez C, Haddjeri N (February 2007). "Allosteric modulation of the effect of escitalopram, paroxetine and fluoxetine: in-vitro and in-vivo studies". The International Journal of Neuropsychopharmacology. 10 (1): 31–40. doi:10.1017/S1461145705006462. PMID 16448580.  ^ Owens, J. M.; Knight, D. L.; Nemeroff, C. B. (2002-08-01). "[Second generation SSRIS: human monoamine transporter binding profile of escitalopram and R-fluoxetine]". L'Encéphale. 28 (4): 350–355. ISSN 0013-7006. PMID 12232544.  ^ Owens, MJ; Knight, DL; Nemeroff, CB (1 September 2001). "Second-generation SSRIs: human monoamine transporter binding profile of escitalopram and R-fluoxetine". Biological Psychiatry. 50 (5): 345–50. doi:10.1016/s0006-3223(01)01145-3. PMID 11543737.  ^ Roth, BL; Driscol, J (12 January 2011). "PDSP Ki Database". Psychoactive Drug Screening Program (PDSP). University of North Carolina at Chapel Hill and the United States National Institute of Mental Health. Archived from the original on November 8, 2013. Retrieved 22 November 2013.  ^ a b c d Kaye, CM; Haddock, RE; Langley, PF; Mellows, G; Tasker, TC; Zussman, BD; Greb, WH (1989). "A review of the metabolism and pharmacokinetics of paroxetine in man". Acta psychiatrica Scandinavica. Supplementum. 350: 60–75. PMID 2530793.  ^ a b Jornil, J; Jensen, KG; Larsen, F; Linnet, K (March 2010). "Identification of cytochrome P450 isoforms involved in the metabolism of paroxetine and estimation of their importance for human paroxetine metabolism using a population-based simulator". Drug Metabolism and Disposition. 38 (3): 376–85. doi:10.1124/dmd.109.030551. PMID 20007670.  ^ Tonks A (February 2002). "Withdrawal from paroxetine can be severe, warns FDA". BMJ. 324 (7332): 260. doi:10.1136/bmj.324.7332.260. PMC 1122195 . PMID 11823353.  ^ Angell M (15 January 2009). "Drug Companies & Doctors: A Story of Corruption". New York Review of Books. 56 (1).  ^ Kondro W, Sibbald B (March 2004). "Drug company experts advised staff to withhold data about SSRI use in children". CMAJ. 170 (5): 783. doi:10.1503/cmaj.1040213. PMC 343848 . PMID 14993169.  ^ https://www.gov.uk/government/news/cma-fines-pharma-companies-45-million ^ http://www.catribunal.org.uk/files/1252_GlaxoSmithKline_Summary_180416.pdf ^ http://www.catribunal.org.uk/files/1251_Generics_Summary_180416.pdf ^ http://www.catribunal.org.uk/files/1253_Xellia_Summary_180416.pdf ^ http://www.catribunal.org.uk/files/1255_Merck_Summary_180416.pdf ^ http://www.catribunal.org.uk/files/1254_Actavis_Summary_180416.pdf ^ The paroxetine prescriptions were calculated as a total of prescriptions for Paxil CR and generic paroxetine using data from the charts for generic and brand-name drugs."Top 200 generic drugs by units in 2006. Top 200 brand-name drugs by units". Drug Topics, Mar 5, 2007. Retrieved 2007-04-08.  ^ The paroxetine prescriptions were calculated as a total of prescriptions for Paxil CR and generic paroxetine using data from the charts for generic and brand-name drugs."Top 200 generic drugs by units in 2007". Drug Topics. February 18, 2008. Archived from the original on 2009-07-18. Retrieved 2008-10-23.  ^ "Top 200 brand drugs by units in 2007". Drug Topics, Feb 18, 2008. Archived from the original on 2009-06-29. Retrieved 2008-10-23.  ^ Coleman, Andrew (2006). Dictionary of Psychology (Second Edition). Oxford University Press. p. 552.  ^ Coleman, Andrew (2006). Dictionary of Psychology (Second Edition). Oxford University Press. p. 161.  ^ Waldinger MD, Hengeveld MW, Zwinderman AH, Olivier B (August 1998). "Effect of SSRI antidepressants on ejaculation: a double-blind, randomized, placebo-controlled study with fluoxetine, fluvoxamine, paroxetine, and sertraline". Journal of Clinical Psychopharmacology. 18 (4): 274–81. doi:10.1097/00004714-199808000-00004. PMID 9690692.  ^ Waldinger MD, Zwinderman AH, Olivier B (2001). "SSRIs and ejaculation: a double-blind, randomized, fixed-dose study with paroxetine and citalopram". Journal of Clinical Psychopharmacology. 21 (6): 556–60. doi:10.1097/00004714-200112000-00003. PMID 11763001.  ^ a b Waldinger MD, Zwinderman AH, Olivier B (2004). "On-demand treatment of premature ejaculation with clomipramine and paroxetine: a randomized, double-blind fixed-dose study with stopwatch assessment". Eur. Urol. 46 (4): 510–5; discussion 516. doi:10.1016/j.eururo.2004.05.005. PMID 15363569.  ^ Kim SW, Grant JE, Adson DE, Shin YC, Zaninelli R (2002). "A double-blind placebo-controlled study of the efficacy and safety of paroxetine in the treatment of pathological gambling". Journal of Clinical Psychiatry. 63 (6): 501–7. doi:10.4088/JCP.v63n0606. PMID 12088161.  ^ Weitzner MA, Moncello J, Jacobsen PB, Minton S (2002). "A pilot trial of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer". Journal of Pain and Symptom Management. 23 (4): 337–345. doi:10.1016/S0885-3924(02)00379-2. PMID 11997203.  ^ Sindrup SH, Gram LF, Brøsen K, Eshøj O, Mogensen EF (1999). "The selective serotonin reuptake inhibitor paroxetine is effective in the treatment of diabetic neuropathy symptoms". Pain. 42 (2): 135–144. doi:10.1016/0304-3959(90)91157-E. PMID 2147235.  ^ Langemark M, Olesen J (1994). "Sulpiride and paroxetine in the treatment of chronic tension-type headache. An explanatory double-blind trial". Headache. 34 (1): 20–4. doi:10.1111/j.1526-4610.1994.hed3401020.x. PMID 8132436.  ^ Gartlehner G, Gaynes BN, Hansen RA, Thieda P, DeVeaugh-Geiss A, Krebs EE, Moore CG, Morgan L, Lohr KN (November 2008). "Comparative benefits and harms of second-generation antidepressants: background paper for the American College of Physicians". Ann. Intern. Med. 149 (10): 734–50. doi:10.7326/0003-4819-149-10-200811180-00008. PMID 19017592. 

External links[edit]

Wikimedia Commons has media related to Paroxetine.

List of international brand names for paroxetine Detailed Paroxetine
Consumer Information: Uses, Precautions, Side Effects from medlibrary.org

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Antidepressants (N06A)

Specific reuptake inhibitors and/or receptor modulators


Citalopram Escitalopram Fluoxetine# Fluvoxamine Indalpine‡ Paroxetine Sertraline Zimelidine‡


Desvenlafaxine Duloxetine Levomilnacipran Milnacipran Tofenacin Venlafaxine


Atomoxetine Reboxetine Viloxazine


Amineptine‡ Bupropion Nomifensine‡


Mianserin Mirtazapine Setiptiline


Etoperidone Nefazodone Trazodone


Vilazodone Vortioxetine


Agomelatine Amisulpride Esketamine† Etryptamine‡ Indeloxazine flupentixol Ketamine† Medifoxamine‡ Metryptamine‡ Oxaflozane‡ Pivagabine‡ Tandospirone Teniloxazine Tianeptine

and tetracyclic antidepressants


Amineptine‡ Amitriptyline# Amitriptylinoxide Butriptyline‡ Clomipramine# Demexiptiline‡ Desipramine Dibenzepin Dimetacrine‡ Dosulepin Doxepin Imipramine Imipraminoxide‡ Iprindole‡ Lofepramine Melitracen Metapramine‡ Nitroxazepine Nortriptyline Noxiptiline Opipramol Pipofezine Propizepine‡ Protriptyline Quinupramine‡ Tianeptine Trimipramine


Amoxapine Maprotiline Mianserin Mirtazapine Setiptiline



Monoamine oxidase inhibitors


Irreversible: Benmoxin‡ Iproclozide‡ Iproniazid‡ Isocarboxazid Isoniazid# Linezolid# Mebanazine‡ Nialamide‡ Octamoxin‡ Phenelzine Pheniprazine‡ Phenoxypropazine‡ Pivhydrazine‡ Safrazine‡ Tedizolid Tranylcypromine

Reversible: Caroxazone‡

Mixed: Bifemelane


Reversible: Eprobemide Metralindole Minaprine‡ Moclobemide Pirlindole Tetrindole Toloxatone


Irreversible: Selegiline

Adjunctive therapies

Atypical antipsychotics (aripiprazole, brexpiprazole, lurasidone, olanzapine, quetiapine, risperidone) Buspirone Lithium (lithium carbonate, lithium citrate) Thyroid hormones (triiodothyronine (T3), levothyroxine (T4))


(SAMe) Hypericum perforatum
Hypericum perforatum
(St. John's Wort) Oxitriptan
(5-HTP) Rubidium chloride
Rubidium chloride
(RbCl) Tryptophan

#WHO-EM ‡Withdrawn from market Clinical trials:

†Phase III §Never to phase III

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Anxiolytics (N05B)

5-HT1AR agonists

Buspirone Gepirone† Tandospirone


Benzodiazepines: Adinazolam Alprazolam Bromazepam Camazepam Chlordiazepoxide Clobazam Clonazepam Clorazepate Clotiazepam Cloxazolam Diazepam# Ethyl loflazepate Etizolam Fludiazepam Halazepam Ketazolam Lorazepam# Medazepam Nordazepam Oxazepam Pinazepam Prazepam; Others: Alpidem‡ Barbiturates (e.g., phenobarbital) Carbamates (e.g., meprobamate) Chlormezanone‡ Ethanol (alcohol) Etifoxine Imepitoin; Herbs: Kava Skullcap Valerian

Gabapentinoids (α2δ VDCC blockers)

Gabapentin Gabapentin
enacarbil Phenibut Pregabalin


SSRIs (e.g., escitalopram) SNRIs (e.g., duloxetine) SARIs (e.g., trazodone) TCAs (e.g., clomipramine) TeCAs (e.g., mirtazapine) MAOIs (e.g., phenelzine); Others: Agomelatine Bupropion Tianeptine Vilazodone Vortioxetine

Sympatholytics (Antiadrenergics)

Alpha-1 blockers (e.g., prazosin) Alpha-2 agonists (e.g., clonidine, dexmedetomidine, guanfacine) Beta blockers (e.g., propranolol)


Benzoctamine Cannabidiol Cycloserine Fabomotizole Hydroxyzine Kanna Lavender Lorpiprazole Mebicar Mepiprazole Nicotine Opipramol Oxaflozane‡ Phenaglycodol Phenibut Picamilon Selank Tiagabine Tofisopam Validolum

#WHO-EM ‡Withdrawn from market Clinical trials:

†Phase III §Never to phase III

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OCD pharmacotherapies


SSRIs (e.g., fluoxetine, fluvoxamine, sertraline) SNRIs (e.g., venlafaxine) TCAs (e.g., clomipramine) MAOIs (e.g., phenelzine)


Antiandrogens (e.g., cyproterone acetate, leuprorelin) Antipsychotics (e.g., risperidone) Benzodiazepines (e.g., clonazepam) Lamotrigine Memantine Mirtazapine N-Acetylcysteine Ondansetron Pregabalin Psychedelics (e.g., psilocybin) Riluzole Topiramate

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Monoamine reuptake inhibitors


Piperazines: DBL-583 GBR-12783 GBR-12935 GBR-13069 GBR-13098 Nefazodone Vanoxerine

Piperidines: 4-Fluoropethidine Benocyclidine
(BTCP) Desoxypipradrol Dexmethylphenidate Difemetorex Ethylphenidate HDMP-28 Methylphenidate Pethidine
(meperidine) Phencyclidine Pipradrol Tenocyclidine

Pyrrolidines: Diphenylprolinol MDPV Naphyrone Prolintane Pyrovalerone

Tropanes: Altropane Benzatropine
(benztropine) Brasofensine CFT Cocaine Dichloropane Difluoropine Etybenzatropine
(ethybenztropine) FE-β-CPPIT FP-β-CPPIT Ioflupane (123I) RTI-55 RTI-112 RTI-113 RTI-121 RTI-126 RTI-150 RTI-177 RTI-229 RTI-336 Tesofensine Troparil Tropoxane WF-11 WF-23 WF-31 WF-33

Others: Adrafinil Amifitadine Armodafinil Amfonelic acid Amineptine Ansofaxine BTQ BTS 74,398 Bupropion Chaenomeles speciosa Ciclazindol Dasotraline Desmethylsertraline Desmethylsibutramine Diclofensine Didesmethylsibutramine Dimethocaine Diphenylpyraline Dizocilpine
(MK-801) DOV-102,677 DOV-216,303 Efavirenz Ephenidine Esketamine EXP-561 Fencamfamin Fezolamine Fluorenol GYKI-52895 Indatraline Ketamine Lefetamine Levophacetoperane Liafensine LR-5182 Manifaxine Mazindol Medifoxamine Mesocarb Metaphit MIN-117
(WF-516) Modafinil Nefopam Nomifensine NS-2359 O-2172 Oroxylin A Perafensine Pridefine Radafaxine Rimcazole Sertraline Sibutramine Solriamfetol Tametraline Tedatioxetine Tripelennamine Venlafaxine


Selective norepinephrine reuptake inhibitors: Amedalin Alseroxylon Ciclazindol Daledalin Edivoxetine Esreboxetine Lortalamine Mazindol Nisoxetine Reboxetine Talopram Talsupram Tandamine Teniloxazine Viloxazine

Norepinephrine–dopamine reuptake inhibitors: Amineptine Bupropion Fencamine Fencamfamin Hydroxybupropion Lefetamine Levophacetoperane LR-5182 Manifaxine Methylphenidate Nomifensine O-2172 Radafaxine Solriamfetol

Serotonin–norepinephrine reuptake inhibitors: Atomoxetine (tomoxetine) BTS-54505 CP-39,332 Desvenlafaxine Duloxetine Eclanamine Levomilnacipran McN-5652 Milnacipran N-Methyl-PPPA Nafenodone PPPA Tofenacin Venlafaxine WY-45233

Serotonin–norepinephrine–dopamine reuptake inhibitors: 3,3-Diphenylcyclobutanamine Amifitadine Ansofaxine Bicifadine Brasofensine Centanafadine Cocaine Dasotraline Desmethylsertraline Desmethylsibutramine Diclofensine Didesmethylsibutramine DOV-102677 DOV-216303 EXP-561 Fezolamine HDMP-28 Indatraline JNJ-7925476 JZ-IV-10 Liafensine Mazindol Naphyrone Nefazodone Nefopam NS-2359 Perafensine PRC200 Pridefine SEP-228431 SEP-228432 Sibutramine Tedatioxetine Tesofensine Tropanes (e.g., cocaine)

antidepressants: Amitriptyline Butriptyline Cianopramine Clomipramine Desipramine Dosulepin
(dothiepin) Doxepin Imipramine Lofepramine Melitracen Nortriptyline Protriptyline Trimipramine

Tetracyclic antidepressants: Amoxapine Maprotiline Mianserin Oxaprotiline Setiptiline

Others: Antihistamines (e.g., brompheniramine, chlorphenamine, pheniramine, tripelennamine) Antipsychotics (e.g., loxapine, ziprasidone) Arylcyclohexylamines (e.g., ketamine, phencyclidine) Dopexamine Ephenidine Ginkgo biloba Indeloxazine Nefazodone Opioids (e.g., desmetramadol, methadone, pethidine (meperidine), tapentadol, tramadol, levorphanol)


Selective serotonin reuptake inhibitors: Alaproclate Centpropazine Cericlamine Citalopram Dapoxetine Desmethylcitalopram Didesmethylcitalopram Escitalopram Femoxetine Fluoxetine Fluvoxamine Indalpine Ifoxetine Norfluoxetine Omiloxetine Panuramine Paroxetine PIM-35 Pirandamine RTI-353 Seproxetine Sertraline Zimelidine

Selective serotonin reuptake inhibitors
Selective serotonin reuptake inhibitors
and serotonin receptor modulators: Etoperidone Litoxetine Lubazodone LY-393558 SB-649915 TGBA01AD Trazodone Vilazodone Vortioxetine

Serotonin–norepinephrine reuptake inhibitors: Atomoxetine (tomoxetine) Bicifadine BTS-54505 CP-39332 Desvenlafaxine Duloxetine Eclanamine Levomilnacipran McN-5652 Milnacipran N-Methyl-PPPA PPPA Tofenacin Venlafaxine WY-45233

Serotonin–norepinephrine–dopamine reuptake inhibitors: 3,3-Diphenylcyclobutanamine Amifitadine Ansofaxine Bicifadine Brasofensine Centanafadine Cocaine Dasotraline Desmethylsertraline Desmethylsibutramine Diclofensine Didesmethylsibutramine DOV-102677 DOV-216303 EXP-561 Fezolamine HDMP-28 Indatraline JNJ-7925476 JZ-IV-10 Liafensine Mazindol Naphyrone Nefazodone Nefopam NS-2359 Perafensine PRC200 Pridefine SEP-228431 SEP-228432 Sibutramine Tedatioxetine Tesofensine Tropanes (e.g., cocaine)

antidepressants: Amitriptyline Cianopramine Clomipramine Cyanodothiepin Desipramine Dosulepin
(dothiepin) Doxepin Imipramine Lofepramine Nortriptyline Pipofezine Protriptyline

Others: A-80426 Amoxapine Antihistamines (e.g., brompheniramine, chlorphenamine, dimenhydrinate, diphenhydramine, mepyramine (pyrilamine), pheniramine, tripelennamine) Antipsychotics (e.g., loxapine, ziprasidone) Arylcyclohexylamines (e.g., 3-MeO-PCP, esketamine, ketamine, methoxetamine, phencyclidine) Cyclobenzaprine Delucemine Dextromethorphan Dextrorphan Efavirenz Medifoxamine Mesembrine Mifepristone MIN-117
(WF-516) N-Me-5-HT Opioids (e.g., dextropropoxyphene, methadone, pethidine (meperidine), levorphanol, tapentadol, tramadol) Roxindole


Amiodarone Amphetamines (e.g., amphetamine, methamphetamine, MDMA) APP AZIK Bietaserpine Deserpidine Deutetrabenazine Dihydrotetrabenazine Efavirenz GBR-12935 GZ-793A Ibogaine Ketanserin Lobeline Methoxytetrabenazine Reserpine Rose bengal Tetrabenazine Valbenazine Vanoxerine


DAT enhancers: Luteolin

DAT modulators: Agonist-like: SoRI-9804 SoRI-20040; Antagonist-like: SoRI-20041

See also: Receptor/signaling modulators • Monoamine releasing agents • Adrenergics • Dopaminergics • Serotonergics • Monoamine metabolism modulators • Monoamine neurotoxins

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Muscarinic acetylcholine receptor
Muscarinic acetylcholine receptor



77-LH-28-1 AC-42 AC-260,584 Aceclidine Acetylcholine AF30 AF150(S) AF267B Alvameline AQRA-741 Arecoline Bethanechol Bevonium Butyrylcholine Carbachol CDD-0034 CDD-0078 CDD-0097 CDD-0098 CDD-0102 Cevimeline Choline cis-Dioxolane Clozapine Desmethylclozapine
(norclozapine) Ethoxysebacylcholine Itameline LY-593,039 L-689,660 LY-2,033,298 McNA343 Methacholine Milameline Muscarine NGX-267 Ocvimeline Oxotremorine PD-151,832 Pilocarpine RS86 Sabcomeline SDZ 210-086 Sebacylcholine Suberyldicholine Talsaclidine Tazomeline Thiopilocarpine Vedaclidine VU-0029767 VU-0090157 VU-0152099 VU-0152100 VU-0238429 WAY-132,983 Xanomeline YM-796


3-Quinuclidinyl benzilate 4-DAMP Aclidinium bromide
Aclidinium bromide
(+formoterol) Abediterol AF-DX 250 AF-DX 384 Ambutonium bromide Anisodamine Anisodine Antihistamines (first-generation) (e.g., brompheniramine, buclizine, captodiame, chlorphenamine (chlorpheniramine), cinnarizine, clemastine, cyproheptadine, dimenhydrinate, dimetindene, diphenhydramine, doxylamine, meclizine, mepyramine (pyrilamine), mequitazine, perlapine, phenindamine, pheniramine, phenyltoloxamine, promethazine, propiomazine, triprolidine) AQ-RA 741 Atropine Atropine
methonitrate Atypical antipsychotics (e.g., clozapine, fluperlapine, olanzapine (+fluoxetine), rilapine, quetiapine, tenilapine, zotepine) Benactyzine Benzatropine
(benztropine) Benzilone Benzilylcholine mustard Benzydamine BIBN 99 Biperiden Bornaprine Camylofin CAR-226,086 CAR-301,060 CAR-302,196 CAR-302,282 CAR-302,368 CAR-302,537 CAR-302,668 Caramiphen Cimetropium bromide Clidinium bromide Cloperastine CS-27349 Cyclobenzaprine Cyclopentolate Darifenacin DAU-5884 Desfesoterodine Dexetimide DIBD Dicycloverine
(dicyclomine) Dihexyverine Difemerine Diphemanil metilsulfate Ditran EA-3167 EA-3443 EA-3580 EA-3834 Emepronium bromide Etanautine Etybenzatropine
(ethybenztropine) Fenpiverinium Fentonium Fesoterodine Flavoxate Glycopyrronium bromide
Glycopyrronium bromide
(+beclometasone/formoterol, +indacaterol) Hexahydrodifenidol Hexahydrosiladifenidol Hexbutinol Hexocyclium Himbacine HL-031,120 Homatropine Imidafenacin Ipratropium bromide
Ipratropium bromide
(+salbutamol) Isopropamide J-104,129 Hyoscyamine Mamba toxin 3 Mamba toxin 7 Mazaticol Mebeverine Meladrazine Mepenzolate Methantheline Methoctramine Methylatropine Methylhomatropine Methylscopolamine Metixene Muscarinic toxin 7 N-Ethyl-3-piperidyl benzilate N-Methyl-3-piperidyl benzilate Nefopam Octatropine methylbromide
Octatropine methylbromide
(anisotropine methylbromide) Orphenadrine Otenzepad (AF-DX 116) Otilonium bromide Oxapium iodide Oxitropium bromide Oxybutynin Oxyphencyclimine Oxyphenonium bromide PBID PD-102,807 PD-0298029 Penthienate Pethidine pFHHSiD Phenglutarimide Phenyltoloxamine Pipenzolate bromide Piperidolate Pirenzepine Piroheptine Pizotifen Poldine Pridinol Prifinium bromide Procyclidine Profenamine
(ethopropazine) Propantheline bromide Propiverine Quinidine Revefenacin Rociverine RU-47,213 SCH-57,790 SCH-72,788 SCH-217,443 Scopolamine (hyoscine) Scopolamine butylbromide (hyoscine butylbromide) Silahexacyclium Sofpironium bromide Solifenacin SSRIs (e.g., femoxetine, paroxetine) Telenzepine Terodiline Tetracyclic antidepressants
Tetracyclic antidepressants
(e.g., amoxapine, maprotiline, mianserin, mirtazapine) Tiemonium iodide Timepidium bromide Tiotropium bromide Tiquizium bromide Tofenacin Tolterodine Tricyclic
antidepressants (e.g., amitriptyline (+perphenazine), amitriptylinoxide, butriptyline, cidoxepin, clomipramine, desipramine, desmethyldesipramine, dibenzepin, dosulepin (dothiepin), doxepin, imipramine, lofepramine, nitroxazepine, northiaden (desmethyldosulepin), nortriptyline, protriptyline, quinupramine, trimipramine) Tridihexethyl Trihexyphenidyl Trimebutine Tripitamine (tripitramine) Tropacine Tropatepine Tropicamide Trospium chloride Typical antipsychotics (e.g., chlorpromazine, chlorprothixene, cyamemazine (cyamepromazine), loxapine, mesoridazine, thioridazine) Umeclidinium bromide
Umeclidinium bromide
(+vilanterol) WIN-2299 Xanomeline Zamifenacin

Precursors (and prodrugs)

Acetyl-coA Adafenoxate Choline
(lecithin) Citicoline Cyprodenate Dimethylethanolamine Glycerophosphocholine Meclofenoxate
(centrophenoxine) Phosphatidylcholine Phosphatidylethanolamine Phosphorylcholine Pirisudanol

See also: Receptor/signaling modulators • Nicotinic acetylcholine receptor modulators • Acetylcholine
metabolism/transport modulators

v t e



Pakistan GlaxoSmithKline
Pharmaceuticals Ltd Stiefel Laboratories ViiV Healthcare (85%)

Predecessors, acquisitions

Allen & Hanburys Beecham Group Block Drug Burroughs Wellcome Glaxo Glaxo Wellcome Human Genome Sciences Recherche et Industrie Thérapeutiques Reliant Pharmaceuticals S. E. Massengill Company SmithKline Beecham Smith, Kline & French




Advair Alli Augmentin Avandia Beconase Boniva Flixonase Hycamtin Lamictal Paxil/Seroxat Serlipet Tagamet Ventolin Wellbutrin/Zyban Zantac … more


Hepatyrix Pandemrix Twinrix


Aquafresh Horlicks Nicoderm Nicorette NiQuitin Sensodyne Tums
… more


BC Powder Geritol Goody's Powder Lucozade Ribena


Board of Directors

Philip Hampton Emma Walmsley Simon Dingemans Roy M. Anderson Manvinder Banga Patrick Vallance Vivienne Cox Lynn Elsenhans Jesse Goodman Judy Lewent Urs Rohner Laurie Glimcher


Thomas Beecham Silas M. Burroughs Mahlon Kline John K. Smith Henry Wellcome Andrew Witty Chris Gent


Canada v. GlaxoSmithKline
Inc. Christopher v. SmithKline Beecham Corp. GlaxoSmithKline
Services Unlimited v Commission United States v. Glaxo Group Ltd. United States v. GlaxoSmithKline


Drug Industry Document Archive GlaxoSmithKline
Prize Side Effects Study 3