Clinical reference

Panic disorder

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 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)

Verified against4 documents

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 date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (11)

Most patients report recurrent chest pain, palpitations, or breathlessness [breathlessness · chest pain · palpitations]
Sweating, shaking, a choking feeling, nausea, chills, tingling, or a sense of unreality are other common complaints [chills · nausea · sweating · tingling · tremor]
Patients tend to seek out non-psychiatric specialists for reassurance rather than mental health care, since most complaints are physical
The attack reaches its peak within minutes, and four or more physical symptoms come with it
Feeling dizzy, unsteady or light-headed, and close to fainting, is part of the attack [dizziness · syncope]
Fear of losing control and fear of dying belong to the attack itself
Attacks come without warning, usually with no trigger at all, and the patient feels a lack of control
Frequency runs from several attacks a day to only a few in a whole year
A month or more of persistent worry about further attacks, and behaviour that now avoids whatever the person blames for them, is what separates the disorder from a single attack [anxiety]
The fear and anxiety are felt in the body rather than in the mind, which is why these patients present to a physical clinic [anxiety]
Quality of life suffers and it leads on to low mood and disability, with a higher risk of alcohol and substance misuse [low mood]

If not this — what else fits (6)

Angina is on the differential
Congestive heart failure is on the differential
Mitral valve prolapse is on the differential
Pulmonary embolism is on the differential
Panic disorder is diagnosed only after other medical or psychiatric conditions that could better explain the symptoms are excluded
Substances, medicines and a general medical condition such as an overactive thyroid or vestibular disease can all produce panic attacks, and then the diagnosis is not panic disorder

SourceStatPearls "Panic Disorder" - disease-level clinical article

Presentation findings are traced to the source above.

SERTRALINE

1st line

Strength50 mg

Formoral.solid

Adult dose and duration

25 mg once daily for 1 week, then increase to 50 mg once daily; titrate up to max 200 mg daily if required

Paediatric dose

Specialist child and adolescent psychiatry referral required

Choice

Alternatives. Sertraline is first-line for panic disorder; paroxetine's discontinuation syndrome and teratogenic signal make it the second pick.

Dose source

Sertraline Hydrochloride US prescribing information, Dosage and Administration (DailyMed SetID 61835f25-bfe4-49ac-9dbf-3d6387866e78)

Why

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
OPIRALINE 50 MG 20 F.C. TABS.	EL-OBOUR	29.00 EGP (1.45/unit)
AGRELOCIT 50 MG 20 TAB.	MEMPHIS > ATM PHARMACEUTICAL INDUSTRIES	34.80 EGP (1.74/unit)
DEPR-STAT 50MG 10 CAPS.	MEMPHIS	21.60 EGP (2.16/unit)
SESERINE 50MG 30 TAB.	ADWIA	75.00 EGP (2.50/unit)
SERPASS 50MG 30 F.C.TAB.	GLOBAL NAPI PHARMACEUTICALS	102.00 EGP (3.40/unit)
SIRTO 50MG 10 F.C. TABS.	HI-PHARM	34.00 EGP (3.40/unit)
MOODAPEX 50 MG 30 F.C.TAB.	MULTI-APEX	111.00 EGP (3.70/unit)
LUSTRAL 50 MG 20 F.C.TABS.	VIATRIS	136.00 EGP (6.80/unit)

PAROXETINE

1st line

Strength20 mg

Formoral.solid

Adult dose and duration

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) - long-term

Paediatric dose

Contraindicated in children and adolescents under 18 years (increased risk of suicidal behavior)

Dose source

Paroxetine 20 mg Tablets SmPC section 4.2 (eMC product 537)

Why

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
XANDOL 20MG 20 TAB.	EUROPEAN EGYPTIAN PHARM. IND.	42.00 EGP (2.10/unit)
PAXETIN 20 MG 10 F.C.TABS.	PHAROPHARMA	22.80 EGP (2.28/unit)
DEPANX 20MG 10 F.C. TAB.	GLOBAL NAPI PHARMACEUTICALS	24.00 EGP (2.40/unit)
PAROXETINE 20 MG 30 F.C.TABS.	EVA PHARMA	93.00 EGP (3.10/unit)

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Panic Disorder - disease-level clinical article (panic-disorder-clinical.txt)

Why

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.

ALPRAZOLAM

add-on - not a substitute

Strength0.5 mg

Formoral.solid

Adult dose and duration

0.25-0.5 mg 3 times daily as needed for severe disabling acute panic crisis - Maximum of 2-4 weeks

Paediatric dose

Contraindicated in children

Dose source

Xanax (alprazolam) 500 microgram tablets SmPC sections 4.2 and 4.4 (eMC product 1656)

Why

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ZOLAPAR 0.5 MG 20 TABS.	DELTA PHARMA	12.00 EGP (0.60/unit)
ZOLAPAR XR 0.5 MG 20 TABS.	DELTA PHARMA	12.00 EGP (0.60/unit)
PRAZONEX 0.5 MG 30 TABS.	UP PHARMA	19.50 EGP (0.65/unit)
PRAZOLAM 0.5 MG 30 TABS.	EVA PHARMA	36.00 EGP (1.20/unit)
RESTOLAM 0.5 MG 20 TABS.	GLOBAL NAPI PHARMACEUTICALS	24.00 EGP (1.20/unit)
RESTOLAM 0.5 MG 30 TABS.	GLOBAL NAPI PHARMACEUTICALS	36.00 EGP (1.20/unit)
ZOLAM 0.5 MG 30 TABS.	AMOUN	36.00 EGP (1.20/unit)
XANAX 0.5 MG 100 TABS.	PFIZER > VIATRIS EGYPT	195.00 EGP (1.95/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.