Patient/caregiver was educated on precautions to be exercised while taking paroxetine as follows:
- Paroxetine intake can also induce a life-threatening reaction called Neuroleptic Malignant Syndrome (NMS). Individuals with NMS can present with high fever, episodes of confusion, intense muscle rigidity and contractions, elevated blood pressure, and rapid heart rate. Uncontrolled seizure activity and intense muscle contractions from paroxetine use can lead to muscle damage and breakdown. Potassium ion from within the damaged muscle cells can leak out into the blood and body fluids, thus causing an acute increase in blood potassium levels. This acute elevation of potassium levels in the blood from paroxetine use can lead to life-threatening cardiac arrhythmias. Individuals can present with episodes of chest pain, intense shortness of breath, altered heartbeat, ineffective heart contractions, dizziness/loss of consciousness from arrhythmias. Report the cardiac arrhythmias to your physician promptly for any appropriate measures to be considered.
- 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. Paroxetine 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. Paroxetine 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. Paroxetine 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 paroxetine, by observing a window period of atleast 2 weeks, before the transition to paroxetine is made. This helps with complete elimination of these medications from the body, reduce the risk for interaction with paroxetine, and reduce risk for development of serotonin syndrome.
- If you miss a dose, try taking it at the earliest notice of noncompliance. If it is time for the next dose, skip the missed dose and take the dose scheduled. Do not take an extra dose to try making up for the missed dose. Notify your doctor and other health care personnel regarding your dose noncompliance.
