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Going off Paxil


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#1 woodbee

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Posted 24 March 2012 - 10:08 PM

Mark, I am 60 and was diagnosed with PD several years ago. Last Oct, because I was suffering with anxiety and low motivation, my MDS put me on 20 mg Paxil 1 xday. I also take generic carbidopa/levodopa and ropinirole. I saw my MDS recently and I reported new memory issues, stop-go, stop-go- pattern of urination only during the night time and early morning hours, new hoarseness and some swallowing issues, increased constipation. In spite of these "new" symptoms, I was very happy with how Paxil has helped me especially with low motivation and anxiety.My MDS did not make any changes in my meds.regimen. I did not tie any of these symptoms to the initiation of Paxil, nor is it for certain that they are.

The very next day I learned about anticholinergics burden scale in the New York TImes but since have found a more clear article at

http://www.uea.ac.uk.../drughealthrisk

After reading this article I calculated my ACB and because of the Paxil I have an ACB score of 3. I talked to my MDS and he read the article and recommended I stay on the Paxil BUT he was going to leave it up to me to decide. He did warn me that going off Paxil can be bumpy. I take that to me "withdrawals"

Mark, what do you know about the anticholinergics burden scale? The article doesn't sound good. Inreased risk of death, memory and cognitive problems? But I am getting some great benefit from the Paxil. It is hard to know what to do. In addition, when I was taken off Miripex in 2007 i suffered DAWS...so I'm not excited about going that bumpy route. but If I need to I will. How do i evaluate the risk verses the benefits of being on Paxil? Maybe you can help me understand the risks I take by staying on the drug

Also, are you familiar with how doctors recommend to a patient to go off the Paxil?

my daughter is getting Married in mid June. I am wondering if I need to stop the paxil soon OR wait til after her wedding. I would prefer to go off paxil really slowly, in tiny increments after her wedding IF it really is deemed a high risk.

what are your thoughts please/and thanks for patiently going thru this
Eileen

#2 MComes RPH

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Posted 25 March 2012 - 08:53 PM

First off, thanks for taking the time to write me. Let me first ease your mind and let you know that Paxil, as mqny meds, may have some anti-cholinergic effects but is not classified as an anti-cholinergic. I will let you know that most, if not all, anti-depressants have some sort of anti-cholinergic side effect. One anti-cholinergic side effect is dry mouth. There are so many meds, anti-depressants and a multitude of other meds outside the anti-depressants that cause this.
I will also tell you that I take Lexapro, which is in the sqme class as Paxil, and I am not going to change. I had many questions after reading the article, and here are some:
1- they used patients 65 years and older. The never give an average or median age. There could be 1,298 patients at 92 yeqrs ol and 2 at 65 years old.
2- they never tell you the background of the patient, such as disease states, kidmey and liver function, family history, and other meds they may be taking.
3- they randomly chose 1,300 people all from the U.K. First off, were they randomly chosen off the street or from a physician list. If it was a physician list, did the Dr just hand them files or, did the reseachers specifically look for vertain patients on certain meds. That way would not be so random.
4- they used info from another study to help with their study. How do we know if the original study they used had the correct info.
5- the study used 1,300 patients, but all from the same area. This does not give the diversity thqt is needed in a study. Lifestyle jas a great deal to do with creating a better study. A study should have people from all nationalities and genders.
6- I did not see anywhere who funded the study. They tell who performed it, but who funded it is a bigger issue. If I have a new drug and want to prove it is better than the others in the same class, I would pay a ton of money to my own reseachers, which could definitely skew the numbers. I am not saying this is what happened, but there is a great deal of missing info that makes this study 100% believable to me. There are some valid points in the study, but none that I found that had that "WOW" factor to me.
I am not going to change my Lexapro, and if I were you, I would take your Dr's advice. If it is going to be that bothersome to you, then change. I hope you see my view on this. I have reviewed many studies in my past 21 years, and I wanyed to pass along my knowledge of what I see wrong with the study. Also, to let you know that I am not changing my med in the same class should show you how I feel about the study.
I will tell you this, if aspirin were put in front of the FDA today, it would never make it to the stores. With side effects like ulcers, blood thinning, and esophagus bleeding....the FDA would say no.
Hope this helps. If you have any other questions, feel free to ask.


Mark, I am 60 and was diagnosed with PD several years ago. Last Oct, because I was suffering with anxiety and low motivation, my MDS put me on 20 mg Paxil 1 xday. I also take generic carbidopa/levodopa and ropinirole. I saw my MDS recently and I reported new memory issues, stop-go, stop-go- pattern of urination only during the night time and early morning hours, new hoarseness and some swallowing issues, increased constipation. In spite of these "new" symptoms, I was very happy with how Paxil has helped me especially with low motivation and anxiety.My MDS did not make any changes in my meds.regimen. I did not tie any of these symptoms to the initiation of Paxil, nor is it for certain that they are.

The very next day I learned about anticholinergics burden scale in the New York TImes but since have found a more clear article at

http://www.uea.ac.uk.../drughealthrisk

After reading this article I calculated my ACB and because of the Paxil I have an ACB score of 3. I talked to my MDS and he read the article and recommended I stay on the Paxil BUT he was going to leave it up to me to decide. He did warn me that going off Paxil can be bumpy. I take that to me "withdrawals"

Mark, what do you know about the anticholinergics burden scale? The article doesn't sound good. Inreased risk of death, memory and cognitive problems? But I am getting some great benefit from the Paxil. It is hard to know what to do. In addition, when I was taken off Miripex in 2007 i suffered DAWS...so I'm not excited about going that bumpy route. but If I need to I will. How do i evaluate the risk verses the benefits of being on Paxil? Maybe you can help me understand the risks I take by staying on the drug

Also, are you familiar with how doctors recommend to a patient to go off the Paxil?

my daughter is getting Married in mid June. I am wondering if I need to stop the paxil soon OR wait til after her wedding. I would prefer to go off paxil really slowly, in tiny increments after her wedding IF it really is deemed a high risk.

what are your thoughts please/and thanks for patiently going thru this
Eileen


Edited by MComes RPH, 25 March 2012 - 09:47 PM.

Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#3 woodbee

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Posted 27 March 2012 - 05:35 PM

Mark, thanks so much for going over the study and giving it your time. It relieves me considerably to read what you wrote. I thought you made several very good points.

The study was funded by the Medical Research Council(MRC) and the US National Institute of Aging (NIA) which I don't have any particular knowledge of other than what I can find on line.
There were 13,000. participants, half using meds with ACB effects. they claimed they accounted for underlying disease.(?)

I'm confused about Paxil. On their ac burden lists of drugs Paxil or paroxetine (spelling) is listed in the category with the most severe ac effects, thus rating 3 on their scale, and yet you say it has 'some' ac effects but is not classified as an anti cholinergic. As a lay person can you help me understand that difference of classification or why they and you might view the drug differently ?

In the Q&A at the end of the article they list anti cholinergic side effects..Of those listed I have several but MILDLY....mild mouth dryness, mild difficulties urinating, increased constipation after starting Paxil and needing longer naps nearly every day. As I said, mild though.


anyway...thanks ever so much Mark..I really appreciate your taking valuable time to respond.

eileen

#4 MComes RPH

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Posted 15 April 2012 - 09:23 AM

First, thank you for the kind words. Here is how I explain the anti-cholinergic effects that can happen with Paxil. Paxil is an SSRI (Selective Serotonin Reuptake Inhibitor) which means it bloch serotonin from beingg "vaccuumed" up by the receptors, so more serotonin is available for use to help with depression.
Anti-cholinergic can be used 2 ways. (1) to describe a drug class, or (2) to describe the effects of that drug class. The only example I use that seems to work best is, "That girl has a boyish build to her."
Now let's deal with the situation of Paxil. It was first thought that Paxil just had anti-cholinergic like side effects. Newer studies have shown that Paxil does have an affinity for the acetylcholine (a nerotransmitter in the brain), but the amount of affinity can not be measured and will differ from patient to patient. Where as the serotonin effect was about the same from patient to patient.
The amount of affinity a medication has for a receptor can dictate it's classification. So, in this case, Paxil is an SSRI.
when dealing with neurotransmitters and receptors of the body and brain, it can be very, very confusing. So, if you have any further questions, please ask.


Mark, thanks so much for going over the study and giving it your time. It relieves me considerably to read what you wrote. I thought you made several very good points.

The study was funded by the Medical Research Council(MRC) and the US National Institute of Aging (NIA) which I don't have any particular knowledge of other than what I can find on line.
There were 13,000. participants, half using meds with ACB effects. they claimed they accounted for underlying disease.(?)

I'm confused about Paxil. On their ac burden lists of drugs Paxil or paroxetine (spelling) is listed in the category with the most severe ac effects, thus rating 3 on their scale, and yet you say it has 'some' ac effects but is not classified as an anti cholinergic. As a lay person can you help me understand that difference of classification or why they and you might view the drug differently ?

In the Q&A at the end of the article they list anti cholinergic side effects..Of those listed I have several but MILDLY....mild mouth dryness, mild difficulties urinating, increased constipation after starting Paxil and needing longer naps nearly every day. As I said, mild though.


anyway...thanks ever so much Mark..I really appreciate your taking valuable time to respond.

eileen


Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#5 woodbee

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Posted 16 April 2012 - 03:08 PM

First, thank you for the kind words. Here is how I explain the anti-cholinergic effects that can happen with Paxil. Paxil is an SSRI (Selective Serotonin Reuptake Inhibitor) which means it bloch serotonin from beingg "vaccuumed" up by the receptors, so more serotonin is available for use to help with depression.
Anti-cholinergic can be used 2 ways. (1) to describe a drug class, or (2) to describe the effects of that drug class. The only example I use that seems to work best is, "That girl has a boyish build to her."
Now let's deal with the situation of Paxil. It was first thought that Paxil just had anti-cholinergic like side effects. Newer studies have shown that Paxil does have an affinity for the acetylcholine (a nerotransmitter in the brain), but the amount of affinity can not be measured and will differ from patient to patient. Where as the serotonin effect was about the same from patient to patient.
The amount of affinity a medication has for a receptor can dictate it's classification. So, in this case, Paxil is an SSRI.
when dealing with neurotransmitters and receptors of the body and brain, it can be very, very confusing. So, if you have any further questions, please ask.


Mark,

Many Thanks once again for taking time to clear up my confusion. I appreciate it greatly. You have provided the most clear answers to my questions, of many people I have asked. Thank you for taking time to follow up on the secondary questions. Have a great day.

Eileen

#6 MComes RPH

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Posted 02 May 2012 - 04:55 AM

Anytime. Thank you
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org




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