Paxil®

What is Paxil?

Paxil is the brand name of the generic medication paroxetine, a selective serotonin reuptake inhibitor (SSRI). SSRIs (a type of antidepressant medication that can also be used to treat anxiety) work by boosting the level of serotonin in your brain. Serotonin is a neurotransmitter that affects your mood and emotions such as contentment, optimism, and satisfaction. SSRIs make more serotonin available in your brain by preventing it from being reabsorbed into the nerve cells (neurons) in your brain.

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Paxil is used to treat several conditions:

• Generalized anxiety disorder (GAD)
• Major depressive disorder (MDD)
• Obsessive-compulsive disorder (OCD)
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Premenstrual dysphoric disorder (PMDD)
• Social anxiety disorder
• Some symptoms of menopause, such as hot flashes and night sweats

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Paxil may also be prescribed for “off-label” use to treat other conditions, including irritable bowel syndrome (IBS). Off-label use is when a medication is prescribed for a condition other than one it has been approved by the Food and Drug Administration (FDA) to treat. This is a common and acceptable medical practice.

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Paxil is available in tablet, capsule and liquid forms:

Paxil (immediate release tablet)

• 10 mg
• 20 mg
• 30 mg
• 40 mg

Paxil (capsule)

• 7.5 mg

 Paxil (liquid)

• 10 mg/5 mL

Paxil CR (controlled release tablet)

• 12.5 mg
• 25 mg
• 37.5 mg

A typical starting Paxil dosage will depend on what you are taking it for, which form you are taking it in, and your age (older adults should typically start at a lower dose due to an increased risk of negative side effects at higher doses). If the starting dose is not enough to ease your symptoms, your prescribing doctor, nurse practitioner, or Minded provider may adjust your dose.

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Regardless of the dosage, Paxil is typically a once-daily medication (usually in the morning) that can be taken with or without food. One exception to this is if you are taking Paxil to treat premenstrual dysphoric disorder (PMDD). In that case, you may take it daily or intermittently—typically beginning 14 days before the start of your period all the way through the first full day of your cycle. 

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Whether you are taking Paxil for anxiety, PMDD, depression, or any of the other conditions it is used to treat, your prescribing doctor, nurse practitioner, or Minded professional will provide you with details on when to take this medication and how often.

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If you accidentally miss your dose of Paxil you will want to either take the missed dose as soon as you remember or, if it is closer to when you would take the next dose, just go ahead and take the next dose.

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Paxil side effects, warnings, and interactions

Paxil side effects

Common side effects of Paxil and Paxil CR include:

• Blurred vision
• Constipation
• Decreased appetite
• Diarrhea
• Difficulty sleeping
• Dizziness
• Dry mouth
• Infection
• Nausea
• Nervousness
• Problems functioning sexually
• Shaking/tremor
• Sleepiness
• Sweating
• Weakness
• Yawning

While some side effects of Paxil tend to improve during the first few weeks of taking this medication, other adverse effects—such as sexual side effects—may not go away with time while you are on this medication.

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Let your prescribing doctor, nurse practitioner, or Minded professional know if you experience these or any other new or worsening Paxil side effects. 

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Rare or serious side effects of Paxil include:

• Angle-closure glaucoma (symptoms include: pain in your eye, vision changes, or swelling or redness in or around your eye)
• Low sodium levels in your blood (symptoms include: headaches, feeling weak, or having a hard time concentrating or remembering things)
• Serotonin Syndrome (symptoms include: shivering, diarrhea, confusion, severe tightness in your muscles, fever, or seizures. Serotonin Syndrome is very serious and may be fatal if not properly and promptly diagnosed and treated.)
• Teeth grinding

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Paxil (as well as other SSRIs) may also increase your risk for potentially life-threatening bleeding, especially in your gums, nose, stomach, or intestines. This risk may be further increased if you are also taking certain other medications, such as:

• Anticoagulants (such as Eliquis or Warfarin)
• Aspirin
• Nonsteroidal anti-inflammatories (NSAIDs, such as ibuprofen or naproxen)  

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Seek medical attention right away if you experience these (or any other) serious side effects.

Paxil warnings

Paxil comes with an FDA “Black Box” warning. This means that the Food and Drug Administration (FDA) has identified certain serious safety risks that might occur when taking this medication. These “Black Box” warnings are serious safety warnings—though the actual risk may be low or even rare.

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The Black Box warning for Paxil states:

• Children, adolescents, and young adults (under age 24) who take antidepressants might be at an increased risk of suicidal thoughts or behaviors. Studies did not show this increased risk in people older than 24—and the risk decreased in people age 65 and older.
• Paxil is not approved for use in children.

Paxil and pregnancy

Discuss your treatment plan with your prescribing doctor, nurse practitioner, or Minded provider if you are planning on becoming pregnant and/or breastfeeding. SSRIs—including Paxil—may affect your baby during pregnancy and be passed to them through breast milk.

Paxil withdrawal symptoms

If you need to stop taking Paxil for any reason, work with your prescribing doctor or nurse to develop a plan to do so carefully and gradually in order to avoid antidepressant medication withdrawal symptoms. In some cases, these symptoms can be mild and last a week or two—but in other cases, they may be more severe and continue on for weeks or even months.

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Symptoms of Paxil withdrawal include:

• Dizziness
• Headaches
• Irritability
• Nausea
• Nightmares
• Prickling and/or tingling sensation on the skin (paresthesias)
• Vomiting

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Paxil interactions

Always let your prescribing doctor, nurse practitioner, or Minded professional know about any other medications and/or supplements you are taking to determine if Paxil may have any negative interactions with them.

Paxil may interact with:

• Antipsychotics, such as Abilify (aripiprazole), Mellaril (thioridazine), Orap (pimozide), or Risperdal (risperidone)
• Buspar (buspirone), an anti-anxiety medication
• Cardiac (heart) medications, such as Inderal (propranolol), Lopressor (metoprolol), Toprol XL (metoprolol), or Rythmol (propafenone)
• Coumadin (warfarin)
• Intravenous methylene blue, used to treat a condition called methemoglobinemia (when your blood is unable to deliver oxygen where it is needed in your body)
• Lithobid (lithium), a mood stabilizer used to treat bipolar disorder
• Medications that may cause bleeding, such as Advil (ibuprofen), aspirin, or Motrin (ibuprofen)
• Migraine medications (triptans)
• Monoamine oxidase inhibitors (MAOIs—another type of antidepressant medication)
• Other selective serotonin reuptake inhibitors (SSRIs)
• Soltamox (tamoxifen), a medication used to treat certain types of breast cancer
• Some pain medications, such as Ultram (tramadol)
• Strattera (atomoxetine), a medication used to treat ADHD
• Tricyclic antidepressants, such as Norpramin (desipramine) or Tofranil (imipramine)
• Zyvox (linezolid), an antibiotic

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Paxil and alcohol

You should not drink alcohol if you are taking Paxil or other antidepressant medications. Though it may seem to boost your mood short-term, it can worsen anxiety and depression symptoms long-term. Alcohol can decrease the positive effects of antidepressant medications while also increasing the negative effects, such as sedation. And there is a risk of accidentally overdosing on Paxil if it is taken with alcohol.

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Symptoms of a Paxil overdose include:

• Abnormally excited, frenzied mood
• Aggressive behavior
• Coma
• Confusion, fast or irregular heartbeat, fever, severe muscle stiffness or twitching, and/or sweating
• Dark red or brown urine
• Diarrhea, nausea, and/or vomiting
• Drowsiness
• Seizures

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SSRI medications—including Paxil—must be taken regularly to both effectively treat depression and/or anxiety and to avoid withdrawal symptoms. Do not skip doses of Paxil in order to drink alcohol.