What to know about Paxil (paroxetine)

Drugs
Paxil is an antidepressant in the selective serotonin reuptake inhibitor class. Doctors prescribe Paxil to treat major depressive disorder.

Paxil is the brand name of a generic drug paroxetine. Doctors may prescribe Paxil for other uses, too.

In this article, we review the various uses, side effects, warnings, and drug interactions of Paxil.

What can people use Paxil for?

 A man in an office holding his glasses whilst feeling tired who could benefit from paxil
Uses for Paxil include treating sleep disturbance, depression, and difficulty with concentration.

The active ingredient in Paxil is paroxetine, which is a selective serotonin reuptake inhibitor (SSRI). SSRIs treat depression by increasing the levels of serotonin in the brain.

A disturbance in serotonin can lead to symptoms of depression, including:

  • sleep disturbance
  • a decrease in pleasure or interest
  • feelings of guilt or worthlessness
  • fatigue and changes in energy levels
  • difficulty with attention and concentration
  • changes in appetite or weight
  • motor dysfunction
  • suicidal thoughts
  • depressed mood

SSRIs are effective treatments for major depressive disorder, but doctors can also prescribe Paxil for other reasons, including:

Doctors usually do not recommend that children or adolescents less than 18 years old use Paxil. However, they can prescribe Paxil to people under 18 years old for OCD and social anxiety disorder. The Food and Drug Administration (FDA) has not approved Paxil for these uses in children.

People can also use Paxil to help relieve hot flashes and night sweats during menopause.


How to take Paxil

Paxil is available in three different oral dosage forms: an immediate release tablet, an oral suspension, and a controlled release tablet (Paxil CR).

The following table lists the different dosages and strengths in milligrams (mg) and milligrams per milliliter (mg/ml) of Paxil.

Dosage form Strength
Paxil immediate release tablets 10 mg, 20 mg, 30 mg, 40 mg
Paxil suspension 10 mg/5 ml
Paxil CR (controlled release) tablets 12.5 mg, 25 mg, 37.5 mg

The dose of Paxil that a doctor will prescribe depends on its intended use. Doctors will recommend a starting dose and may increase or decrease the dose depending on the person’s symptoms and side effects.

Major depressive disorder

People can use both the immediate release and controlled release tablets for major depressive disorder. Doctors will typically start adults on 20 mg of immediate release Paxil once daily and 10 mg once daily for older adults.

Immediate release tablets

Depending on the person’s response to Paxil, the doctor may increase the dose by 10 mg every week if needed. The maximum daily dose of Paxil for major depressive disorder in adults is 50 mg and 40 mg for older adults.

Controlled release tablets

When using controlled release tablets of Paxil, adults may begin on 25 mg once daily, and older adults will start on 12.5 mg once daily. Doctors may increase the dose by 12.5 mg every week, depending on the person’s response to treatment.

The maximum daily dose of Paxil CR in adults is 62.5 mg and 50 mg in older adults.

Generalized anxiety disorder

Doctors will recommend immediate release tablets of Paxil for treating people with generalized anxiety disorder.

The starting and continued dose is 20 mg/day, and doctors have found no evidence that higher dosages provide further benefits.

OCD

When treating people with OCD, doctors will choose immediate release tablets of Paxil.

Adults will typically start on 20 mg per day and increase this by 10 mg per day at one-week intervals. The recommended continued daily dose is 40 mg. The maximum dose is 60 mg daily.

The FDA does not approve the use of Paxil in children and adolescents, though doctors sometimes prescribe 10–50 mg of Paxil to people 7 years and older as an off label use.

Panic disorder

senior man in bed taking prescription medication statin pills and drinking water
A person can use either immediate release or controlled release tablets to help treat a panic disorder.

Adults with panic disorder can use both immediate release and controlled release tablets.

Immediate release tablets

Adults will usually take 40 mg per day for panic disorder. People typically start on 10 mg/day and increase this by 10 mg per day at intervals of at least 1 week. People should not exceed 60 mg per day.

Controlled release tablets

When choosing controlled release tablets, people can start with 12.5 mg per day and will typically reach an effective dose between 12.5 mg and 75 mg.

Social anxiety or social phobia

People aged 8 years and older can use immediate release or controlled release tablets to treat social phobias.

The following table shows the starting dose, weekly increase, and maximum daily dose for each dosage form of Paxil for children, adults, and older adults.

Starting daily dose Weekly increase Maximum daily dose
Adults Immediate release: 20 mg
Controlled release: 12.5 mg
Immediate release: 10 mg
Controlled release: 12.5 mg
Immediate release: 60 mg
Controlled release: 37.5 mg
Older adults Immediate release: 10 mg Immediate release: 10 mg Immediate release: 40 mg
Children and adolescents 8 years and older Immediate release: 10 mg Immediate release: 10 mg Immediate release : 50 mg

PTSD

Adults and older adults can use immediate release Paxil to help with the symptoms of PTSD.

Adults will typically start on 20 mg per day, with a maximum dose of 50 mg. Older adults may begin with 10 mg per day up to a maximum dose of 40 mg.

PDD

People can take Paxil to treat PDD. This is a depressive condition linked with the menstrual cycle. People will only take Paxil at certain times in their menstrual cycle, such as the luteal phase.

People can use immediate release or controlled release tablets for PDD. The effective dose is:

Mild to severe side effects

The most common side effects of Paxil are:

Serious side effects of Paxil may include:

  • suicidal thoughts or actions
  • serotonin syndrome
  • severe allergic reactions
  • abnormal bleeding
  • seizures or convulsions
  • episodes of mania
  • changes in appetite or weight
  • a decrease in sodium levels


Warnings

Paxil carries a boxed warning from the FDA stating that it can increase the risk of suicidal thoughts or actions.

Short term research studies have suggested that antidepressants may increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Studies do not show these effects in people over 24 years old.

Doctors will consider the individual benefits and risks of prescribing Paxil to anyone under 24 years old.

People should speak to a doctor about any changes in their thoughts, feelings, and mood after starting to take antidepressants. They can change the dose, medication, and help people manage their symptoms.

People should not take Paxil during pregnancy. Studies have shown that infants exposed during the first trimester had a higher risk of heart related congenital disabilities. The drug can pass into breastmilk, so speak to a doctor before taking Paxil while breastfeeding.

Suicide prevention

  • If you know someone at immediate risk of self-harm, suicide, or hurting another person:
  • Call 911 or the local emergency number.
  • Stay with the person until professional help arrives.
  • Remove any weapons, medications, or other potentially harmful objects.
  • Listen to the person without judgment.
  • If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.

Drug interactions

Paxil interacts with monoamine oxidase inhibitors (MAOIs). Like SSRIs, MAOIs increase the level of serotonin in the body. High levels of serotonin may be dangerous and may cause serotonin syndrome.

People cannot take MAOIs and Paxil at the same time. People taking MAOIs must stop the drug for 14 days before starting Paxil.

Thioridazine and pimozide are two antipsychotic medications that interact with Paxil. Paxil may inhibit how well the body breaks down thioridazine and pimozide, which may increase the levels of these two drugs in the blood. High levels of thioridazine and pimozide may affect the heartbeat.

People taking cimetidine, phenobarbital, and phenytoin must use Paxil with caution.


Withdrawal

doctor with patient in office discussing pap smear test
A doctor can run through any withdrawal symptoms that might occur when taking Paxil.

Withdrawal symptoms can occur when people abruptly stop taking Paxil. Anyone who wishes to stop taking Paxil must consult with a doctor. The doctor will recommend a dosing schedule to reduce the dose over time gradually.

When people stop taking Paxil, they may experience the following withdrawal symptoms:

  • depressed mood
  • irritability
  • agitation
  • dizziness
  • electric shock sensations
  • ringing in the ears
  • anxiety
  • confusion
  • headache
  • lack of energy
  • elevated mood or energy
  • exaggerated mood changes
  • sleeplessness

Summary

Doctors prescribe Paxil for many reasons, including depression and anxiety. Although the FDA does not recommend its use in people under 18 years old, some doctors will prescribe Paxil for OCD and social phobia in younger people.

Paxil may not be appropriate for everyone, so it is important to speak with a doctor before taking this antidepressant. People should also talk to their doctor if they experience any worsening of symptoms or suicidal thoughts when taking Paxil or any antidepressant.

When coming off Paxil, it is essential to follow a tapering schedule to avoid withdrawal symptoms.

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