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What Should Be Paroxetine Dosage?

Posted on Tue, 29 Apr 2014

Question: Hi, I need to take a second opinion from a psychiatrist on the medicines that I am taking. Thanks, XXXXXXX

Answered by Dr. Abhishek Kapoor (19 minutes later)

Brief Answer: Need to decrease the dose of paroxetine Detailed Answer: Hi Thanks for using healthcare magic. I, Dr Abhishek Kapoor, would help you in this query. Maximum dose of Paroxetine CR is 37.5 mg and your are on more than double. There is no need to increase or take paroxetine at such a high dose. It could lead to serious side effects like serotonin syndrome. So, there is need to decrease the dose gradually by 12.5 mg per week to avoid withdrawal or any major side effects. If you are not getting any benefit on paroxetine, you can try another antidepressant like venlafaxine or relaxation exercise like JPMR. Before going on another antidepressant, consult a psychiatrist rather than physician to decrease the dose of paroxetine and then shift to venlafaxine. Mean time, you can try relaxation exercise and carry on with clonazepam 0.5 mg twice a day. In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Abhishek Kapoor (48 minutes later)

Thank you for your reply Dr XXXXXXX I am under the supervision of a Psychiatrist and not a general phsysician. I understand from various articles that Paroxetine CR maximum dosage is 75 mg per day. The following link confirms that. http://www.medicinenet.com/paroxetine/article.htm In any case, I am going to meet the psychiatrist tomorrow and have the dose reduced from 100 mg to 75 mg. I was told that venlafaxine is an SNRI and can actually increase my anxiety. Is this true? Also, I have hypertension and am told that SNRI medicines actually increase hypertension to a certain level. Please let me know if this is not the case and then I would be interested in trying out venlafaxine. JPMR seems to be a good suggestion and I will start looking at it from tomorrow. Is there an option for me to consult you regularly? Thanks, XXXX

Answered by Dr. Abhishek Kapoor (31 minutes later)

Brief Answer: Maximum effective dose is 37.5mg in anxiety dis Detailed Answer: HI According to guideline, the maximum effective dose of Paroxetine CR is 37.5 mg and above that, there is no benefit. For social phobia (social anxiety disorder), the starting dose is 12.5 mg once daily. The recommended maximum dose for treating social phobia is 37.5 mg daily. Few psychiatrist try to give it at high dose, but most of studies say, it is of no use and this thing even we have noticed. You can try venlafaxine. You are right, at higher dose more than 300mg, there are chances of high blood pressure, but in your case, blood pressure may be due to underline anxiety. Due to anxiety, heart would pump more and this could lead to high blood pressure. Try JPMR and it would keep you calm. I am in Gurgaon and if it is feasible for you, you can check my profile and clinic location. You can consult me through healthcare magic or we can arrange online consultation. In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Abhishek Kapoor (12 hours later)

hello Dr XXXXXXX I would like to have an online (skype) or a phone consultation with you. Please let me know when it is suitable for you. I have taken off from my work today so I will be free anytime to talk to you. Thanks, XXXX

Answered by Dr. Abhishek Kapoor (2 hours later)

Brief Answer: Skype consultation will be better Detailed Answer: HI I think skype online consultation would be more feasible. You can connect me at 2:30pm. I would remain online. Connect me at dr.abhishekkapoor. I will add you. Regards Dr. Abhishek Kapoor Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Abhishek Kapoor (7 minutes later)

Thanks doctor. I have added you on skype. Looking forward to talk to you. XXXX

Answered by Dr. Abhishek Kapoor (24 minutes later)

Brief Answer: Thanks Detailed Answer: Thanks.Do not worry, will meet at 3:15pm. Regards Dr. Abhishek Kapoor Psychiatrist

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar