The Pharmaceutical Journal
Vol 270 No 7255 p887
28 June 2003

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Letters to the Editor

Paroxetine

Alternate day regimen unhelpful

From Mr S. G. Bleakley, MRPharmS

The recent advice from the Medicines and Healthcare products Regulatory Agency concerning paroxetine in children (PJ, 14 June, p813) suggests that paroxetine should not be stopped suddenly but tapered slowly then taken on alternate days. Although I would concur with much of this advice, it is our experience that an alternate day regimen in paroxetine withdrawal is unhelpful.

Paroxetine has been associated with a greater number of discontinuation reports than other selective serotonin reuptake inhibitors.¹ This may be due to its short half-life (24 hours) and its ability to inhibit its own metabolism via a concentration-dependent effect. Consequently withdrawal symptoms may appear after one day of abrupt cessation.

With alternate day dosing patients can experience withdrawal symptoms on one day but not the next. A more patient friendly approach is a slow tapering of the dose, using the liquid if required, over at least four weeks but continuing with a daily dose.

Stephen Bleakley
Medicines Information Pharmacist
National Psychiatry Medicines Information Centre,
Maudsley Hospital, London

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