The liquid selective serotonin reuptake inhibitor (SSRI) paroxetine (Seroxat; GSK) 20mg/10mL oral suspension is to be discontinued, raising concerns for patients in the process of tapering off the drug.
On 14 July 2022, the Pharmaceutical Services Negotiating Committee (PSNC) announced via a medicine supply notification that paroxetine (Seroxat) 20mg/10mL oral suspension would be discontinued in July 2022 and that there were “limited” supplies remaining.
The notification said that paroxetine tablets and unlicensed specials of paroxetine 10mg/5mL oral suspension remained available and could “support an uplift in demand”.
A spokesperson for GSK said the discontinuation was part of a “broader strategic review” of the paroxetine product family.
“GSK has decided to discontinue manufacturing, supply and marketing of paroxetine hydrochloride oral suspension products,” they said.
“We recognise that paroxetine hydrochloride oral suspension is an important medicine for some patients and regret any inconvenience the discontinuation may cause.”
Experts have highlighted that liquid formulations, such as paroxetine 20mg/10mL oral suspension, are “essential” for successful tapering from paroxetine and that, for the patients for whom this particular formulation has worked, the product withdrawal would be “of concern”.
Roz Gittins, president of the College of Mental Health Pharmacy, said: “Paroxetine, because of it’s relatively short half-life, can be more often associated with discontinuation symptoms’
“The liquid can be especially useful because it can enable more flexible dosing for dose reductions.
“Whilst the number being prescribed is not as great as some other formulations, it restricts the licensed versions available for the people who really need it,” she added.
Nicola Greenhalgh, lead pharmacist for mental health at North East London NHS Foundation Trust, said: “In terms of paroxetine … it is not an easy one to withdraw.
“We are increasingly learning that the old advice of withdrawing over at least four weeks is simply not tolerated by many patients and the advice that discontinuation reactions are normally mild and short lived is not the case for a significant number of people coming off of antidepressants.”
Greenhalgh added that some patients may need a few months to come off their antidepressants and may need liquid for only part of it, while others will have a prolonged withdrawal and may remain on the liquid for some time.
“But, [the discontinuation] is likely to impact any of those patients who are coming off,” she said. “Some advice has been to switch to an SSRI with a longer half-life but, from practice, it is not always as simple.”
Steve Bazire, honorary professor at the School of Pharmacy at the University of East Anglia, said that paroxetine was “rarely started these days” but that there were people still on it in the community.
He added that other paroxetine liquids and strengths, such as 10mg/5mL, 20mg/5mL and 30mg/5mL, had been mentioned by the Specialist Pharmacy Service as alternatives, but said it was not easy to find out who the manufacturers are.
“I’ve no idea how many people have the liquid … but overall, I’d say it’s a bit of a pain having this product discontinued, but if we can find out who makes the other liquids it would solve the issue,” he said.
David Taylor, director of pharmacy and pathology at the Maudsley Hospital and professor of psychopharmacology at King’s College London, said that he understood that other liquid formulations remained available.
“There may be differences in the formulation of different liquid oral products but I doubt they have any clinical significance given that the paroxetine content is the same,” he added.
The patient view
Sarah Tilley came off Seroxat over several years using the oral solution. She said:
“Many people trying to wean off Seroxat know how vital it is to get hold of the liquid version of the drug to help facilitate a safe and gradual taper. Without access to this it throws up lots of questions around how to taper safety and puts people at greater risk of experiencing severe withdrawal symptoms. The decision to stop making liquid Seroxat is both concerning and hugely disruptive for those trying to come off.”
Another patient, who wished to remain anonymous, had been taking Seroxat since they were in their early 20s. Frustrated by the side effects, they had attempted to stop taking it numerous times since 2004:
“For my latest attempt to stop Seroxat, starting from 20mg in 2018, I have used the oral suspension form to follow a hyperbolic taper. Doing so lets me precisely measure doses, avoids the risks of crushing tablets to make my own suspension, and is quicker and easier to order from my GP.
“So to learn GSK will no longer make the liquid form of this drug is yet another blow for me and for patients in the same precarious position. GSK must reverse this decision.”
Paul Sams, based in the North West of England, has now had a number of years medication free:
“The idea that this liquid form of Seroxat is no longer going to be available fills me with horror for the people hoping to come off this medication. I think the people who provide the tablet form should be firmly supported to continue making the liquid form of the medication available.”
- This article was updated on 27 July 2022 to include patients’ views