Start paroxetine at 20mg for depression
Prescribers have been reminded that the starting dose for paroxetine in adults should be 20mg daily for most indications.
Gordon Duff, chairman of the Committee on Safety of Medicines, has written
to health professionals after a CSM review found that as many as 17,000
patients were started on doses of paroxetine above 20mg last year.
Patients with depression currently treated successfully at higher doses
should continue at this dose but new patients should receive the recommended
daily dose of 20mg. Patients not doing well at higher doses should have
their treatment reviewed and a change of treatment should be considered.
The recommended daily dose of paroxetine for adults with obsessive compulsive
disorder or panic disorder is 40mg.
Professor Duff says there is no evidence from clinical trials to suggest
that the efficacy of paroxetine in the treatment of depression is increased
at doses above 20mg. He adds: “The adverse events that occur soon
after starting therapy may be difficult to distinguish from the underlying
condition. There is evidence that increasing the dose in this situation
may be detrimental.”
A spokesman for GlaxoSmithKline, manufacturer of Seroxat, expressed surprise
at the MHRA statement. “We do not agree with the MHRA’s assertion
that there is no evidence of increased effectiveness above these recommended
doses.” He said that data from clinical trials show that some patients
benefit from taking paroxetine above the recommended levels for these
indications.
Paediatric prescriptions The use of antidepressants in children
is increasing, say researchers in a letter to the BMJ (20 March,
p711). They report a 4.5-fold increase in the rate of prescriptions
for selective serotonin reuptake inhibitors between 200 and 2002.
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