Patient/caregiver was educated on contraindications for using 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.
- Paxil is extensively metabolized in the liver and inactive metabolites are excreted in the urine and feces. If liver function is deficient, the metabolism of Paxil can be compromised. In this case, paxil can stay in the body for prolonged duration of time in comparison to normal leading to increased blood levels of the medication for longer periods of time. This can lead to increased risk for side-effects and consequent toxicity. So, Paxil could be cautiously administered or avoided for an alternative medication, in individuals with hepatic dysfunction. Periodical labs for liver function could be ordered and individuals monitored for development of any toxic symptoms. Discuss with your physician regarding history of compromised liver function, if any.
