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Tips for tapering off Paxil (paroxetine)

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snostorm

This medication should be illegal.  I would have NEVER went on this medication had I known what I was in store for.  I started this medication in 2002.  The makers of this drug should be made to pay for all the people they got hooked on this drug.  

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grandmaD

I only just noticed that my box of aropax is manufactured by "Aspen" Australia.  Previously it was from GSK.  I cannot tell you at what point it changed, probably in the last year.

 

Would it still be EXACTLY THE SAME ingredients/tablet???  Because Aropax from GSK says it is "paroxetine hydrochloride" whereas the one from Aspen says it is "paroxetine hydrochloride hemihydrate"

 

I wonder if this would explain why I experienced many symptoms being the worst ever in year 6 of taper and especially the last 4-5 months with unexplainable muscle spasms and severe back and hip aches????

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scallywag

Aspen is a generic manufacturer.  GSK is the brand name. A change from one to the other could explain increased symptoms.

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grandmaD

Well that's just great!  That could explain it.  Have other people had problems when changing over brands?

Has anyone else on Aropax in Australia experienced this problem recently?

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dreamspirit

Oh yes, I switched to a different manufacturer once years ago and it put me into withdrawal it was terrible. I ended up going to my other pharmacy and got my other prescription and within a week I felt better. 

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grandmaD

How long were you on the other brand before you realised it and switched back?  It is crazy isn't it!  They tell you the ingredients are the same, but I see many people have trouble with generic brands.

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Miranda99

Some tips that I've learnt in my time tapering from paxil are: 

* Store the medicine in the fridge

* Make sure I wipe my syringe after expelling the liquid as there is always some residual. 

* On my manufactured bottle from GSK UK it states you must use an disuse an open bottle of paxil after 30 days. ( I thought they were pulling a fast one, as wanted one to use more costing them more) but I have found out by trying this that I seem to start withdrawing if use the medicine 5 days post the recommended 30 days. 

* I always ensure I get the exact same brand every month. They have tried to give my parallel imports from Russia and Greece and I've gone into withdrawal

* I get withdrawals every morning, so I take my medicine at 4 am ish daily, then go back to sleep. I've recently found that taking 2 high dose fish oil capsules at this time helps with the morning nightmares/ jerks/ sleep paralysis and more recently loud crashing noise which was coming from my brain! 

* If in get panicky at work, I do some deep breathing, and make myself a cup of chamomile tea with x 2 bags in it. It really seems to work! 

* If I have to get up for work after a few days off which tends to worry me, I spray my body with magnesium oil spray night before. 

* I have downloaded headspace which is great for sleep, and after stressful days mindfulness techniques. 

* I try to get 9 hours sleep a night

* I keep a diary on a menstrual app as some days I sweat more, and get really angry etc where hormones affect my withdrawal. I've recently started taking chaste berry so will be waiting to see what my PMT is like this month. 

* I get super dizzy in withdrawal and the only thing that works for me is a travel sickness tablet called cinnarizine. ( I could not have gone as low as 3 mgs without this med, but understand the desire to minimise meds. 

* If I'm anxious in the morning I make sure I raise my blood sugars by eating a banana and then some other breakfast. This seems to help lots too. 

These are probably not any new idea just what I've learnt over the past couple of years. The main thing I've learnt it to never go up to an insane high dose to cope with withdrawals but just go back up by a tiny amount. Ie) I dropped to 2.5mg, got bad withdrawals went back up to 20 mg when I had only been at 10 mg before. If I'd been advised to have just gone to 5 mg I would be off by now! 

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brassmonkey

" On my manufactured bottle from GSK UK it states you must use an disuse an open bottle of paxil after 30 days. ( I thought they were pulling a fast one, as wanted one to use more costing them more) but I have found out by trying this that I seem to start withdrawing if use the medicine 5 days post the recommended 30 days. "

 

Each person is going to have an individual reaction the their medication so it's quite likely that this may be happening Miranda.  I would like to point out however that there have been several studies conducted (no I can't give references)  that showed that these medications maintained 90% of their potency when they were stored for over ten years.  Any decrease in the potency of the drug over the time span of a slow taper would be taken into account by the slow change and shouldn't be factor that needs consideration.  I personally used the same bottle of paxil 40mg for the last three and a half years of my taper and didn't notice a thing.  Home made liquids are another story.  Impurities are added in the making of the liquid that will cause it to spoil in a matter of days.  Kept refrigerated the liquid is usable for about a week maybe two.

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Miranda99

Some tips that I've learnt in my time tapering from paxil are: 

* Store the medicine in the fridge

* Make sure I wipe my syringe after expelling the liquid as there is always some residual. 

* On my manufactured bottle from GSK UK it states you must use an disuse an open bottle of paxil after 30 days. ( I thought they were pulling a fast one, as wanted one to use more costing them more) but I have found out by trying this that I seem to start withdrawing if use the medicine 5 days post the recommended 30 days. 

* I get withdrawals every morning, so I take my medicine at 4 am ish daily, then go back to sleep. I've recently found that taking 2 high dose fish oil capsules at this time helps with the morning nightmares/ jerks/ sleep paralysis and more recently loud crashing noise which was coming from my brain! 

* If in get panicky at work, I do some deep breathing, and make myself a cup of chamomile tea with x 2 bags in it. It really seems to work! 

* If I have to get up for work after a few days off which tends to worry me, I spray my body with magnesium oil spray night before. 

* I have downloaded headspace which is great for sleep, and after stressful days mindfulness techniques. 

* I try to get 9 hours sleep a night

* I keep a diary on a menstrual app as some days I sweat more, and get really angry etc where hormones affect my withdrawal. I've recently started taking chaste berry so will be waiting to see what my PMT is like this month. 

* I get super dizzy in withdrawal and the only thing that works for me is a travel sickness tablet called cinnarizine. ( I could not have gone as low as 3 mgs without this med, but understand the desire to minimise meds. 

* If I'm anxious in the morning I make sure I raise my blood sugars by eating a banana and then some other breakfast. This seems to help lots too. 

These are probably not any new idea just what I've learnt over the past couple of years. The main thing I've learnt it to never go up to an insane high dose to cope with withdrawals but just go back up by a tiny amount. Ie) I dropped to 2.5mg, got bad withdrawals went back up to 20 mg when I had only been at 10 mg before. If I'd been advised to have just gone to 5 mg I would be off by now! 

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Miranda99

I think I have read the same studies, but have these studies not been on unopened packets of pills, and not on liquid that has been made up? Surely once a bottle of liquid has been opened it is not going to keep its sell by date for as long? I'm my experience different liquids have a different time span as use before once opened such as oramorph has 90 days, and insulin has 28 days etc. I understand that you could probably get a bit longer out of them, but I don't think as long as you've suggested! I used it for around an extra 2 weeks ignorantly and I definitely suffered stronger withdrawal due to it. Here is one study. 

 

https://www.drugs.com/article/drug-expiration-dates.html

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brassmonkey

The studies were on unopened, factory sealed packages of tablets. Opening a package of tablets doesn't change much as long as you keep it cool and dry.  Moisture and heat will cause trouble.  No, an open package of tablets will not keep for ten years, but they will last a lot longer than 30 days.  Like I said, liquids are another story, even the commercial ones.  If they stay sealed from the factory they will last a long time if stored correctly.  Once they are opened, yes they need to be used with in the month.  Oramorph and insulin are totally different from ssris in their structure and play by their own set of rules.

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kateinsocal
Quote

Once they are opened, yes they need to be used with in the month.

WOAH!

 

I've been on liquid Paxil for several months and I didn't know this. It could explain a lot. 

Since my dose is so low, my supply usually lasts 2-3 months (it's supplied for 30 days at 5mg/day, I take 1.6mg currently).  It costs me at least $50 per bottle though, and will be $100 next year. I don't want to have to buy a new bottle every month. Will putting it in the fridge help prolong it? Is there anything else I can do? If I had the pharmacy put it in a couple smaller bottles, that wouldn't help, right? Because it's been exposed to air when they pour it in the bottles to give out?

 

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grandmaD
5 hours ago, brassmonkey said:

 

 

 I would like to point out however that there have been several studies conducted (no I can't give references)  that showed that these medications maintained 90% of their potency when they were stored for over ten years.

Hi Brass, I recall you asked me if I was taking a "mix" of tablets - old and new ones when I crashed earlier this year and couldn't figure out why.  Yes, I was taking a mixture.

 

The chemist also told me the tablets never get "old" and last forever.  Just the same, I didn't know what was causing my downhill spiral into the pits where I stayed for months and months so I went on the "new" ones full time.

 

However, what I didn't ask YOU or the CHEMIST, was that these tablets - the old ones, that is - were what was left from when I cut and shaved previous ones from years and years before and kept in a bottle.  SO the question needs to be asked, WHAT IF THE TABLET IS NO LONGER IN THE FOIL!  How long does it keep THEN?

 

ANYWAY, what happened, was these "new" tablets I began taking, I eventually noticed they were in a slightly different box, packed slightly different and a slightly different size..... which led me to discover they were a generic.  That, I believe explains why I went downhill for so long and could not get back up.

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grandmaD

I was going to go over to liquid as it is supposed to be more accurate, but to do it accurately you would need to dissolve a 20mg tablet in 20ml of water is my understanding. I worked out I would be taking 3mg and throwing the rest out as liquid only lasts a week.

 

Oh, boy, my head.  I now look at this and realise this can't be right!  3mg a day equals 21mg a week.  Is that right!  I can't trust my brain, honestly!

My tablet weighs 53mg, so over a week I am consuming 37mg.  Is that right?  HELP!  I think I better just stay how I am going with crushing tabs.!

 

Brass, you didn't go to liquid did you, but stayed on the crushed tablet?

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Miranda99

Apologies if I've duplicated anything. Getting the hang of the site still!! 

It's a tricky one with the use by date once opened. I'm pretty sure I noticed a difference when I used it past 40 days. 

I am a registered nurse for 20 years. One of the first things that we learn is to check the dates on everything! With liquids some of these are mixed locally or even on the ward. I'm not sure about paxil liquid but I would think with all the extra ingredients it would start to erode at some point. However, I am still learning, and I've thought for years that generic brands were the same as manufacturers brands, but now I know that they're not identical and I definitely need to get the same make every time. With the Greek one ( still GSK) it made me sick, which is when I first noticed it, and then I started getting head shocks. Pharmacy have tried to give me another parallel import this month, but I have declined as I am so sensitive to even minor differences. I actually sent 2 bottles of parallel imported paxil back to GSK about a year ago for them to test, but have heard nothing back. 

I've tried to research this loads and loads, and have found a study that showed that epileptics were sensitive to medications from different manufacturers, and they brought on fits with some people. I'm thinking that SSRI's must be similar due to it working on your brain. I  pay a low fee for my prescription so I can renew the liquid every month, but I can see the dilemma with people who have high costs with new bottles

 

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brassmonkey

GrandmaD-- that's one of the problems with homemade liquid, you waste a lot which drives the cost up.  Yes, you are only taking 21mg a week.  That's way down from the 140mg a week you were taking a few years ago, well done.  I'm not sure how you're getting the numbers 53mg and 37mg?

 

If your taper is working then I would stay with how you're doing things. 

 

Yes, I stayed on the crushed pills for my entire taper.

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brassmonkey

HI Kate--  As you get lower in dose it will take longer and longer to use up a bottle.  I tapered for three and a half years on one bottle of tablets and still had some left over.  It will really help to store it in the refrigerator, and I like the idea of getting several smaller bottles from the pharmacist.  Keep those in the fridge too until you need them.  Don't Freeze them, it sounds like a good idea, but is really bad for the medication. 

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Cheeky

Needing a little advice to make sure I’m doing this correctly. I’m on 36mg paxil, I’ve been so far taking 30mg in tablet and the 10mg that was left I’ve crushed that in a jar with 10mg of water, I shake it vigorously, take out 4mg throw that out and drink the 6mg remaining in the jar.

is that a safe way of doing it.

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brassmonkey

That is a fine way of doing it. How are you getting the 10mg that you dissolve in the water?

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Cheeky

The 10mg is what halve a tablet is, they come in 20mg tablets, so i take one and a halve 30mg and the other halve i crash with 10ml of water.

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grandmaD
On 11/8/2017 at 6:05 AM, brassmonkey said:

GrandmaD-- that's one of the problems with homemade liquid, you waste a lot which drives the cost up.  Yes, you are only taking 21mg a week.  That's way down from the 140mg a week you were taking a few years ago, well done.  I'm not sure how you're getting the numbers 53mg and 37mg?

 

If your taper is working then I would stay with how you're doing things. 

 

Yes, I stayed on the crushed pills for my entire taper.

I don't know how I came up with 37mg either!  My head is so bad, so many headaches again and if not a headache having pressure heads and very difficult to think.  Also very, very sore head (to touch)

 

In fact, I am beginning to wonder if the "changes" I've done this drop are causing all this, as I am taking a mixture of tablet cut and filed and powder in capsules.  Of course, it could also be the drop, first one after 6 months hold, but usually the first drop after a hold isn't too bad.  Or it could still be the effects of the switch to the generic. 

 

Thanks for your help I will stay on how I'm doing it rather than go to liquid.

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Cheeky

Brassmonkey does that seem right ?

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brassmonkey

Your's sounds fine Cheeky, the numbers all add up correctly.

 

Well, I wouldn't worry about the 37mg GrandmaD.  We know that you're taking 3mg a day and that's all we need to think about.  I have the feeling that symptoms are from the latest drop and hopefully will settle out soon.

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grandmaD

Thanks brass, I will stay on the tablet form as long as I can for now.  I had been using the powder to put in capsules and I wonder if that can cause worsening symptoms too, so have gone back to just the tablet.  I will wait a few weeks and try the capsules again then and see...

Yes, of course, it could also be from doing this drop, or everything combined, I guess!

 

That brings me to the next question:  do you know how long the powder (filing remains) keeps?  I have it in a dark, airtight bottle, kept in pantry (dark/cool)

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Krasiyan

I wanted to ask something about Paxil. In my case I took 40mg for 6 years, and stopped it pretty fast. When I reinstated at 5mg it did help a little, but it was not enough.

 

Now I'm at 10mg, and was wondering, because my history has such a high dose do I have to work my way up to 20mg? Like September I was on 40, and now I'm on 10 so will my system be expecting 20 I'm not sure.

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grandmaD

It all depends on how you are coping?  Hopefully a Mod will be along to direct you - or else you could set up your own journal if you haven't already.

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ChessieCat

 

Note the Discard the contents of the bottle one month after opening.

 

 

8 hours ago, DeterminedAnna said:

 

uk-liquid-seroxat-march2019.jpg

 

 

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Colonial

 

My Liquid Paxil has always had a  Manufacture expiration date of between 2 years and 2 year 3 months from when I would pic them up from the pharmacy.

Stamped from the company right on the box and on the bottles as well.  

I feel bad for  DeterminedAnna  is Her liquid really isn't good for much longer than one month, goodness gracious.

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ChessieCat

@Colonial

 

There are two different use by dates.  One is the unopened use by date which is probably the one that you are referring to.

 

The other use by date is AFTER OPENING.  If you look at the right hand side you will see that it says:

 

Discard the contents of the bottle one month after opening.

 

uk-liquid-seroxat-march2019.jpg.a614755e

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Colonial

 

Then I must either have a different formulation here in the USA than your UK And Australian manufacturers or your all being lied to for profit,  because on Ours there is only a "use by date".

I must have the same manufacturer- formula here in the USA that BrassMonkey had who used the same bottle for, I think 3 years He said.

I have: Made in Canada by GlaxoSmithKline.  Distributed by Apotex group out of the State of Florida.

It's this thick soupy orange stuff.

 

They are on mostly already opened bottles poured into smaller containers.

So Whether I get a "unopened bottle"  with a stamped use by date from the manufacturer or they open the bottle and pour a months worth out in a smaller take home bottle,  it's the same.

 

The Pharmacy is sneaky though,  because they always put this arbitrary "use by" date of exactly ONE YEAR from the day they fill it,

But that's their "recommendation date", for their legal lawsuit  protection purposes.

So  the pharmacy says its good a magical 365 days,  and then you need to throw it out...sure...like we're idiots...

But It's not the actual expiry from the Manufacturer.

They just want you to throw it out after 1 year so you have to by more new and make more profit.

 

Whenever I ask them to write the actual expiration date from the manufacture on the bottle for me instead of their recommendation date it's always that 2 plus year range.

Now, if that's the manufacturers Legal cut off date for their law suit purposes is 2 to 2.5 years,  what is it really good to? 

For the manufacturer to guarantee a liquid for 2.5 years, it's good for much longer than that.

My Nephew is a Pharmacist and He said probably 3.5 to 4 years if kept cool and out of light, hard to tell.

He said that the REAL expirary date is  usually at least a YEAR past what they put on the bottles, because they have to 100% sure its still potent when you take it.

 

I'm finishing up a bottle I found that I got filled January 9th, 2018 and the expiry date is December 31st  2019.  That's only 10 days shy of 2 years.

They had dumped it out of a larger manufacturer container and put it in a smaller take home bottle and its still fine.

 

My question, though, is... how are you  in the UK and Australia even getting entire bottles of stuff you can't use in even 60 days, much less 30,

That it's even an issue of having to waste and throw it out?

Your laws must be completely different than Ours

 

Generally here it's not even an issue, because in the USA you cant just walk in a "buy"  and entire bottle of  Liquid Paxil..

They can only legally give me 30 days at a time, by what your doctor says your dose is.

So unless Your taking less than your telling your doctor, you wouldn't be "saving up" a supply to have that much left over anyway.

But there would not  even be a benefit to doing that because the cost is prorated, so you wouldn't be saving any money buying more...

It's not like, "buy bulk and save".

 

Obviously there's a little waste in the end of the syringe so you have to have your doctor prescribe a bit more than your actual dose but

If you keep getting it filled on time every 30 days as your dose goes down it compensates if your still filling the old dose.

 

So every month I have to go pick up this little tiny bottle of 30 days worth of the daily equivalent of 0.56 mgs of Paxil...

It's like, 2 tablespoonfuls every month now, but that's the law, you can't dispense more than 30 days worth at a time.

And I KNOW their not throwing out the rest of the manufactures bottle their taking it from 30 days after opening it, that would be too cost prohibitive.

An entire bottle costs  over $400.  

Their not going to sell me 30 days worth of Paxil  at $35.00 and throw the other $365.00 worth of that liquid out...

 

They wouldn't agree to buy entire bottles of Paxil from the manufacture if it was going to expire after 30 days of opening,

If they can only legally give me 5-10% of that bottle at a time.

Because they can only legally charge me what 5 to 10% of what that total bottle costs a month...

 

Either your laws are too lax in allowing them to dispense way more than you need per month,

And your all being taken advantage of by it, you have a really crappy formula, or their lying to you.

 

I just can't imagine why your governments would allow people to be walking out of a pharmacy with 6 plus months of psych meds at a time...

If your only taking smaller dosages

That sounds like a disaster waiting to happen for multiple reasons....

 

Not to mention insurance fraud if your selling it on the psych black market: but if You Governments pay for all your drugs that might not be a concern there...

That's not how things work here...

My insurance company is only gonna pay my pharmacy for me to have "just enough" for me,

Not  paying for me to be walking out with 6 months worth of meds for me to be doing only God knows what with it, like selling it to who ever doesn't have insurance...

 

 

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ChessieCat

Here is some information about Lexapro use by after opening:

 

 

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Colonial

 

Update from Yesterday:

I seem to be very fortunate to have the Name Brand Liquid Paxil which after a long discussion today in person with the Head Pharmacist who just happened to be at the store.

Does NOT have 2 different expiry dates.

I explained to Her the issue and She spent a good long time looking into it...

And She says there is nothing from the manufacturer of My Particular NAME BRAND that indicates it will loose effectiveness just because the bottle is opened.

She did say that You DO need to maintain the temperature an out of the light, but at least for My Name Brand version there is NO  legal warning to "use by after opening".

If it did, there would be a huge legal disclaimer from the company both in the literature AND ON THE BOTTLE ITSELF..

 

Perhaps the generic liquid Paraxotine is different, or the formulas in different countries of this "type" of med have different regulations,

Or perhaps 8 years ago when this thread was originally started it may have been an issue .

 

But as of right now it seems the Name Brand Paxil Made in Canada by GlaxoSmithKline and Distributed by Apotex group out of the State of Florida doesn't seem to have a "use by" date different than Manufacturer expiration.

 

So if your in the United States, ask your Doctor-Pharmacist to work with You to get that particular Name Brand- Manufacturer.

As I said yesterday I'm finishing up the rest of a bottle that was dispensed to Me January of 2018 and it's fine.

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ChessieCat

Reply I got after contacting the pharmaceutical company who manufactures product:

According to Dispedia/Apotex/GlaxoSmithKline:

Stability of product after opening - Paxil Oral Susupension

The product is stable until expiry date.  Store suspension at or below 25C / 77F degrees.

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DeterminedAnna

Liquid Seroxat shortage in the UK until January 2020:

 

https://psnc.org.uk/our-news/seroxat-paroxetine-20mg-10ml-oral-solution-out-of-stock-until-january-2020/

 

Sorry if this has already been shared, but thought it might be important to people in the UK using liquid Seroxat to taper.

Only found this out on Friday (22 November) after a frustrating experience with my local, regular (Well) pharmacy whose staff are clueless about antidepressant withdrawal and why it's vital to not stop abruptly. Tried two independent pharmacies immediately after – no luck – and then a LloydsPharmacy which, without much confidence, said they might be able to get me my prescription by Monday (25 November).

After crashing in January having got down to 5.96mg after 20mg for 17 years, I am only just stabilising, 11 months later, having updosed to 7.72mg in May. Friday's discovery that I might be thrown back into withdrawal sent me into panic that I've not had for months. Is it possible to be traumatised by withdrawal?

Anyway, I ordered this repeat prescription from my GP AFTER this nationwide alert and my GP didn't inform me of the shortage. My GP should be very aware of this because I've been in and out of local mental healthcare this year thanks to Seroxat withdrawal, and leaving me without liquid Seroxat will inevitably be more troublesome (and therefore costly to local NHS) than sorting my prescription proactively.

Luckily, on returning home I realised I have two spare bottles of liquid Seroxat that I kept when my GP mistakenly prescribed too much in the past.

 

My advice – when possible, get yourself some backup bottles for these situations (when it's available again, try to get an extra bottle from your GP). Yes, you can make liquid from Seroxat tablets, but be aware that changes to formulation and dosing can have effects, so personally I try to stick with stable routines.

If you're due to get a liquid Seroxat prescription before January, try to do so in person, with plenty of time before you run out of your current bottle, and show your GP the above link if necessary.

 
UPDATE 25 NOVEMBER 2019: further to the above, my local LloydsPharmacy can't get hold of liquid Seroxat. Local mental health team suggested I switch over to 10mg tablets in case the shortage continues (I'm still on 7.72mg). After months of explaining how sensitive I am to dose changes, they clearly still don't get it – and how reluctant I am to increase my dose and backtrack on my holding for nearly seven months, especially as it's only been in the last month that I've seen a return to relative normality. Think it might be time to revisit this...

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Altostrata

https://psnc.org.uk/our-news/seroxat-paroxetine-20mg-10ml-oral-solution-out-of-stock-until-january-2020/

 

Quote

 

  • For patients who do not have sufficient supplies of paroxetine 20mg/10ml oral solution for the duration of the expected out of stock period, clinicians should consider the alternatives below as soon as possible.
  • Prescribing paroxetine tablets in place of oral solution.
  • UK Medicines Information (UKMi) have advised that tablets can be crushed and mixed with water for administration, however this would be an off-label use. The crushed tablets are bitter and have a slight local anaesthetic effect.
  • Prescribing an unlicensed preparation of paroxetine 20mg/10ml oral solution, which is currently available to order from the following importers – Clinigen, WEP Clinical, Mawdsleys and Target Healthcare Ltd.
  • Clinicians will need to work with local pharmacies to understand which specific unlicensed products can be sourced and lead times. The price of specials varies.

 

 

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