Medication and Treatment Reviews

Paxil

Generic: Paroxetine Hydrochloride

Uses

Paxil is a selective serotonin reuptake inhibitor (SSRI) medication taken orally that is primarily used to treat major depressive disorder (MDD) in adults. It can help relieve the sadness, difficulty sleeping, and changes in appetite and mood associated with depression. The safety and effectiveness of Paxil in children and adolescents under age 18 has not been established. Physicians may recommend a reduced dose for adults over age 65.

Paxil can also be used to treat obsessive compulsive disorder (OCD), panic disorder, social anxiety disorder, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD).

How to Use Paxil

Before starting or refilling a Paxil prescription, read the medication guide included with your pills, as it may be updated with new information.

This guide should not replace a conversation with your doctor, who has a holistic view of your medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.

Dosage

As with all medications, follow your Paxil prescription instructions exactly. Paxil is taken orally, with or without food, typically once daily in the morning. It is available in three formulations:

  • Tablet: Tablets should be swallowed whole with water or other liquids. Tablets should never be crushed or chewed.
  • Oral Suspension: Oral suspension should be shaken well, then measured with the included device and swallowed entirely.
  • Controlled Release Tablet: Paxil CR is an extended-release tablet, swallowed whole with water or other liquids. Tablets should never by crushed or chewed. The time-release formulation is designed to maintain a steady level of medication in your body throughout the day.

The optimal dosage varies by condition treated, age, and patient health. If you are over 65 years of age, or have certain health conditions, your doctor may recommend a lower dosage.

Do not drink alcohol while taking this medication.

Your doctor may incrementally adjust your daily dosage until you experience the best response – that is, until you find the lowest dosage at which you experience the greatest improvement in symptoms without side effects.

When discontinuing treatment, or decreasing dosage, patients should work with a doctor to gradually taper the level of medication. Stopping Paxil suddenly can create serious symptoms including anxiety, irritability, changes in mood, feelings of restlessness, difficulty sleeping, headache, sweating, nausea, dizziness, electric shock-like sensations, shaking, or confusion.

Side Effects

The most common side effects of Paxil are similar to those associated with other SSRIs, like Lexapro, and are as follows: nausea, sleepiness, weakness, dizziness, feeling anxious, difficulty sleeping, sexual problems, sweating, shaking, change in appetite, dry mouth, constipation, and infection.

Other serious side effects include increased risk of suicidality or manic episode, vision problems, seizures, and severe allergic reaction. Patients should be monitored and observed closely for worsening depression, changes in behavior, or suicidality, especially when starting treatment or changing dosage.

Taking Paxil may impair your ability to drive, operate machinery, or perform other potentially dangerous tasks. This side effect usually wears off with time. If side effects are bothersome, or do not go away, talk to your doctor.

Most people taking this medication do not experience any of these side effects.

Disclose to your physician all mental health issues including any family history of suicide, bipolar disorder, mania, or depression. The FDA recommends evaluating patients for bipolar disorder prior to the administration of Paxil to avoid inducing a manic episode. Paxil may create new or exacerbate existing behavior problems, bipolar disorder, or suicidal ideation, especially in the first few months of treatment or after a dosage change. Call your doctor immediately if you experiences new or worsening mental health symptoms including reckless behavior, panic, or sudden excessive happiness or irritability.

Paxil increases serotonin levels in the brain, and can rarely lead to life-threatening serotonin syndrome, or toxicity. If you experience changes in mental status, coordination problems, muscle twitching, racing heartbeat, high or low blood pressure, sweating, vomiting or diarrhea, seek medical help immediately.

Discuss any bleeding disorders or irregular sodium levels with your doctor. Paxil can cause abnormal bleeding for some patients, and low salt concentration in the blood. The elderly may be at greater risk for these problems.

The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.

Precautions and Safety

Store Paxil in a secure place out of the reach of children, and at room temperature. Do not share your Paxil prescription with anyone, even another person with depression or anxiety. Sharing prescription medication is illegal, and can cause harm.

You should not take Paxil if you have an allergy to paroxetine or any of the other ingredients in Paxil.

You should not take Paxil if you have taken a monoamine oxidase inhibitor (MAOI) within 14 days; it can cause a serious, even life-threatening reaction.

You should not take Paxil if you are taking the antipsychotic medication Orap or Mellaril (thioridazine), because it can cause serious heart problems or even death.

You should use caution when taking any SSRIs, including Paxil, and speak with your doctor if you have liver or kidney problems, heart problems, glaucoma, seizures, bipolar disorder, low blood sodium levels, a history of stroke or high blood pressure, or a history of bleeding problems.

If you’re thinking of becoming pregnant, discuss the use of Paxil with your doctor. It is not known if Paxil can cause fetal harm during pregnancy. It is recommended that mothers do not nurse while taking Paxil, as its safety for infants is unknown, and Paxil passes into breastmilk.

Interactions

Before taking Paxil, discuss all other active prescription medications with your doctor. Paxil can have a dangerous, possibly fatal, interaction with antidepressants including MAOIs, the antipsychotic medication Orap, and Mellaril (thioridazine).

Taking Paxil while taking blood thinners like Coumadin, ibuprofen, or aspirin can increase the risk of abnormal bleeding. Using Paxil concurrently with medication that increases serotonin – like St. John’s wort, SSRIs, tryptophan, or street drugs like MDMA – can increase the risk of serotonin syndrome.

Paxil can impact how your body processes certain drugs including atomoxetine, other antidepressants, cimetidine, fentanyl, metoprolol, pimozide, procyclidine, and tamoxifen. This may affect how they work.

Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications, you take with the pharmacist when you fill your prescription, especially any drugs that cause drowsiness. Let all doctors and physicians know you are taking Paxil before having any surgery or laboratory tests.

The above is not a complete list of all possible drug interactions.

Sources:

http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020031s067,020710s031.pdf
http://www.fda.gov/downloads/drugs/drugsafety/ucm088676.pdf
http://www.fda.gov/downloads/drugs/drugsafety/ucm249171.pdf

6 reviews

  1. When I was first diagnosed, I had anxiety, depression, and ADHD. My psychiatrist treated the anxiety and depression first, and ultimately Paxil got rid of both. Due to side effects, I was taken off Paxil. The anxiety did not return, but depression did. Eventually, we arrived at Wellbutrin SR and Adderall. A few years later, we added 20 mg of Citalopram (Celexa) for depression. These keep my ADHD and depression under control.

  2. I have been taking Paxil for years to manage my anxiety and depression. It does wonders for my anxiety but is lacking in the depression area. I was diagnosed with ADHD a few years ago and started taking Vyvanse with great results. However, I developed heart palpitations and after going off of the Vyvanse they went away – therefore stimulants don’t seem to be the best option for me and doctors of course don’t want to prescribe them. I then tried Strattera, which seemed to help me feel better but I had a headache that lasted for weeks until I went off of that. The doctor felt that a long acting version of Paxil might help. I have been on that for about 3 months now and don’t see an improvement in how I am feeling and also I seem to be very sleepy all the time except at night when I should be sleeping!

  3. Last year my 7-year-old daughter was taking Vyvanse and Paxil. It was disastrous. Her agitation and aggression kept escalating and we couldn’t understand why things were getting worse. The doctor increased dosage and again she grew more aggressive.

  4. I have been taking Paxil CR for so many years that I’m not sure but it was not long after the controlled released came out. I do very well on 50mg and it helped my anxiety a bit better than Prozac did. However, I realized I have had an anxiety disorder all of my life along with Major Depressive Disorder. Thus, I take 0.5mg Xanax up to 4x a day if needed. Then in my early 50’s I was diagnosed with ADHD and started taking Concerta. He began me on 36mg per day then upped it to 72mg per day. I have been taking the combination for about 12 years now and I never knew what it was like to feel this “normal”. It took many, many years but in addition to so many newer medications coming out and sticking with a good doctor, we finally got the best cocktail for me.

  5. About 10 years ago, had some panic attacks and ended up in ER. The 2nd time they threw me on Paxil. We went through my GP and I stayed on Paxil for many years. It wasn’t until last year (May 2011) that I was officially diagnosed with ADHD as well as a mood disorder. In hindsight, the Paxil was probably only making the condition worse. However, I stayed on the Paxil and she put me on Seroquel at night. Just a few months ago when I still didn’t feel like I was operating at an optimal level, I asked my doc if we could try Lamictal (she was hesitant to put me on that at the get go because I had had some skin allergies…that’s the med that has a fatal rash as a side effect in small cases). So we added the Lamictal and I’ve had no problems.

  6. Dr. Charles Parker warns (page 72-75, New ADHD Medication Rules). Prozac/Paxil will block the 2D6 pipes and the “amphetamines accumulate, with resultant anger, rage, mind racing, sleep deprivation and subsequent lack of control.” It will take a bit of time for the stim meds to accumulate – so if you just recently started be aware. It seems like this has been the problem for several of the reviewers.

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