title: Multiple dose pharmacokinetics of paroxetine in children and adolescents with major depressive disorder or obsessive-compulsive disorder.
abstract: The current study examined the pharmacokinetics (PK), safety, and tolerability of paroxetine after repeated multiple oral dosing in children and adolescents with major depressive or obsessive-compulsive disorder. In this 6-week, open-label, repeat dose, dose-rising study, 62 patients (27 children and 35 adolescents) were treated with paroxetine 10 mg/day for the first 2 weeks of the study, 20 mg/day for the next 2 weeks, and 30 mg/day for the final 2 weeks. Pharmacokinetic sampling and safety assessments occurred at baseline and subsequently on the final treatment day of each dosing level. Between-patient variability in PK was pronounced at the 10 mg dose level, but markedly reduced at higher doses. A supra-proportional increase in plasma concentrations with increasing dose was evident in both age groups. Data for C(max) and AUC(0-24) indicated that, at each dose level, paroxetine steady-state systemic exposure was higher in children than in adolescents. The differences between age groups, however, diminished with each increasing dose, and were virtually abolished when differences in weight among different age groups were considered. Stepwise regression analysis indicated that both oral clearance and volume of distribution were highly dependent on paroxetine dose, cytochrome P4502D6 genotype, and weight (p<0.0001), but not age or sex. Paroxetine was generally safe and well tolerated in both age groups, with the most frequently observed adverse events being largely consistent with those observed in prior paroxetine studies of adult psychiatric patients. Certain gastrointestinal and behavioral activation events (aggressive reaction and nervousness) were reported more frequently in the youngest age group.
authors.affiliation: Department of Psychiatry, Case Western Reserve University, University Hospitals of Cleveland, OH 44106-5080, USA. robert.findling@uhhs.com
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
authors.forename: Gianluca
authors.initials: G
authors.lastname: Nucci
authors.forename: Antoni A
authors.initials: AA
authors.lastname: Piergies
authors.forename: Roberto
authors.initials: R
authors.lastname: Gomeni
authors.forename: Edward I
authors.initials: EI
authors.lastname: Bartolic
authors.forename: Regan
authors.initials: R
authors.lastname: Fong
authors.forename: David J
authors.initials: DJ
authors.lastname: Carpenter
authors.forename: J Steven
authors.initials: JS
authors.lastname: Leeder
authors.forename: Andrea
authors.initials: A
authors.lastname: Gaedigk
authors.forename: Theodore M
authors.initials: TM
authors.lastname: Danoff
mesh_terms: D000293:Adolescent; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use; D019540:Area Under Curve; D002648:Child; D019389:Cytochrome P-450 CYP2D6 / Q000378:metabolism; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000378:metabolism* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000378:metabolism* / Q000503:physiopathology / Q000523:psychology; D017374:Paroxetine / Q000009:adverse effects / Q000493:pharmacokinetics* / Q000627:therapeutic use; D011594:Psychometrics / Q000379:methods; D013997:Time Factors
chemical_list: D018687:Antidepressive Agents, Second-Generation; D017374:Paroxetine; D019389:Cytochrome P-450 CYP2D6