GENERIC NAME: Paroxetine

COMMON BRANDS: Seroxat, Seroxat CR, Paxil, Paxil CR, Brisdelle, Pexeva

Paroxetine is an oral prescription medicine, that belongs to a class of drugs known as a selective serotonin reuptake inhibitor (SSRI) used to treat depression, anxiety disorders, panic attacks, and a severe form of premenstrual syndrome (premenstrual dysphoric disorder).

What is Paroxetine used for?

Paroxetine is used for the treatment of depression, anxiety disorders, panic attacks, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder. It works by maintaining the balance serotonin(a natural substance) in the brain.

This medicine may improve your mood, sleep, appetite, and energy level and may help to restore your interest in daily life. It may decrease anxiety, fear, unwanted thoughts, and panic attacks. It may also lessen the urge to perform repeated tasks (compulsions like hand-washing, counting, and checking) that interfere with daily life.

How to use Paroxetine?

Read the Medication Guide carefully and the Patient Information Leaflet, if available provided by your pharmacist before you initiate using paroxetine and whenever you get a refill. If you have any query, ask your doctor/pharmacist.

Take this medication orally with or without food as directed by your doctor/physician, usually once a day in the morning. Take this medicine with food to avoid nausea. If this medication makes you drowsy during the day, then talk to your doctor/physician about taking it in the evening.

The dose of the drug is based on your medical condition, response to treatment, age, and other medications you may be taking. Inform your doctor/ physician/ pharmacist about all the products you are using (prescription drugs, nonprescription drugs, and herbal products). To minimize the chance of developing any side effects, your doctor may prescribe you lowest dose at the start and gradually increase your dose. Follow your doctor’s instructions carefully. Do not increase or alter your dose or use this drug more frequently or for longer than prescribed. Your condition will not improve, but your risk of side effects will increase. Do not miss the dose of the drug to get the most benefit from it. To avoid confusion take the drug at the same time each day.

Before taking tablet do not to chew/ crush as instructed by the manufacturer. However, many similar drugs (like immediate release tablets) can be chewed/crushed. Follow your doctor/physician’s instruction on how to take this medication.

If you are using paroxetine for premenstrual problems, your doctor/physician may instruct you to take it daily for a month or just for the two weeks before your period through the first full day of your period.

It is essential to continue using this drug even if you feel well. Do not stop using this medicine without consulting your doctor/physician. Few conditions may become worse if, this drug stopped suddenly. Also, you may experience symptoms like mood swings, sleep changes, headache, tiredness, and brief feelings similar to electric shock. To avoid these symptoms at the end of treatment with this drug, your doctor/ physician may decrease your dose gradually. Consult your doctor/physician/pharmacist for further details. Inform any new or worsening symptoms immediately.

It may take some weeks to get the full benefit of this drug. Inform your doctor/ physician if your condition does not improve or if it worsens.

What are the side effects of Paroxetine?

See also Warning section.

Drowsiness, dizziness, trouble sleeping, weakness, loss of appetite, nausea, dry mouth, blurred vision, sweating, and yawning may occur. If any of the side effects continue or get worse, inform your doctor/ physician/ pharmacist immediately.

Remember that your doctor/ physician has prescribed this medication because the doctor/physician has found the benefits to you are higher than the side effects. Most of the people using this medication do not have serious side effects.

Inform your doctor/ physician right away, if you have any severe side effects, like restlessness, shaking (tremor), inability to keep still, decreased interest in sex, changes in sexual ability, easy bruising/bleeding, numbness/tingling, fast/irregular heartbeat, muscle weakness/spasm, seizures.

Get medical assistance promptly if you have any severe side effects, like black stools, vomit that looks like coffee grounds, widened pupils, eye pain/swelling/redness, vision changes (like seeing rainbows around lights at night).

This medication may increase serotonin level in brain and rarely cause a severe condition known as serotonin syndrome/ toxicity. The risk higher if you are also taking other drugs that increase the level of serotonin, so inform your doctor/ physician/ pharmacist of any medicines you may be using (see Drug Interactions section as well). Get medical immediately if you have some of the following symptoms such as fast heartbeat, loss of coordination, hallucinations, severe nausea/vomiting/ diarrhea, severe dizziness, twitching muscles, unusual agitation/restlessness, unexplained fever.

In some cases, males may have a painful or prolonged erection lasting 4 or more hours. If this happens, stop taking this drug and get medical assistance right away, or permanent problems could occur.

Severe allergic reaction to this drug is very uncommon. However, get medical assistance immediately if you notice any of the following symptoms such as rash, severe dizziness, trouble breathing, itching/swelling (especially of the face/ tongue/ throat).

This is not a full record of all possible side effects. If you notice any other effects not listed above, contact your doctor/ physician/ pharmacist.

What are the precautions while using Paroxetine?

Before taking paroxetine, inform your doctor/ physician/ pharmacist if you are allergic to it or if you have any other allergies. This product may contain inactive ingredients, that may cause allergic reactions or other issues. Talk to your pharmacist for more details.

Before taking this medication, inform your doctor/ physician/ pharmacist about your medical history, mainly personal or family history of bipolar/ manic-depressive disorder/ suicide attempts, seizures, liver problems, low sodium in the blood, kidney problems, bleeding problems, intestinal ulcers/bleeding (peptic ulcer disease) or glaucoma (angle-closure type).

This medicine may cause dizziness or drowsiness. Alcohol or marijuana can cause more dizziness or drowsiness. Avoid driving, or use of any machinery, or do anything that requires alertness or clear vision till you can do it safely. Avoid alcoholic beverages. Inform your doctor if you are taking marijuana.

Before surgery, inform your doctor or dentist about all the products you are using (like prescription drugs, nonprescription drugs, and herbal products).

Older adults are more prone to the side effects of this drug, mainly loss of coordination or bleeding. Older adults more likely to develop a type of salt imbalance (hyponatremia), mainly if they are also using “water pills” (diuretics). Loss of coordination can enhance the risk of falling.

Children are more sensitive to the side effects of this drug, such as loss of appetite and weight loss. Monitor weight and height regularly in children who are using this drug.

This medicine is not advised for use during pregnancy. It may harm the fetus, and babies born to mothers who have used the drug in last trimester of pregnancy may sometimes develop withdrawal symptoms like feeding/breathing difficulties, seizures, muscle stiffness, or constant crying. However, untreated mental/mood problems (like depression, panic attack, obsessive-compulsive disorder, and anxiety) may harm the pregnant woman and her fetus, do not discontinue this medication unless instructed by your doctor. Instead, ask your doctor/physician if a different drug would be right for you. If you are planning a pregnancy, become pregnant, or think you may be pregnant, inform your doctor immediately.

This drug passes into breast milk. Consult your doctor before you start breastfeeding.

What are the drug interactions of Paroxetine?

Drug interactions may alter how your drug works or may enhance your risk for serious side effects. This list does not consist of all possible drug interactions. Keep a record of all the products you are using including prescription/nonprescription drugs and herbal products and inform your doctor/ pharmacist. Don’t start, stop, or alter the dosage of any medicines without your doctor/physician’s consent.

Some of the products may interact with this drug like thioridazine, other medicines that can cause bleeding/bruising (like antiplatelet drugs such as clopidogrel, NSAIDs like ibuprofen, “blood thinners” like warfarin).

Aspirin can raise the risk of bleeding when used with this drug. However, if your doctor/ physician has instructed you to take low-dose of aspirin for heart attack or stroke prevention (generally at dosages of 81-325 milligrams per day), regularly take this drug unless your doctor advises you otherwise. Inform your doctor/ physician/ pharmacist for further details.

Paroxetine may slow down the removal of other drugs from your body, and affect how they work for example atomoxetine, phenothiazines, pimozide, risperidone, tamoxifen, tetrabenazine, antiarrhythmics like propafenone/flecainide, TCA antidepressants like desipramine/ amitriptyline, among others.

Using MAO inhibitors with this drug may induce a severe (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, phenelzine, procarbazine, methylene blue, moclobemide, rasagiline, safinamide, selegiline, tranylcypromine) during therapy with this medicine. Avoid most MAO inhibitors for two weeks before and after treatment with this drug. Seek advice from your doctor/ physician when to start or stop taking this medication.

The risk of serotonin toxicity/ syndrome increases if you are using other drugs that increase serotonin level. Like street drugs such as MDMA “ecstasy,” St. John’s wort, certain antidepressant SNRIs(duloxetine/ venlafaxine), including other SSRIs such as citalopram/ paroxetine, tryptophan, among others. The risk of serotonin toxicity/ syndrome may be more likely when you start or change the dose of these drugs.

Inform your doctor/ physician/ pharmacist if you are using other products that cause drowsiness such as alcohol, marijuana, antihistamines (like cetirizine, diphenhydramine), drugs for sleep or anxiety (like alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain relievers (like codeine).

Read the labels carefully on all your medicines (like an allergy or a cough and cold products) as they may have ingredients that cause drowsiness. Seek advice from your pharmacist about using those products safely.

This medicine may intervene with certain medical/ laboratory tests (like brain scan for Parkinson’s disease), may result in the false test. Make sure laboratory personnel and all your doctor/physician’s know you use this drug.

WARNINGS:

Antidepressant drugs are used to treat a variety of conditions, for example, depression and mental/ mood disorders. These medications help to prevent suicidal attempts/ thoughts and provide other significant benefits. However, a small number of people (particularly people below 25 years ) who use antidepressants for any condition may observe worsening depression, other mental/ mood symptoms, or suicidal thoughts/ attempts. However, it is necessary to seek advice from your doctor/ physician about the risks and benefits of the antidepressant medication.

Inform your doctor/ physician immediately if you notice worsening of depression or other psychiatric conditions, unexpected behavior changes (possible like suicidal thoughts/attempts), or other mental/ mood changes (new/worsening anxiety, panic attacks, trouble sleeping, severe restlessness, very rapid speech, irritability, hostile/ angry feelings, impulsive actions). Carefully observe these symptoms when a new antidepressant drug is started or when the dose is altered.

What are the forms and strengths of Paroxetine?

Form: Oral tablet
Strength: 10mg, 20mg, 30mg and 40mg.

Form: Oral capsule
Strength: 7.5mg.

Form: Tablet, extended-release
Strength: 12.5mg, 25mg and 37.5mg.

Form: Oral suspension
Strength: 10mg/5mL

What is the dosage of Paroxetine?

For Depression:

Adults:

Conventional: Initially 20 mg orally every day and dose may be increased by 10mg/day every week not to exceed 50mg/day.
Paxil CR: Initially 25mg orally every day and dose may be increased by 12.5mg/day every week not to exceed 62.5mg/day.

For Obsessive-Compulsive Disorder:

Adults:

Initially 20mg orally every day and dose may be increased by 10mg every week, not to exceed 60mg/day.

For Panic Disorder:

Adults:

Initial dose: 10 mg orally every day and dose may be increased by 10mg every week (target dose 40mg/day), not to exceed 60mg/day, or
Paxil CR: Initially 12.5 mg orally every day and increase by 12.5 mg every week not to exceed 75mg/day.

For Social Phobia:

Adults:

Initial dose: 20 mg orally every day or
Paxil CR: Initially 12.5 mg orally every day and dose may be increased by 12.5mg every week, not to exceed 37.5mg/day.

For Generalised Anxiety Disorder:

Adults:

Initial dose: 20 mg orally every day and dose may be increased by 10 mg every week, up to 50mg/day doses have been used but no increase in benefit seen at doses >20mg/day.

For Post-traumatic Stress Disorder:

Adults:

Initially, 20mg orally every day and dose may be increased by 10 mg every week, up to 50mg/day doses have been used but no increase in benefit seen at doses >20 mg/day.

For Premenstrual Dysphoric Disorder:

Adults:

Paxil CR: Initially 12.5mg orally every day and dose may be increased at 1-week intervals not to exceed 25mg/day.

For Menopausal Vasomotor Symptoms:

Adults:

Brisdelle: Indicated to treat moderate-to-severe vasomotor symptoms associated with menopause
Brisdelle: 7.5mg orally every day at bedtime
Paxil CR (Off-label): 12.5-25mg orally every day.

Dosing Modifications:

Severe renal impairment (CrCl <30 mL/min):

Conventional: Initially 10mg orally every day and dose may be titrated not to exceed 40mg/day.
Paxil CR: Initially 12.5mg orally every day and dose may be titrated; not to exceed 5 mg/day.

For stuttering (Off-label):

20mg orally every day.

For vasovagal syncope (Off-label):

20mg/day orally.

For diabetic neuropathy (Off-label):

Adults: Initially, 10mg/day orally and dose may be increased to 20-60 mg/day.

Pediatric:

It is not recommended to use in children as the safety and efficacy is not established.

Geriatric:

Caution should be taken in the elderly as paroxetine is the most sedating and anticholinergic of the selective serotonin reuptake inhibitors and older adults are more prone to SSRI/SNRI-induced hyponatremia. It is recommended to monitor closely.

Disclaimer

TheMedPharma has made every effort to make sure that all the information is factually correct, comprehensive, and up-to-date. However, this website should not be considered as a substitute for the advice, knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or licensed health care professional before taking any medication. The drug information contained herein is subjected to changes if required. The lack of warnings or other information for a given drug does not mean that the drug or its combination is safe, effective or appropriate for use in all patients.