Generally these symptoms are mild to moderate, but in some patients they may be severe. Usually they occur in the first few days after preparation, but in rare cases occur in patients who inadvertently missed reception of only one dose.
Usually, these are the symptoms disappear spontaneously within 2 weeks, but some patients may last much longer (2-3 months or more). It recommended to where to buy testosterone enanthate reduce the dose of paroxetine gradually, over several weeks or months before full cancellation, depending on the particular needs of the patient.
The emergence of withdrawal symptoms does not mean that the drug is abused or cause dependence, as is the case with narcotic drugs and psychotropic substances. Symptoms that may occur when you stop treatment with paroxetine in children and adolescents: As a result of clinical trials in children and adolescents occurrence adverse events with the abolition of paroxetine was 32%, whereas the incidence of adverse events in the placebo group was 24%. Symptoms cancellation paroxetine (emotional lability, including suicidal ideation, suicide attempt, mood changes and tearfulness, as well as nervousness, dizziness, nausea and abdominal pain) were recorded in 2% of patients on the background of reducing the dose of paroxetine or after its complete abolition and met 2 times more often than in the placebo group. fractures Based on the results of epidemiological studies of risk of bone fractures revealed a connection of bone fractures with antidepressants, including SSRIs. The risk was observed during the course of antidepressant treatment and was maximal at the beginning of therapy.The possibility of fractures should be considered in the appointment of paroxetine.
Interaction with other medicinal products and other forms of interaction Serotonergic drugs: The use of paroxetine, as well as other drugs of SSRI, together with serotonergic drugs (including L-tryptophan, triptans, tramadol, drugs SSRI, fentanyl, lithium and herbal remedies containing St. John’s wort ) can cause effects associated with 5-HT (serotonin syndrome). The use of paroxetine with MAO inhibitors (including linezolid, an antibiotic which can be transformed into neselektivnsh MAO inhibitor) is contraindicated. Pimozide: raising pimozide were reported in the study of the possibility of joint use of paroxetine and a low dose pimozide (2 mg single dose). This fact is explained by the well-known property of paroxetine inhibit CYP2D6 system. Due to the narrow therapeutic index of pimozide and its known ability to prolong QT interval, the combined use of pimozide and paroxetine contraindicated. Using these drugs in combination with paroxetine must be careful to carry out careful clinical monitoring. The enzymes involved in the metabolism of drugs: Metabolism and pharmacokinetics of paroxetine can vary under the influence of the induction or inhibition of enzymes involved in the metabolism of drugs.
When using paroxetine simultaneously inhibitor of enzymes involved in the metabolism of drugs should assess the feasibility of using paroxetine, located in the lower where to buy testosterone enanthate range of therapeutic doses. The starting dose of paroxetine is not necessary to correct, if it is used together with the drug, which is a known inducer of enzymes involved in drug metabolism (e.g., carbamazepine, rifampin, phenobarbital, phenytoin).Any subsequent dosage adjustment of paroxetine should be determined by its clinical effects (tolerability and efficacy). Fosamprenavir / ritonavir: The combined use of fosamprenavir / ritonavir with paroxetine significantly decreased paroxetine plasma concentrations. Any subsequent dosage adjustment of paroxetine should be determined by its clinical effects (tolerability and efficacy). Protsiklidina:Daily intake significantly increases the paroxetine protsiklidina plasma concentrations. If you have anticholinergic effects protsiklidina dose should be reduced. Anticonvulsants: carbamazepine, phenytoin, sodium valproate. The simultaneous use of these drugs paroxetine and does not affect their pharmacokinetics and pharmacodynamics in patients with epilepsy.
The ability to inhibit the enzyme CYP2D6 paroxetine As with other antidepressants, including SSRIs other drugs, paroxetine inhibits hepatic enzyme CYP2D6, belonging to the cytochrome P450 system. Inhibition of CYP2D6 enzyme can lead to increased plasma concentrations simultaneously used drugs which are metabolized by this enzyme. These drugs include tricyclic antidepressants (e.g., amitriptyline, nortriptyline, imipramine and desipramine), phenothiazine neuroleptics series (and perphenazine, thioridazine), risperidone, atomoxetine, some type 1c antiarrhythmics (e.g., flecainide and propafenone) and metoprolol. The use of paroxetine, which inhibits CYP2D6 system can reduce the concentration of the active metabolite of tamoxifen in the blood plasma, and as a result, reduce the effectiveness of tamoxifen. CYP3A4 interaction study in vivo , while the application in-equilibrium conditions, paroxetine and terfenadine, which is a substrate of the enzyme CYP3A4 revealed that paroxetine has no effect on the pharmacokinetics of terfenadine. In a similar study the interaction in vivo has not been found to influence the pharmacokinetics of paroxetine alprazolam, and vice versa.
Concomitant use of paroxetine with terfenadine, alprazolam and other drugs that are substrates of the enzyme CYP3A4, is unlikely to cause harm to the patient. Clinical studies have shown that the absorption and pharmacokinetics of paroxetine is independent or almost independent (ie existing relationship does not require a change in dose ) from:
- alcohol: paroxetine where to buy testosterone enanthate does not increase the negative effects of alcohol on psychomotor functions, however, is not recommended while taking paroxetine and alcohol.