Paroxetine, also known by its brand name of Paxil, is a selective serotonin reuptake inhibitor (SSRI). It is commonly used to treat depression but may also be used to treat anxiety disorders, including generalized anxiety disorder and social anxiety disorder [1].

Paroxetine brand names

While paroxetine refers to the generic or chemical name of the medication, this drug can be sold under several brand names [2]:

  • Paxil
  • Paxil CR
  • Pexeva
  • Brisdelle

What is paroxetine prescribed for?

As an SSRI medication, paroxetine is most notable for its use in the treatment of depression. Other conditions that healthcare providers commonly prescribe paroxetine for include [1]:

Paroxetine is not intended to be prescribed for children under 18, but some physicians may use it for teens and children with an obsessive-compulsive disorder or social anxiety disorder [1].

Beyond the uses noted above, some less common uses of paroxetine are as follows [1]:

How does paroxetine work?

Paroxetine works by changing the availability of a neurotransmitter, or brain chemical, called serotonin. As a selective serotonin reuptake inhibitor (SSRI), paroxetine increases the availability of serotonin in the nervous system. This is important because low serotonin concentrations are believed to be involved in symptoms of depression, can help with anxiety symptoms such as panic attacks, and relieve symptoms of post-traumatic stress disorder.[1]

How is paroxetine usually taken?

Paroxetine is taken orally, typically as a pill. In addition, it is available as a regular and extended-release tablet, which is released slowly into the body.[1]

Initial doses of paroxetine tablets are prescribed with a typical starting dose of 20 mg daily for depression. The daily dose may be increased by 10mg each week until a person reaches a dose of 50 mg per day. The extended-release pill is typically started at a dose of 25 mg per day, with an increase of 12.5 mg per day until a maximum dose of 62.5 mg daily is reached.[1]

Doses may vary slightly based on the condition for which paroxetine is prescribed. For instance, dosages for anxiety may vary from dosages for depression or other conditions. Doses may also be lower for individuals with kidney or liver problems. Your doctor can determine the best dose for your specific needs.[1]

How long does paroxetine stay in your system?

Paroxetine has a half-life of 21 hours, meaning that every 21 hours, half of the concentration of the drug is removed from the body. Given this fact, paroxetine is completely eliminated from the system within about five days.[3]

Paroxetine side effects

While paroxetine is an approved medication with legitimate medical uses, that does not mean that it is without side effects. The following common side effects with paroxetine use are generally considered to be mild but may still require medical advice[2]:

  • Problems concentrating
  • Weakness or dizziness
  • Headaches
  • Confusion or forgetfulness
  • Feelings of nervousness
  • Sleepiness
  • Gastrointestinal symptoms like nausea, vomiting, or diarrhea
  • Gas and constipation
  • Stomach pain
  • Muscle and joint pain
  • Dry mouth
  • Reduced sex drive
  • Changes in appetite
  • Weight loss or gain

Some of the more serious adverse effects of paroxetine include [2]:

  • Hallucinations
  • Racing heart/irregular heartbeat
  • Fainting
  • Chest pain
  • Seizures
  • Breathing problems
  • Uncoordinated walking/falling
  • Abnormal bleeding or bruising
  • Signs of infection, such as fever, chills, or cough
  • Peeling or blistering skin
  • Numbness in your legs, arms, hands, or feet
  • Uncontrollable shaking in the body
  • Hives, rash, or itching
  • Bloody vomit or stools
  • Swelling in the face or other parts of the body
  • Painful erections lasting for hours
  • Risk of serotonin syndrome
  • Discontinuation syndrome

While mild paroxetine side effects are manageable and will improve with time, you should seek immediate medical attention if you experience severe side effects. If you have continuous side effects that do not improve with time or that interfere significantly with daily life, talk with your doctor.

Paroxetine precautions

Before taking paroxetine, you should tell your doctor about any other health conditions or medications you are taking. Your doctor will determine whether any dose adjustments need to be made to accommodate your health problems. Your doctor may also choose a different medication if paroxetine could interact negatively with other prescriptions you are taking.

Another precaution that comes along with paroxetine is the potential increased risk of suicidal thoughts. Children, teens, and young adults may experience increased suicidal thinking after being prescribed paroxetine. It is important to discuss this risk with your doctor and weigh the risks and benefits of taking the medication. Sometimes, the risk of not using paroxetine is greater than the risk of taking the medication, as untreated depression can also increase suicide risk. [2]

Paroxetine drug interactions

As noted above, paroxetine may interact with other medications you are taking. Some medications that may interact negatively with paroxetine include [4]:

  • Tryptophan
  • Pimozide
  • Lithium
  • Fentanyl
  • Tramadol
  • Thioridazine
  • St. John’s wort
  • Warfarin
  • Phenobarbital
  • Cimetidine
  • Phenytoin
  • Theophylline
  • NSAIDs, like ibuprofen
  • Fosamprenavir
  • Ritonavir
  • Digoxin
  • Tricyclic antidepressants, like protriptyline, amitriptyline, and desipramine
  • Atomoxetine
  • Risperidone
  • MAOIs, like selegiline, isocarboxazid, and phenelzine

If you are also taking one of these medications, it may be unsafe for you to take paroxetine. Be sure to tell your doctor about all other medications you are taking, as paroxetine may interact with other prescription drugs not included on this list.

Paroxetine storage

Paroxetine should be stored in the original prescription container and kept at a temperature of 15-30 degrees Celsius or 59 to 86 degrees Fahrenheit.[4] Failing to store paroxetine in the original container, with the prescription label, could result in someone accidentally taking a medication not intended for them, which can be dangerous. In addition, storing the medication at extreme temperatures can change some of the chemicals in the drug.

What to do if you overdose on paroxetine

Taking too large of a dose of paroxetine can result in an overdose. Some paroxetine overdose symptoms include [2]:

  • Drowsiness
  • Seizures
  • Coma
  • Nausea, vomiting, or diarrhea
  • Aggression
  • Urine that is dark red or brown in color
  • Extremely excited mood
  • Elevated heart rate
  • Severe twitching or stiffness of muscles
  • Confusion
  • Fever or sweating

If you or a loved one experiences these symptoms while taking paroxetine, call the nearest Poison Control Center or report immediately to the local emergency room. A patient who collapses, has a seizure, cannot be awakened, or struggles to breathe requires emergency medical attention. Contact 911 immediately.[2]

Frequently asked questions about paroxetine

The answers to the following common questions provide additional information about paroxetine.

How long does it take for paroxetine to work?

Everyone will respond differently to paroxetine, depending upon their unique medical history, symptom profile, and metabolism. People generally notice an improvement in sleep, appetite, and energy levels within a week or two of beginning paroxetine. Other symptoms may not improve immediately, including depressed mood and lack of pleasure with usual activities. It may take 6-8 weeks to experience the full benefits of paroxetine [5]. Do not be discouraged if the medication does not immediately improve depression symptoms.

Is paroxetine addictive?

Paroxetine is generally not considered addictive in the same way that substances of abuse, such as cocaine or heroin, are addictive. However, people may become dependent upon the medication, meaning that the body does not function the same without it. This means abrupt discontinuation of paroxetine can lead to withdrawal side effects, like irritability, depressed mood, agitation, dizziness, ringing in the ears, anxiety, confusion, headache, mood swings, sleep problems, or lethargic behavior. To prevent withdrawal, healthcare providers generally recommend that patients gradually taper their doses of paroxetine before stopping the medication completely [4].

What’s the difference between paroxetine and fluoxetine?

Paroxetine and fluoxetine belong to the SSRI class of drugs, meaning they have similar effects. Research has shown that these medications are about equally effective [6]. However, some people may respond better to one SSRI when compared to another. Your doctor can help you determine which medication best fits you.

Resources:

  1. Shrestha, P, Fariba, KA, Abdijadid, S. Paroxetine [Updated 2022 July 29]. In: StatPearls [Internet] Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available fromhttps://www.ncbi.nlm.nih.gov/books/NBK526022/#:~:text=Paroxetine%20is%20a%20selective%20serotonin,disorder%2C%20and%20premenstrual%20dysphoric%20disorder.
  2. Paroxetine: MedlinePlus Drug Information (n.d.). Retrieved October 29, 2022, fromhttps://medlineplus.gov/druginfo/meds/a698032.html#:~:text=Paroxetine%20is%20in%20a%20class,that%20helps%20maintain%20mental%20balance.
  3. Bourin, M., Chue, P., & Guillon, Y. (2006). Paroxetine: A review. CNS Drug Reviews, 7(1), 25-47. https://doi.org/10.1111/j.1527-3458.2001.tb00189.x
  4. PAXIL® (paroxetine hydrochloride) Tablets and Oral Suspension Prescribing Information. (2012, December). FDA.gov. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020031s067,020710s031.pdf
  5. Paroxetine (Paxil) | NAMI: National Alliance on Mental Illness. (n.d.)Retrieved October 30, 2022, fromhttps://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/paroxetine-(paxil)
  6. Fava, M., Rosenbaum, J.F., Hoog, S.L., Tepner, R.G., Kopp, J.B., & Nilsson, M.E. (2000). Fluoxetine versus sertraline and paroxetine in major depression: Tolerability and efficacy in anxious depression. Journal of Affective Disorders, 59(2), 119-126. https://doi.org/10.1016/s0165-0327(99)00131-7