Paxil (Paroxetine HCl)

About Paxil

Paxil is an antidepressant and anxiety medication used for treating several mood disorders. Paxil belongs to a group of antidepressant drugs called SSRIs (selective serotonin reuptake inhibitor), which are thought to work by increasing the amount of serotonin (a chemical involved in communication between nerve cells) available to the brain, so that it comes back to a normal level. Low levels of serotonin are believed to be associated with mood disorders, and high levels of serotonin seem to have an antidepressant effect.

Paxil has been shown to be effective in relieving several kinds of emotional disturbance that decrease the ability to function normally. This includes: panic attacks, depression, posttraumatic stress syndrome, obsessive-compulsive disorder, and persistent anxiety. In low doses, Paxil may be used to treat fibromyalgia. Paxil may take several weeks to improve your condition.

Paxil is normally taken once a day, and can be taken with or without food. If you miss a dose, do not take a double dose the following day. You will get better results if you take Paxil regularly, according to the schedule worked out with your doctor.

Paxil should be stopped slowly, by gradually decreasing dosage as directed by your doctor. Suddenly stopping Paxil treatment can cause increased side effects. Paxil is only available by prescription, and is used to treat several mood and anxiety disorders.

Paxil should be stored away from heat and light.

Paxil Side Effects

Paxil side effects are usually temporary and can include the following, based on a Paxil dosage of 20-50 mg/day.

Paxil side effects that may occur in 5% or more of patients: asthenia (lack or loss of strength), sweating, nausea (can be helped by taking with food), dry mouth, decreased appetite, somnolence (drowsiness), dizziness, insomnia, tremor, constipation, diarrhea, decreased libido, yawn, nervousness, sexual side effects.

Take care to avoid operating a vehicle or other heavy machinery until you know how you react to Paxil. Paxil side effects may include impaired thinking and motor skills, or cause blurred vision.

Cautions: Paxil should be used cautiously in patients with: manic disorders, blood circulation and metabolism difficulties, or a history of seizures. Paxil may not be an appropriate medication for patients with brain damage or disease, or congenital brain defects. Paxil dosages should be lower for patients with kidney or liver trouble. Tell your doctor if you have ever had an allergic reaction to Paxil, to an antidepressant or anxiety medication of any type, or any other medication.

Paxil Interactions

Paxil and alcohol have not been shown to interfere with each other, but taking them together is not recommended.

Certain medications and supplements may increase the risk of serotonin syndrome in combination with Paxil. Serotonin syndrome may cause confusion, restlessness, lowered coordination, shivering or trembling, diarrhea, fever, sweating, twitching, or behaving with an excitement you can't control. If you experience a cluster of these symptoms, and you suspect that it may be due to a drug interaction or overdose, seek medical attention immediately. (This condition is very rare.)

Paxil interactions with the following drugs may be limited by following your doctor's advice. Always tell your doctor if you are taking any of the following:

Appetite suppressants like Phentermine/Adipex (fastin) or Meridia (sibutramine).
Benzodiazepines (a class of antidepressants, anti-panic agents, and muscle relaxants) such as Ativan (lorazepam), Valium (diazepam), Halcion (triazolam), Restoril (temazepam), Librium (chlordiazepoxide), Xanax (alprazolam), Tranxene-SD (clorazepate), Paxipam (halazepam), ProSom (estazolam), Klonopin (clonazepam) should probably not be mixed with Paxil.
Beta Blockers - Drugs like Inderal (propranolol), Lopressor (metoprolol), Tenormin (atenolol), and others may build up in the body to toxic levels when combined with SSRIs.
BuSpar (buspirone)
Cough medicine (dextromethorphan)
Coumadin (warfarin) - may cause bleeding problems when used with Paxil. Your doctor may prevent this by adjusting the dosage of one of these medications.
Desyrel (trazodone)
Dilantin (phenytoin)
Effexor (venlafaxine) - When used with Paxil, increases the chance of developing serotonin syndrome.
Hismanal (astemizole) - May alter your heartbeat if used with Paxil.
Inderal, Inderide (propranolol)
Kemadrin (procyclidine)
Lanoxin (digoxin)
Lithium (Eskalith)
Manarex (moclobemide) - This medication should not be mixed with Paxil, and you should allow a week following the use of Manarex before starting Paxil. Allow 2 full weeks after stopping Paxil before beginning use of Manarex. Serious side effects, including serotonin syndrome can develop.
MAO inhibitors - Paxil must never be mixed with MAO (monoamine oxidase) inhibitors, a class of antidepressants and antisenility drugs, such as Eldepryl (selegiline), Furoxone (furazolidone), Nardil (phenelzine), Marplan (isocarboxazid), or Parnate (tranylcypromine). Never use Paxil within 2 weeks of starting or stopping an MAO inhibitor. This drug interaction could cause severe heart problems or death. Patients over 65 should allow a longer wait period between using Paxil and an MAO, as Paxil may stay in their system longer than in other patients.
Migraine medications of the triptan class such as Amerge (naratriptan), Imitrex (sumatriptan), Maxalt (rizatriptan), or Zomig (zolmitriptan) can cause coordination difficulties when mixed with SSRIs.
Narcotic pain medication like Codeine, Demerol (meperidine), Buprenex (buprenorphine), Darvon (propoxyphene), Dilaudid (hydromorphone), MS Contin or Kadian (morphine), nalbuphine, OxyContin (oxycodone), Percocet (oxycodone and acetaminophen), Stadol (butorphanol), Talwin compound (pentazocine), Vicodin (hydrocodone and acetaminophen), or Vicoprofen (hydrocodone and ibuprofen) should be used cautiously with Paxil.
Parlodel (bromocriptine)
Quinaglute (quinidine)
Rhythmol (propafenone)
Sedatives like Fioricet (butalbital, acetaminophen, and caffeine), Fiorinal, Phenobarbitol, Seconal, or other barbiturates.
Selective serotonin reuptake inhibitors (SSRIs) of any other type, like Celexa (citalopram), Prozac (fluoxetine), Luvox (fluvoxamine), or Zoloft (sertraline).
Serzone (nefazodone)
Sinemet (carbidopa, levodopa)
Sleep medication like Ambien (zolpidem), Sonata (zaleplon), or over the counter sleeping pills should be used with Paxil only as, and if, advised by your doctor.
Street drugs such as LSD, Ecstasy (MDMA), or marijuana. These drugs also affect serotonin levels in the brain and may react strongly with an SSRI like Paxil. These interactions have not been studied in clinical tests and the side effects may prove very dangerous.
Tagamet (cimetidine)
Tambocor (flecainide)
Thioridazine - Severe Paxil interactions can occur with this medication. Paxil should not be taken within two weeks of thioridazine. This drug interaction could cause severe heart problems or death. Patients over 65 should allow a longer wait period between using Paxil and thioridazine, as Paxil may stay in their system longer than in other patients.
Tranquilizers such as Haldol (haloperidol) or Thorazine (chlorpromazine) may cause oversedation.
Tricyclic antidepressants such as Elavil (amitriptyline), Asendin (amoxapine), Anafranil (clomipramine), Pertofrane or Norpramin (desipramine), Sinequan (doxepin), Tofranil (imipramine), Aventyl or Pamelor (nortriptyline), Vivactil (protriptyline), and Surmontil (trimipramine), may increase the risk of side effects from Paxil. The use of Paxil with Elavil, Anafranil, or Tofranil can increase the chance of developing serotonin syndrome.
Tryptophan or 5-HTP (Contained in certain amino acid supplements or by itself) - This supplement may increase the risk of serotonin syndrome when mixed with Paxil.
Ultram (Tramadol)
Wellbutrin/Zyban (bupropion)

Talk with your doctor if you are considering mixing an antidepressant and anxiety medication like Paxil with any other antidepressant, or any medication that may cause drowsiness. Anxiety medication can have increased, unexpected, or severe side effects when mixed with other medications that affect the central nervous system.

Paxil Dosages

Paxil is available as a tablet, or liquid. Your Paxil dosage should be the least amount required to treat your symptoms.

Paxil 10 mg, yellow tablet
Paxil 20 mg, pink tablet
Paxil 30 mg, blue tablet
Paxil 40 mg, green tablet
Paxil liquid, orange color and flavor, 5mL equals 10 mg. Shake well, store below 77°F (25°C), but do not freeze.

Paxil dosages usually begin at 20 mg/day, except for panic disorders, where the beginning dose is usually 10 mg/day. The dosage may be stepped up at a rate of 10 mg/week according to your doctor's advice. If you are planning to stop taking Paxil, ask your doctor about reducing your dose gradually. It is not usually recommended for patients to stop Paxil all at once.

People with kidney or liver trouble, the elderly, or those with weak constitutions should take no more than 40 mg/day.

Paxil is currently prescribed as a medication for:

Major Depressive Disorder (Paxil dosage 20-50 mg/day)
Obsessive Compulsive Disorder (Paxil dosage 20-60 mg/day)
Panic Disorder (Paxil dosage 10-40 mg/day)
Social Anxiety Disorder (Paxil dosage 20 mg/day)
Generalized Anxiety Disorder (Paxil dosage 20 mg/day)
Posttraumatic Stress Disorder (Paxil dosage 20-50 mg/day)

Maximum Paxil dosage should not exceed 60 mg/day. Paxil overdose may cause coma, irritability, dizziness, drowsiness, racing heartbeat, facial flushing, nausea, sweating, tremor, or vomiting, and should be treated by a healthcare professional immediately.

Paxil is a trademark of GlaxoSmithKline

This document is provided for information only. It is not a substitute for consultation with a physician, either to diagnose symptoms or prescribe treatment. The dosages mentioned are general manufacturers guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. Dosage recommendations for children and seniors may vary significantly from standard dosages, and pregnant women should always speak to their OB/GYN before taking any medication. We have made every effort to ensure that the information presented is accurate, but only your doctor can say if a medication, or drug combination, is safe for you. Information intended for US residents only.