Paroxetine-induced increase in LDL cholesterol levels.
Paroxetine is widely prescribed because it has the indication for multiple psychiatric disorders. Our objective was to assess the effect of short-term administration of paroxetine on low-density lipoprotein cholesterol (LDL-C) levels in both healthy controls (HCs) and in patients with panic disorder (PD). Blood samples for measurement of LDL-C were collected atbaseline, after 8 weeks of paroxetine administration and post-discontinuation in 24 male HCs and nine male patients suffering from PD, for a total of 33 subjects. Paroxetine treatment, both in HCs and PD patients, induced a mean 9% increase per subject in LDL-C that normalized post-discontinuation, suggesting causality. The National Cholesterol Education Program (NCEP) guidelines suggest that this paroxetine-induced increase in LDL-C is clinically significant but would not warrant therapeutic intervention in this population selected to be at low cardiovascular risk. However, the increase in LDL-C levels raised above the threshold of 2.7 mmol/L (100 mg/dL) in 36% of our low-risk subjects. The LDL-C increase in this subgroup would be associated with a minor increase in coronary heart disease (CHD) risk. A similar 9% paroxetine-induced increase in LDL-C observed in the large number of psychiatric patients suffering from comorbid established CHD would be detrimental from a cardiovascular perspective and would oppose the new NCEP therapeutic goals of decreasing LDL-C levels by 30-40% in high and moderately high-risk patients. It is possible that longer treatment duration and use of higher doses of paroxetine would lead to a greater increase in LDL-C.
Le Melledo
J M
JM
Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada. jean-michel.lemelledo@ualberta.ca
Mailo
K
K
Lara
N
N
Abadia
M C
MC
Gil
L
L
Van Ameringen
M
M
Baker
G
G
Perez-Parada
J
J
D000328:Adult; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D006801:Humans; D008297:Male; D016584:Panic Disorder / Q000097:blood / Q000188:drug therapy; D017374:Paroxetine / Q000009:adverse effects* / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D013997:Time Factors; D014280:Triglycerides / Q000097:blood
D002784:Cholesterol; D008078:Cholesterol, LDL; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D014280:Triglycerides