During treatment with Plizil, patients should be given special attention,who have a history of suicidal behavior or suicidal thoughts, patients under the age of 25 years, as well as patients who have suicidal thoughts prior to treatment. Patients and caregivers should be warned about the need to monitor their deterioration and / or the appearance of suicidal thoughts / suicidal behavior or thoughts of self-harm during the course of treatment, especially at the beginning of treatment and during the change in the dose of Plizil (increase and decrease) . If these symptoms occur, seek medical help immediately.
It should be remembered that such symptoms as agitation, akathisia or mania may be associated with a major disease or be a consequence of the therapy used. The likelihood of akathisia is highest in the first few weeks of treatment.
If symptoms of clinical deterioration (including new symptoms) and / or suicidal thoughts / behavior occur, especially if they appear suddenly, the severity of the manifestations increases, or if they are not part of the previous symptomatic complex in this patient, it is necessary to revise the regimen of therapy until the drug Plizil is discontinued.
In rare cases, against the background of paroxetine treatment, serotonin syndrome or symptomatology similar to malignant neuroleptic syndrome may occur, especially if paroxetine apply simultaneously with other serotonergic drugs and / or antipsychotics. These syndromes pose a potential threat to life and therefore treatment with paroxetine must be discontinued if they occur (they are characterized by the following symptoms: hyperthermia, muscle rigidity, myoclonus, autonomic disorders with possible rapid changes in vital signs, changes in mental status, including confusion, irritability, extremely pronounced agitation, progressing to delirium and coma) and begin supporting symptomatic therapy. Paroxetine should not be used concomitantly with serotonin precursors (such as L-tryptophan, oxytryptan) in connection with the risk of developing serotonergic syndrome.
A major depressive episode may be the initial manifestation of bipolar disorder. Treatment of such an episode with antidepressant alone can increase the likelihood of accelerated developmentmixed / manic episode in patients at risk of bipolar disorder. Before starting treatment with an antidepressant, a thorough screening should be performed to assess the risk of developing a bipolar disorder in the patient; such screening should include the collection of a detailed psychiatric history, including data on the presence in the family of cases of suicide, bipolar disorder and depression.
Plizil should be used with caution in patients who have a history of mania.
Treatment with Plizil should be started cautiously, not earlier than 2 weeks after discontinuation of therapy with MAO inhibitors; the dose of the drug Plizil should be increased gradually until an optimal therapeutic effect is achieved. It is advisable to use caution when treating Plisil with patients with impaired renal function and patients with impaired hepatic function.
Like other antidepressants, Plizil should be used with caution in patients with epilepsy. Frequency of convulsive seizures in patients taking paroxetine, is less than 0.1%.In the event of a seizure, treatment with Plizil should be stopped.
There is limited experience in the simultaneous use of paroxetine and electroconvulsive therapy.
Plizil (like other selective serotonin reuptake inhibitors) can cause mydriasis. Plizil should be used with caution in patients with closed-angle glaucoma.
In the treatment with Plizil, hyponatremia occurs rarely and is predominantly in elderly patients and is leveled after its withdrawal.
Hemorrhages in the skin and mucous membranes (including gastrointestinal bleeding) have been reported in patients taking paroxetine, therefore Plizil should be used with caution in patients who simultaneously receive drugs that increase the risk of bleeding in patients with a known tendency to bleeding and patients with diseases predisposing to bleeding.
In the treatment of patients with heart disease, care should be taken to monitor the functional state of the cardiovascular system.
As with the abolition of many psychotropic drugs, discontinuing paroxetine treatment (especially severe) can cause symptoms such as dizziness, sensory disturbances (including paresthesia and a feeling of discharge of electric current), sleep disturbances (including bright dreams), agitation or anxiety, nausea , headache, tremor, confusion, consciousness, diarrhea and sweating. In most patients, these symptoms are mild or moderate, and go away spontaneously. Usually withdrawal symptoms occur in the first few days after drug withdrawal, but in rare cases are noted after accidentally missing one dose. As a rule, these symptoms pass independently for two weeks, but in some patients persist up to 2-3 months. and more. It is recommended to gradually reduce the dose of paroxetine (for several weeks or months before its complete cancellation, depending on the patient's condition). The appearance of withdrawal symptoms does not mean that the drug Plizil causes dependence.
The connection of bone fractures with the use of antidepressants, including, SSRIs, has been revealed. The possibility of bone fractures should be considered when using Plizil.
When treating or preventing breast cancer drug tamoxifen it should be borne in mind that the effectiveness of tamoxifen decreases with simultaneous use with paroxetine, the risk is more likely to increase with simultaneous application for a long time.