Patient/caregiver was educated on precautions to be exercised while taking paxil as follows:
- Serotonin is one chemical in the brain, which in permissible amounts, is believed to reduce anxiety and promote happiness and well-being. Very excessive concentrations of serotonin in the brain can lead to serotonin syndrome. Individuals with serotonin syndrome can present with mania, excitement, hallucinations, agitation, insomnia, pounding heartbeat, very rapid heart rate, overactive reflexes, and diarrhea. Paxil use, especially along with other antidepressants acting on the same lines, such as, fluoxetine, citalopram, and sertraline, can significantly increase the serotonin levels in the body and lead to development of serotonin syndrome. Paxil use along with a few other antidepressants, such as, phenelzine, selegiline, and tranylcypromine can also significantly increase the serotonin levels in the body and lead to development of serotonin syndrome. Paxil use is discouraged along with these medications. Caution must be exercised even when discontinuing on any of the above mentioned antidepressant medications with potential to increase serotonin levels and starting on paxil, by observing a window period of atleast 2 weeks, before the transition to paxil is made. This helps with complete elimination of these medications from the body, reduce the risk for interaction with paxil, and reduce risk for development of serotonin syndrome.
- Individuals with complaint of dehydration, secondary to history of diarrhea, vomiting, or poor fluid intake, can suffer electrolyte disturbances and be more prone to develop arrhythmias with paxil. Also, paxil carries the risk of increasing diarrhea, thus worsening the fluid deficit and dehydration. Electrolyte disturbances, such as, low potassium and magnesium levels, secondary to diuretic pill intake, can also act as a precipitating factor for cardiac arrhythmias with paxil. Observing compliance with recommended supplement intake and/or hydration measures can help prevent development of arrhythmias in these individuals. Also, observe compliance with any periodical lab draws ordered for electrolyte levels and closely follow for development of signs and symptoms of cardiac arrhythmia, such as, episodes of chest pain, rapid heart rate, palpitations, dizziness, and shortness of breath. Report any such findings to your physician immediately, so that, an alternative plan of care could be considered.
