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INTRODUCTION

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paroxetine hydrochloride (par-ox-e-teen)

Paxil, Paxil CR

paroxetine mesylate

Pexeva

Classification

Therapeutic: antianxiety agents, antidepressants

Pharmacologic: selective serotonin reuptake inhibitors (SSRIs)

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Indications
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Paxil, Paxil CR, Pexeva: Major depressive disorder, panic disorder. Paxil, Pexeva: Obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD). Paxil, Paxil CR: Social anxiety disorder. Paxil: Posttraumatic stress disorder (PTSD). Paxil CR: Premenstrual dysphoric disorder (PMDD).

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Action
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Inhibits neuronal reuptake of serotonin in the CNS, thus potentiating the activity of serotonin; has little effect on norepinephrine or dopamine. Therapeutic Effects: Antidepressant action. Decreased frequency of panic attacks, OCD, or anxiety. Improvement in manifestations of posttraumatic stress disorder. Decreased dysphoria prior to menses.

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Adverse Reactions/Side Effects
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CNS: anxiety, dizziness, drowsiness, headache, insomnia, weakness, agitation, amnesia, confusion, emotional lability, hangover, impaired concentration, malaise, mental depression, suicidal behavior, syncope. EENT: blurred vision, rhinitis. Resp: cough, pharyngitis, respiratory disorders, yawning. CV: chest pain, edema, hypertension, palpitations, orthostatic hypotension, tachycardia, vasodilation. GI: constipation, diarrhea, dry mouth, nausea, abdominal pain, decreased appetite, dyspepsia, flatulence, increased appetite, taste disturbances, vomiting. GU: ejaculatory disturbance, decreased libido, genital disorders, urinary disorders, urinary frequency. Derm: sweating, photosensitivity, pruritus, rash. Metab: weight gain, weight loss. MS: back pain, myalgia, myopathy. Neuro: paresthesia, tremor. Misc: chills, fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment, and in children and teenagers. Notify physician or other mental health care professional immediately if patient exhibits worsening depression.

  • Inform physician if patient demonstrates other mood changes such as increased anxiety, agitation, impaired memory, impaired concentration, emotional lability, or confusion (See Appendix D).

  • Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension). Also, assess BP when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg or diastolic BP falls >10 mm Hg.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Assess any breathing problems, and report signs of respiratory disorders such as shortness of breath, cough, pharyngitis, and labored or difficult breathing.

  • Assess any muscle pain or back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

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