Taking Paroxetine and presents to A&E with tremor

  Read the following three case study and answer all questions: A patient is taking Paroxetine and presents to A&E with tremor, tachycardia, hypertension and high temperature. After a genetic screening, the variant CYP2D6*4 is identified. Discuss: • What is Paroxetine and how does it work (mechanism and clinical use)? • What is the role of the CYP2D6 in the drugs’ metabolism in general? • What is the metabolic pathway of Paroxetine and how is it affected by the genetic variant described in this case study? • What is the resulting alteration in the blood levels of Paroxetine? • What is the link between the altered blood levels of Paroxetine and the signs and symptoms reported (can you identify the syndrome)?