Paxil may trigger hypomania or mania episodes in unipolar and bipolar individuals. As with all antidepressants, Paxil should be used cautiously in patients with a history of mania. The possibility of a suicide attempt is inherent in depression and may persist until remission occurs. Therefore, high risk patients should be closely supervised throughout therapy and consideration should be given to the possible need for hospitalization. In order to minimize the opportunity for overdosage, prescriptions for paroxetine should be written for the smallest quantity of drug consistent with good patient management.
Caution is recommended when the drug is administered to patients with a history of seizures.
The drug should be discontinued in any patient who develops seizures. Several cases of hyponatremia have been reported. The hyponatremia appeared to be reversible when Paxil was discontinued. The majority of these occurrences have been in elderly individuals, some in patients taking diuretics or who were otherwise volume depleted. While a causal relationship to paroxetine is unclear, impaired platelet aggregation may result from platelet serotonin depletion and contribute to such occurrences.