パロキセチン

動物種別の用量

投与経路

禁忌

• Patients with known hypersensitivity to paroxetine
• Patients receiving monoamine oxidase inhibitors (MAOIs)
• Known hypersensitivity to paroxetine or other SSRIs
• History of seizures or epilepsy
• Concurrent use of Monoamine Oxidase Inhibitors (MAOIs)
• Concurrent use of other serotonergic agents (due to serotonin syndrome risk)

有害事象

• Anorexia (common, usually transient)
• Lethargy
• GI effects
• Anxiety
• Irritability
• Insomnia/hyperactivity
• Panting
• Aggressive behavior in previously unaggressive dogs
• Constipation (especially in cats)
• Changes in elimination patterns
• Changes in blood glucose levels
• Reduced seizure threshold
• Decreased appetite
• Vomiting
• Trembling
• Restlessness
• Gastrointestinal disturbance

薬物相互作用

• Buspirone · Increased risk for serotonin syndrome
• Cimetidine · May increase paroxetine levels
• Cyproheptadine · May decrease or reverse the effects of SSRIs
• Digoxin · Paroxetine (in humans) can decrease digoxin AUC by 15%
• Insulin · May alter insulin requirements
• Isoniazid · Increased risk for serotonin syndrome
• MAO Inhibitors (including amitraz and selegiline) · High risk for serotonin syndrome; use contraindicated. A 5-week washout period is required after discontinuing paroxetine, and a 2-week washout if discontinuing the MAOI first.
• Pentazocine · Serotonin syndrome-like adverse effects possible
• Phenobarbital · May decrease paroxetine levels
• Phenytoin · Increased plasma levels of phenytoin possible; may decrease paroxetine levels
• Propranolol, Metoprolol · Paroxetine may increase these beta-blockers' plasma levels and cause hypotension; atenolol may be safer
• Tramadol · SSRIs can inhibit the metabolism of tramadol to active metabolites, decreasing efficacy and increasing toxicity risk (serotonin syndrome, seizures)

モニタリング

• Efficacy of behavioral modification
• Adverse effects (including appetite and weight changes)
• Behavioral changes (efficacy, paradoxical anxiety, or increased aggression)
• Frequency of urination (especially in cats)
• Signs of serotonin syndrome (tremors, agitation, hyperthermia)
• Gastrointestinal tolerance (appetite, vomiting)

過量投与

Experience with overdoses in humans yields a mixed picture; while not as toxic as tricyclic antidepressants, fatalities and significant morbidity have occurred. * **Clinical Signs**: ASPCA APCC data (2008-2009) reported common findings in dogs including **hyperactivity, lethargy, mydriasis, and trembling**. In cats, **mydriasis** was commonly noted. * **Treatment**: In small animal overdoses, err on the safe side. Employ **gut evacuation** (if not contraindicated) followed by supportive care. **Activated charcoal** is very effective in binding paroxetine. * **Serotonin Syndrome**: If serotonin syndrome develops, **phenothiazines** and **cyproheptadine** can be effective for control. Contact an animal poison control center for additional guidance.