Paroxetine

• OCD, PTSD — when other SSRIs failed and pregnancy is not planned

SERT inhibition + weak muscarinic antagonism → sedating profile, more discontinuation syndrome than other SSRIs.

• Absolute cardiac malformation risk +0.5–1% (T1)
• Withdraw slowly — worst SSRI for discontinuation
• Switch preconception to sertraline

Depression

20 mg OD; max 50 mg

OCD

40 mg OD; max 60 mg

• AbsoluteConcurrent MAOI
• CautionPlanned or confirmed T1 pregnancy

• Anticholinergic (dry mouth, constipation)
• Weight gain
• Sexual dysfunction
• Marked discontinuation syndrome

• • T1 exposure: OR 1.5–2 for cardiac defects (VSD/ASD)
• • Neonatal adaptation and PPHN like other SSRIs

• Tamoxifen

  Avoid

  Potent CYP2D6 inhibition ↓ endoxifen — AVOID

• MAOIs, linezolid, tramadol

  Avoid

  Serotonin syndrome

• 💡 If a woman becomes pregnant on paroxetine, do not stop abruptly — plan careful switch or continue if benefits > risks
• 💡 Fetal echocardiogram at 20 weeks if T1 exposure