{ "schema_version": 1, "kind": "condition", "id": "panic-disorder", "name": "Panic disorder", "category": "chronic", "sources": "Paroxetine 20 mg Tablets SmPC section 4.2 (eMC product 537) · Xanax (alprazolam) 500 microgram tablets SmPC sections 4.2 and 4.4 (eMC product 1656) · Sertraline Hydrochloride US prescribing information, Dosage and Administration (DailyMed SetID 61835f25-bfe4-49ac-9dbf-3d6387866e78)", "review_status": "reviewed", "verified_against": "Paroxetine 20 mg Tablets SmPC section 4.2 (eMC product 537) · Xanax (alprazolam) 500 microgram tablets SmPC sections 4.2 and 4.4 (eMC product 1656) · Sertraline Hydrochloride US prescribing information, Dosage and Administration (DailyMed SetID 61835f25-bfe4-49ac-9dbf-3d6387866e78) · Panic Disorder - disease-level clinical article (panic-disorder-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 1318, "generic": "Sertraline", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 50.0, "adult_dose": "25 mg once daily for 1 week, then increase to 50 mg once daily; titrate up to max 200 mg daily if required", "adult_duration": null, "dose_source": "Sertraline Hydrochloride US prescribing information, Dosage and Administration (DailyMed SetID 61835f25-bfe4-49ac-9dbf-3d6387866e78)", "rationale": "Sertraline is an SSRI that increases serotonergic transmission and is first-line pharmacotherapy for panic disorder, reducing the frequency and severity of panic attacks as treatment continues.", "cautions": [ "Start at half-standard dose (25 mg) to prevent initial paradoxical worsening of panic symptoms.", "Educate patient on 2-4 week onset delay before clinical response.", "Do not stop abruptly; taper slowly to prevent discontinuation syndrome." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist child and adolescent psychiatry referral required", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "OPIRALINE 50 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL-OBOUR", "price_egp": 29.0, "pack_count": 20, "unit_price": 1.45, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AGRELOCIT 50 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS > ATM PHARMACEUTICAL INDUSTRIES", "price_egp": 34.8, "pack_count": 20, "unit_price": 1.74, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEPR-STAT 50MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 21.6, "pack_count": 10, "unit_price": 2.16, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SESERINE 50MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 75.0, "pack_count": 30, "unit_price": 2.5, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SERPASS 50MG 30 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 102.0, "pack_count": 30, "unit_price": 3.4, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SIRTO 50MG 10 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM", "price_egp": 34.0, "pack_count": 10, "unit_price": 3.4, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MOODAPEX 50 MG 30 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTI-APEX", "price_egp": 111.0, "pack_count": 30, "unit_price": 3.7, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LUSTRAL 50 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "VIATRIS", "price_egp": 136.0, "pack_count": 20, "unit_price": 6.8, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "panic-disorder" }, { "id": 1319, "generic": "Paroxetine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 20.0, "adult_dose": "Start on 10 mg/day, gradually increased in 10 mg steps to recommended dose of 40 mg daily (maximum 60 mg/day if response is insufficient)", "adult_duration": "long-term", "dose_source": "Paroxetine 20 mg Tablets SmPC section 4.2 (eMC product 537)", "rationale": "Paroxetine is an SSRI alternative to sertraline for panic disorder; its teratogenic risk in early pregnancy and heavier discontinuation-syndrome burden make it a second-choice agent for many patients.", "cautions": [ "There is a teratogenic risk (cardiac malformations) in the first trimester of pregnancy.", "Paroxetine has the highest incidence of discontinuation syndrome among SSRIs; a strict gradual taper is required." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Contraindicated in children and adolescents under 18 years (increased risk of suicidal behavior)", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "XANDOL 20MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 42.0, "pack_count": 20, "unit_price": 2.1, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PAXETIN 20 MG 10 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 22.8, "pack_count": 10, "unit_price": 2.28, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEPANX 20MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 24.0, "pack_count": 10, "unit_price": 2.4, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PAROXETINE 20 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 93.0, "pack_count": 30, "unit_price": 3.1, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "panic-disorder" }, { "id": 1320, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Panic Disorder - disease-level clinical article (panic-disorder-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Because of suicide risk, some patients with panic disorder may need inpatient monitoring until symptoms subside - a different pathway from outpatient drug therapy." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "panic-disorder" }, { "id": 1317, "generic": "Alprazolam", "line": 2, "is_adjunct": true, "form": "oral.solid", "strength_mg": 0.5, "adult_dose": "0.25-0.5 mg 3 times daily as needed for severe disabling acute panic crisis", "adult_duration": "Maximum of 2-4 weeks", "dose_source": "Xanax (alprazolam) 500 microgram tablets SmPC sections 4.2 and 4.4 (eMC product 1656)", "rationale": "Short-term bridging agent during initial 2-3 weeks of SSRI initiation; avoid monotherapy due to dependence risk", "cautions": [ "Alprazolam has a high liability for dependence, tolerance, and severe withdrawal seizures if stopped abruptly.", "Strictly limit treatment duration to 2-4 weeks total.", "Two to four weeks, taper included. Not a repeat prescription.", "Never above 3 mg a day. Elderly start at 0.25 mg two or three times daily.", "Dependence can form inside those few weeks at an ordinary dose. Coming off brings the anxiety back worse than it started, and withdrawal can go as far as seizures - so reduce gradually, never stop dead.", "With an opioid this combination causes sedation, respiratory depression, coma and death. In a country where both are easy to obtain, that is the sentence that matters.", "Drowsiness, ataxia, and memory impairment can occur." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Contraindicated in children", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ZOLAPAR 0.5 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 12.0, "pack_count": 20, "unit_price": 0.6, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZOLAPAR XR 0.5 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA PHARMA", "price_egp": 12.0, "pack_count": 20, "unit_price": 0.6, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PRAZONEX 0.5 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 19.5, "pack_count": 30, "unit_price": 0.65, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PRAZOLAM 0.5 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 36.0, "pack_count": 30, "unit_price": 1.2, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RESTOLAM 0.5 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "RESTOLAM 0.5 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS", "price_egp": 36.0, "pack_count": 30, "unit_price": 1.2, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZOLAM 0.5 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 36.0, "pack_count": 30, "unit_price": 1.2, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "XANAX 0.5 MG 100 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER > VIATRIS EGYPT", "price_egp": 195.0, "pack_count": 100, "unit_price": 1.95, "strength_mg": 0.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "panic-disorder" } ] }