Consulta Rápida - Psicofármacos - 1Ed.pdf

LABORATÓRIO
Embora não existam margens terapêuticas estabelecidas
para a paroxetina, sabe-se que suas concentrações
plasmáticas oscilam entre 40 e 240
μg/mL. Em média, doses eficazes no tratamento
da depressão geram níveis de 75 μg/L e, no transtorno
obsessivo-compulsivo, níveis de 225 μg/mL.
Há, entretanto, uma variabilidade muito grande
entre os níveis séricos dos indivíduos que utilizam
a paroxetina, e estes não se correlacionam nem
com a eficácia clínica nem com os efeitos colaterais.
A dosagem sérica, portanto, parece não ter
qualquer utilidade clínica; por isso, não é utilizada
de rotina.
Parece que a paroxetina não interfere nos testes
de laboratório, embora existam relatos de hiponatremia
concomitante ao seu uso.
PRECAUÇÕES
1. Ter cautela em relação a pacientes com diabete,
insuficiência hepática e/ou renal.
2. Se ocorrerem convulsões, suspender o fármaco.
REFERÊNCIAS BIBLIOGRÁFICAS
1. Nemeroff CB. The clinical pharmacology and use of
paroxetine, a new selective serotonin reuptake inhibitor.
Pharmacotherapy 1994;14 (2): 127-138.
2. Preskorn SH. Clinically relevant pharmacology of selective
serotonin reuptake inhibitors. An overview with emphasis
on pharmacokinetics and effects on oxidative metabolism.
Clin Pharmacokin 1997; 32 (suppl1): 1-21.
3. Dumbar GC, Cohn JB, Fabre LF e Cols. A comparison of
paroxetine, imipramine and placebo in depressed outpatients.
Brit J Psychiatry 1991; 159: 394-398.
4. Arminem SL, Ikonem U, Pulkkinem P. A 12-week doubleblind
multi-centre study of paroxetine and imipramine in
hospitalized depressed patients. Acta Psichiat Scand 1994;
89: 382-389.
5. Shrivastava RK, Shrivastava P, Overweg N e cols. A doubleblind
comparison of paroxetine, imipramine and placebo in
major depression. J Clin Psychiatry 1992; 53 (2): 48-51.
6. Wagstaff AJ, Cheer SM, Matheson AJ, Ormrod D, Goa KL.
Paroxetine: an update of its use in psychiatric disorders in
adults. Drugs 2002; 62 (4): 655-703.
7. Rocca P, Fonzo V, Ravizza L, Rocca G, Scotta M, Zanalda E,
Bogetto F.A comparison of paroxetine and amisulpride in
the treatment of dysthymic disorder. J Affect Disord 2002;
70 (3): 313-7.
8. Vieta E, Martinez-Aran A, Goikolea JM, Torrent C, Colom
F, Benabarre A, Reinares M.A randomized trial comparing
paroxetine and venlafaxine in the treatment of bipolar
depressed patients taking mood stabilizers. J Clin Psychiatry
2002; 63 (6): 508-12.
9. Oehrberg S; Christiansen PE; Behnke K e cols. Paroxetine
in the treatment of panic disorder, a randomized doubleblind,
placebo-controlled study. Brit J Psychiatry 1995; 167:
374-379.
10. Lecrubier Y, Judge R, Collaborative Paroxetine Panic Study
Investigators. Long-term evaluation of paroxetine,
clomipramine and placebo in panic disorder. Acta Psychiatr
Scand 1997; 95: 153-160.
11. Pollack MH, Zaninelli R, Goddard A, McCafferty JP, Bellew
KM, Burnham DB, Iyengar MK.Paroxetine in the treatment
of generalized anxiety disorder: results of a placebocontrolled,
flexible-dosage trial. J Clin Psychiatry 2001; 62
(5): 350-7.
12. Rickels K, Zaninelli R, McCafferty J, Bellew K, Iyengar M,
Sheehan D.Paroxetine treatment of generalized anxiety
disorder: a double-blind, placebo-controlled study. Am J
Psychiatry 2003; 160 (4): 749-56.
13. Liebowitz MR, Stein MB, Tancer M, Carpenter D, Oakes
R, Pitts CD.A randomized, double-blind, fixed-dose
comparison of paroxetine and placebo in the treatment of
generalized social anxiety disorder. J Clin Psychiatry 2002;
63 (1): 66-74.
14. Stein DJ, Versiani M, Hair T, Kumar R. Efficacy of paroxetine
for relapse prevention in social anxiety disorder: a 24-week
study. Arch Gen Psychiatry 2002; 59 (12): 1111-8.
15. Tucker P, Zaninelli R, Yehuda R, Ruggiero L, Dillingham
K, Pitts CD. Paroxetine in the treatment of chronic
posttraumatic stress disorder: results of a placebocontrolled,
flexible-dosage trial. J Clin Psychiatry 2001; 62
(11): 860-8.
16. Marshall RD, Beebe KL, Oldham M, Zaninelli R.Efficacy
and safety of paroxetine treatment for chronic PTSD: a fixeddose,
placebo-controlled study. Am J Psychiatry 2001; 158
(12): 1982-8.
17. Zohar J, Judge R, Ocd Paroxetine Study Investigators.
Paroxetine versus clomipramine in the treatment of
obsessive-compulsive disorder. Brit J Psychiatry 1996; 169:
468-474.
18. Kim SW, Grant JE, Adson DE, Shin YC, Zaninelli R.A
double-blind placebo-controlled study of the efficacy and
safety of paroxetine in the treatment of pathological
gambling. J Clin Psychiatry 2002; 63 (6): 501-7.
19. Stearns V, Beebe KL, Iyengar M, Dube E.Paroxetine
controlled release in the treatment of menopausal hot flashes:
a randomized controlled trial. JAMA 2003; 289(21):
2827-34.
20. Stahl SM. Basic Psychopharmacology of antidepressants,
part 1: antidepressants have seven distinct mechanisms of
action. J Clin Psychiatry 1998; 59 (suppl 4): 5-14.
21. Owens MJ, Knight DL, Nemeroff CB.Paroxetine binding
to the rat norepinephrine transporter in vivo. Biol Psychiatry
2000; 47 (9): 842-5.
22. Ohman R, Hagg S, Carleborg L, Spigset O.Excretion of
paroxetine into breast milk. J Clin Psychiatry 1999; 60(8):519-23.
23. Keller MB, Ryan ND, Strober M, Klein RG, Kutcher SP,
Birmaher B, Hagino OR, Koplewicz H, Carlson GA, Clarke
PAROXETINA
MEDICAMENTOS: INFORMAÇÕES BÁSICAS
225