|Systematic (IUPAC) name|
|Trade names||Paxil, Pexeva, Brisdelle, Rexetin|
|Licence data||US FDA:|
|Bioavailability||Extensively absorbed from the GI tract, but extensive first-pass metabolism in the liver|
|Metabolism||Extensive, hepatic (mostly CYP2D6-mediated)|
|Excretion||Renal (64%; 2% unchanged and 62% as metabolites), Faecal (36%; <1% unchanged)|
|(what is this?)|
Paroxetine (also known by the trade name Paxil among others) is an antidepressant drug of the SSRI type. Paroxetine is used to treat major depression, obsessive-compulsive disorder, panic disorder, social anxiety, posttraumatic stress disorder, generalized anxiety disorder and vasomotor symptoms (e.g. hot flashes and night sweats) associated with menopause in adult outpatients.
Marketing of the drug began in 1992 by the pharmaceutical company SmithKline Beecham, now GlaxoSmithKline. Generic formulations have been available since 2003 when the patent expired. As with all antidepressants there may be an increased risk of suicidality in patients receiving paroxetine, although the only solid evidence regarding this is with regard to children and young adults under the age of 25.
Differences between newer antidepressants are usually fairly subtle and mostly confined to side effects. It shares the common side effects and contraindications of other SSRIs, with high rates of nausea, sleepiness, and sexual side effects. Paroxetine is associated with weight gain. Discontinuing paroxetine is associated with a high risk of withdrawal syndrome. Paroxetine is the only SSRI proven to be associated with an increased risk of birth defects.
- 1 Medical uses
- 2 Contraindications
- 3 Adverse effects
- 4 Overdose
- 5 Interactions
- 6 Pharmacology
- 7 Formulations
- 8 Society and culture
- 9 Research
- 10 References
- 11 External links
Paroxetine is primarily used to treat major depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder, generalized anxiety disorder (GAD), social phobia/social anxiety disorder, premenstrual dysphoric disorder (PMDD) and menopausal hot flashes.
Paroxetine was the first antidepressant formally approved in the United States for the treatment of panic attacks.
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 to or inferior to other antidepressants.
Menopausal hot flashes
On June 28, 2013 U.S. FDA approved low dose paroxetine – for the treatment of moderate-to-severe vasomotor symptoms (e.g. hot flashes and night sweats) associated with menopause. Randomized controlled trials have shown modest relief in such cases. At the low dose used for menopausal hot flashes side effects are similar to placebo and dose tapering is not required for discontinuation.
The 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." 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." 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.
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%), diarrhoea 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). 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. Compared to other SSRIs it has a lower incidence of diarrhoea, a higher incidence of anticholinergic effects (e.g. dry mouth, constipation, blurred vision, etc.), sedation/somnolence/drowsiness, sexual side effects and weight gain.
Due to reports of adverse withdrawal reactions upon terminating treatment, CHMP recommends to reduce gradually over several weeks or months if the decision to withdraw is made. 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. 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.
Paroxetine may increase the risk of suicidal ideation and suicidal behaviour in children and adolescents. Because suicide is rare, it is difficult to test its relationship with the use of paroxetine. Some studies instead analyze suicidality, which generally refers to suicidal ideation and suicidal behaviour. The FDA conducted a statistical analysis of paroxetine clinical trials in children and adolescents in 2004, finding an increase in "suicidality" and ideation as compared to placebo; the trend for increased "suicidality" was observed in both trials for depression and for anxiety disorders.
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. 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. 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.
In addition, The Lancet published an analysis of World Health Organization data showing SSRIs taken during pregnancy may cause withdrawal symptoms, including convulsions, in newborn children: among "93 suspected cases of SSRI-induced neonatal withdrawal syndrome...64 were associated with paroxetine, 14 with fluoxetine, nine with sertraline, and seven with citalopram."
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 200–2000 μg/L in poisoned patients. Postmortem blood levels have ranged from 1–4 mg/L in acute lethal overdose situations. It is usually considered, along with the other SSRIs, sertraline and fluoxetine to be a low-risk drug in cases of overdose.
- The development of a potentially life-threatening serotonin syndrome or Neuroleptic Malignant Syndrome (NMS)-like reactions have been reported with SNRIs and SSRIs alone, including treatment with PAXIL, but particularly with concomitant use of serotonergic drugs (including triptans) with drugs that impair metabolism of serotonin (including MAOIs), or with antipsychotics or other dopamine antagonists.
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.
- CYP2D6 for which it is both a substrate and a potent inhibitor.
- CYP2B6 (strong) inhibitor.
- CYP3A4 (weak) inhibitor.
- CYP1A2 (weak) inhibitor.
- CYP2C9 (weak) inhibitor.
- CYP2C19 (weak) inhibitor.
Paroxetine is the most potent and one of the most specific selective serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibitors (SSRIs). It also binds to the allosteric site of the serotonin transporter, similarly, but less potently than escitalopram. This activity of the drug on brain neurons is thought to be responsible for its antidepressant effects. Paroxetine inhibits the reuptake of norepinephrine more than the other SSRIs, just as sertraline inhibits the reuptake of dopamine more than the other SSRIs.
- SERT (Ki = 0.08 nM)
- NET (Ki = 56.7 nM)
- DAT (Ki = 573.7 nM)
- The following muscarinic acetylcholine receptors (mAChRs):
- α1 adrenoceptor (Ki>100,000 nM)
- Histamine H1 receptor (Ki=22,000 nM)
Paroxetine CR (controlled release) was shown to be associated with a lower rate of nausea during the first week of treatment than paroxetine immediate release. However, the rate of treatment discontinuation due to nausea was not significantly different.
Society and culture
GlaxoSmithKline has paid substantial fines, paid settlements in class action lawsuits, and become the subject of several highly critical books in relation to its marketing of paroxetine, in particular the off-label marketing of paroxetine to 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.
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.
The suppression of unfavorable research findings on Paxil by GSK — and the legal discovery process that uncovered it — is the subject of Alison Bass's 2008 book Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial.
Off-label marketing to children
In early 2004, GSK agreed to settle charges of consumer fraud for $2.5 million. The legal discovery process also uncovered evidence of deliberate, systematic suppression of unfavorable Paxil research results. One of GSK's internal documents had said, "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".
In 2012 the 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.
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 United States retail market, with more than 19.7 million prescriptions. In 2007, sales had dropped slightly to 18.1 million but paroxetine remained the fifth-most prescribed antidepressant in the U.S.
In 1999 paroxetine was the second SSRI (after fluvoxamine) to be approved in Japan. Paroxetine became the first and non-hormonal prescription therapy for menopausal hot flashes approved by FDA.
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). 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.
Emerging evidence shows that antipsychotics can be used as a supplement or alternative to paroxetine in patients with generalised anxiety disorder.
- "PRODUCT INFORMATION PAROXETINE SANDOZ 20mg FILM-COATED TABLETS" (PDF). TGA eBusiness Services. Sandoz Pty Ltd. 18 January 2012. Retrieved 22 November 2013.
- "PAROXETINE (paroxetine hydrochloride hemihydrate) tablet, film coated [Mylan Institutional Inc.]". DailyMed. Mylan Institutional Inc. January 2012. Retrieved 22 November 2013.
- "Paroxetine 20 mg Tablets – Summary of Product Characteristics (SPC)". electronic Medicines Compendium. Sandoz Limited. 21 March 2013. Retrieved 22 November 2013.
- "Paxil, Paxil CR (paroxetine) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 22 November 2013.
- Katzman MA (2009). "Current considerations in the treatment of generalized anxiety disorder". CNS Drugs 23 (2): 103–20. doi:10.2165/00023210-200923020-00002. PMID 19173371.
- Food and Drug Administration (June 28, 2013). "FDA NEWS RELEASE: FDA approves the first non-hormonal treatment for hot flashes associated with menopause".
- Smith, Aaron (May 11, 2005). "New profit twist for drugmakers". CNN Money.
- Papakostas GI (2008). "Tolerability of modern antidepressants". J Clin Psychiatry 69 (Suppl E1): 8–13. PMID 18494538.
- Haddad PM (2001). "Antidepressant discontinuation syndromes". Drug Saf 24 (3): 183–97. doi:10.2165/00002018-200124030-00003. PMID 11347722.
- 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.
- "ACOG Committee Opinion No. 354: Treatment with selective serotonin reuptake inhibitors during pregnancy". Obstet Gynecol 108 (6): 1601–3. 2006. doi:10.1097/00006250-200612000-00058. PMID 17138801.
- Baldwin DS, Anderson IM, Nutt DJ, Bandelow B, Bond A, Davidson JR, den Boer JA, Fineberg NA, Knapp M, Scott J, Wittchen HU (2005). "Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology". Journal of Psychopharmacology 19 (6): 567–596. doi:10.1177/0269881105059253. PMID 16272179.
- Baldwin D, Bobes J, Stein DJ, Scharwächter I, Faure M (1999). "Paroxetine in social phobia/social anxiety disorder. Randomised, double-blind, placebo-controlled study. Paroxetine Study Group". The British Journal of Psychiatry 175 (2): 120–6. doi:10.1192/bjp.175.2.120. PMID 10627793.
- Yonkers KA, Gullion C, Williams A, Novak K, Rush AJ (1996). "Paroxetine as a treatment for premenstrual dysphoric disorder". Journal of Clinical Psychopharmacology. 16 (1): 3–8. doi:10.1097/00004714-199602000-00002. PMID 8834412.
- Turner, Francis Joseph (2005). Social Work Diagnosis in Contemporary Practice. Oxford University Press US. ISBN 0-19-516878-X.
- Hansen R, Gaynes B, Thieda P, et al. (October 2008). "Meta-analysis of major depressive disorder relapse and recurrence with second-generation antidepressants". Psychiatr Serv 59 (10): 1121–30. doi:10.1176/appi.ps.59.10.1121. PMC 2840386. PMID 18832497.
- Dunner DL, Lipschitz A, Pitts CD, Davies JT (December 2005). "Efficacy and tolerability of controlled-release paroxetine in the treatment of severe depression: post hoc analysis of pooled data from a subset of subjects in four double-blind clinical trials". Clin Ther 27 (12): 1901–11. doi:10.1016/j.clinthera.2005.12.013. PMID 16507376.
- Carpenter DJ, Fong R, Kraus JE, Davies JT, Moore C, Thase ME (November 2011). "Meta-analysis of efficacy and treatment-emergent suicidality in adults by psychiatric indication and age subgroup following initiation of paroxetine therapy: a complete set of randomized placebo-controlled trials". J Clin Psychiatry 72 (11): 1503–14. doi:10.4088/JCP.08m04927blu. PMID 21367354.
- Barbui C, Furukawa TA, Cipriani A (Jan 29, 2008). "Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials". CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 178 (3): 296–305. doi:10.1503/cmaj.070693. PMC 2211353. PMID 18227449.
- Tignol J, Stoker MJ, Dunbar GC (November 1992). "Paroxetine in the treatment of melancholia and severe depression". Int Clin Psychopharmacol 7 (2): 91–4. doi:10.1097/00004850-199207020-00005. PMID 1487627.
- Gartlehner G, Gaynes BN, Hansen RA, et al. (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.
- Cipriani A, Furukawa TA, Salanti G, et al. (February 2009). "Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis". Lancet 373 (9665): 746–58. doi:10.1016/S0140-6736(09)60046-5. PMID 19185342.
- FDA NEWS RELEASE: FDA approves the first non-hormonal treatment for hot flashes associated with menopause, Jun. 28, 2013http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm359030.htm
- Orleans, Ronald J.; Li, Li; Kim, Myong-Jin; Guo, Jia; Sobhan, Mahboob; Soule, Lisa; Joffe, Hylton V. (2014). "FDA Approval of Paroxetine for Menopausal Hot Flushes". New England Journal of Medicine 370 (19): 1777–1779. doi:10.1056/NEJMp1402080. ISSN 0028-4793. PMID 24806158.
- "PAXIL (paroxetine hydrochloride) Tablets and Oral Suspension: PRESCRIBING INFORMATION" (PDF). Research Triangle Park, NC: GlaxoSmithKline. August 2007. Archived from the original on 2011-08-25. Retrieved 2007-08-14.
- Thormahlen GM (October 2006). "Paroxetine use during pregnancy: is it safe?". Ann Pharmacother 40 (10): 1834–7. doi:10.1345/aph.1H116. PMID 16926304.
- Way CM (2007). "Safety of newer antidepressants in pregnancy". Pharmacotherapy 27 (4): 546–52. doi:10.1592/phco.27.4.546. PMID 17381382.
- Bellantuono C, Migliarese G, Gentile S (2007). "Serotonin reuptake inhibitors in pregnancy and the risk of major malformations: a systematic review". Hum Psychopharmacol 22 (3): 121–8. doi:10.1002/hup.836. PMID 17397101.
- Källén B (July 2007). "The safety of antidepressant drugs during pregnancy". Expert Opin Drug Saf 6 (4): 357–70. doi:10.1517/147403184.108.40.2067. PMID 17688379.
- Bar-Oz B, Einarson T, Einarson A, Boskovic R, O'Brien L, Malm H, Bérard A, Koren G (May 2007). "Paroxetine 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.
- Brunton, L; Chabner, B; Knollman, B (2010). Goodman and Gilman's The Pharmacological Basis of Therapeutics (in English) (12th ed.). New York: McGraw-Hill Professional. ISBN 978-0-07-162442-8.
- Ciraulo, DA; Shader, RI, ed. (2011). Pharmacotherapy of Depression. SpringerLink (2nd ed.) (New York, NY: Humana Press). doi:10.1007/978-1-60327-435-7. ISBN 978-1-60327-434-0.
- "Press release, CHMP meeting on Paroxetine and other SSRIs" (PDF). European Medicines Agency. 2004-12-09. Retrieved 2007-08-24.[dead link]
- Morishita S, Arita S (October 2003). "Induction of mania in depression by paroxetine". Hum Psychopharmacol 18 (7): 565–8. doi:10.1002/hup.531. PMID 14533140.
- Hammad TA (2004-08-16). "Review and evaluation of clinical data: relationship between psychotropic drugs and pediatric suicidality" (PDF). Joint Meeting of the Psychopharmacologic Drugs Advisory Committee and Pediatric Advisory Committee. September 13–14, 2004. Briefing Information. FDA. p. 30. Retrieved 2009-01-27.
- "Anti-depressant addiction warning". BBC News. 2001-06-11. Retrieved 2010-05-21.
- Skaehill, Penny A.; Welch, E.B. (October 1997). "Clinical Reviews: SSRI Withdrawal Syndrome". American Society of Consultant Pharmacists. Archived from the original on 2006-05-03. Retrieved 2007-08-15.
- Bhanji NH, Chouinard G, Kolivakis T, Margolese HC (2006). "Persistent tardive rebound panic disorder, rebound anxiety and insomnia following paroxetine withdrawal: a review of rebound-withdrawal phenomena" (PDF). Can J Clin Pharmacol 13 (1): e69–74. PMID 16456219.
- 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.
- on Antidepressants & Halting SSRIs by Dr David Healy MD, FRCPsych[dead link]. benzo.org.uk. Retrieved on 2013-04-23.
- SSRIs Given During Pregnancy May Cause Withdrawal Symptoms in the Neonate. Medscape.com (2005-02-03). Retrieved on 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.
- Mellerup ET, Plenge P (July 1986). "High affinity binding of3H-paroxetine and3H-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.
- 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. Retrieved 22 November 2013.
- Golden RN, Nemeroff CB, McSorley P, Pitts CD, Dubé EM (2002). "Efficacy and tolerability of controlled-release and immediate-release paroxetine in the treatment of depression". Journal of Clinical Psychiatry 63 (7): 577–584. doi:10.4088/JCP.v63n0707. PMID 12143913.
- "Withdrawal from paroxetine can be severe, warns FDA | BMJ".
- 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.
- Thomas, Katie; Schmidt, Michael S. (July 2, 2012). "Glaxo Agrees to Pay $3 Billion in Fraud Settlement". The New York Times.
- 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.
- Higuchi T, Briley M (February 2007). "Japanese experience with milnacipran, the first serotonin and norepinephrine reuptake inhibitor in Japan". Neuropsychiatric Disease and Treatment 3 (1): 41–58. doi:10.2147/nedt.2007.3.1.41. PMC 2654524. PMID 19300537.
- 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.
- 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.
|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
- The Secrets of Seroxat, BBC Panoramainvestigation
- Healthy Skepticism's repository and analysis of GSK documents related to Study 329