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Updated on April 21, 2022

What Is Paxil?

Paxil is a brand name for a generic drug called paroxetine. It’s primarily used to treat depression. 

As an antidepressant, this drug affects brain chemicals that may be unbalanced in people with depression, anxiety, or other mental health disorders. 

Paxil was first marketed in the U.S. in 1992. It quickly gained a sizable market share after research determined it to be effective against major depression.1

It‘s generally safe when used as prescribed by your healthcare provider. However, be cautious of possible drug interactions.

Paxil can cause side effects, including sexual dysfunction and suicidal tendencies. It can also cause unpleasant withdrawal symptoms if you suddenly discontinue use. 

How Does Paxil Work?

Paxil belongs to the selective serotonin reuptake inhibitor (SSRI) drug class. As an SSRI, Paxil increases serotonin levels in the brain.2

Serotonin is a neurotransmitter, a brain chemical that carries signals between nerve cells. There are links between low serotonin levels and mental health conditions like depression.  

Nerve cells usually reabsorb or “reuptake” serotonin after a signal has been sent. Paxil and other SSRIs block serotonin reuptake. This process ensures serotonin won’t be present in low levels. 

Paxil also has mild to moderate noradrenergic effects. It blocks norepinephrine reuptake, which helps people with both depression and lethargy.1

Norepinephrine is a stress hormone and neurotransmitter. When released into the blood, it triggers processes that boost energy levels during stressful situations. 

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What Does it Treat?

Paxil may be prescribed to treat the following conditions:3

  • Major depressive disorder (MDD)
  • Generalized anxiety disorder (GAD)
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder
  • Social anxiety disorder or social phobia
  • Post-traumatic stress disorder (PTSD)
  • Premenstrual dysphoric disorder (PMDD)

The U.S. Food and Drug Administration (FDA) does not recommend Paxil for children and adolescents. However, healthcare providers may still prescribe this medication to younger people with OCD and social anxiety disorder. 

Other off-label uses of Paxil include:3

  • Separation anxiety 
  • Dysthymia
  • Body dysmorphic disorder
  • Postpartum depression
  • Premature ejaculation
  • Malignancy related pruritus unresponsive to standard treatment

Paxil is also prescribed for:4

  • Hot flashes and night sweats during menopause
  • Diabetes-related tingling in the hands and feet
  • Chronic headaches
  • Bipolar disorder

How to Take Paxil 

Paxil is available in three forms: 

  • Immediate-release tablet
  • Controlled-release tablet
  • Oral suspension

Paxil’s dosage depends on the treated condition and the person’s age. 

Prescribers typically give elderly patients (over 60 years of age), children, and adolescents lower doses than regular adults.

Doctors will start you on a low dose. If needed, they may increase the quantity once per week until the maximum allowable dose is met. 

Here are the typical doses of immediate-release Paxil for adults:3

Condition Starting Dose Per Day Weekly Increase Maximum Dose Per Day
Major depressive disorder (MDD) 20 mg 10 mg 50 mg
Generalized anxiety disorder (GAD) 20 mg 10 mg 60 mg
Obsessive compulsive disorder (OCD) 20 mg 10 mg 60 mg
Panic disorder 10 mg 10 mg 60 mg
Social Phobias 20 mg 10 mg 60 mg

Here are the typical doses of controlled-release Paxil for adults:3

Condition Starting Dose Per Day Weekly Increase Maximum Dose Per Day
Major depressive disorder (MDD) 25 mg 12.5 mg 62.5 mg
Panic disorder 12.5 mg 12.5 mg 75 mg
Social Phobias 12.5 mg 12.5 mg 37.5 mg

Here are some guidelines for the safe use of Paxil:4, 5

  • Take Paxil exactly as your doctor prescribes. Read the prescription label or medication guide for further instructions.
  • Don’t change the dose or frequency unless your healthcare provider advises you to do so. 
  • Swallow a controlled-release Paxil tablet whole. Don’t crush, chew, or break the tablet.
  • Shake the oral suspension before you take a dose. Use a dosing syringe or a medicine dose-measuring device.
  • Improvement of symptoms may take up to 4 weeks. Tell your doctor if there are new or worsening symptoms. 
  • Continue Paxil even if you feel well. Suddenly stopping Paxil can cause unpleasant and even dangerous withdrawal symptoms. Ask your doctor how to stop using Paxil safely. 
  • Immediately take your dose if you forgot about it. Skip the missed dose if it is almost time for your next one. Don’t take two doses at the same time.
  • Tell your doctor if you experience sexual dysfunction. This includes decreased sex drive, impotence, abnormal ejaculation, or difficulty achieving orgasm.

Side Effects

Side effects are one of the reasons people stop taking antidepressants. Awareness of side effects is essential to ensure treatment success.1

The most common side effects of Paxil include:3, 4, 5

  • Dry mouth
  • Loss of appetite
  • Nausea
  • Abdominal pain
  • Vomiting
  • Diarrhea
  • Constipation
  • Flatulence
  • Heartburn
  • Sweating
  • Headache
  • Vision changes
  • Anxiety
  • Drowsiness
  • Insomnia and other sleep problems
  • Sexual dysfunction (like decreased sex drive, impotence, abnormal ejaculation, or difficulty achieving orgasm)
  • Weakness

Paxil has more serious side effects like:3, 4, 5

  • Suicidal thoughts or actions
  • Serotonin syndrome
  • Severe allergic reactions (hives, difficulty breathing, or swelling of the face or throat)
  • Unusual bleeding
  • Seizures
  • Hallucination
  • Fainting
  • Changes in appetite or weight
  • Decrease in sodium levels
  • Chest pain
  • Difficult, frequent, or painful urination
  • Painful erection that lasts for hours
  • Unusual bone pain

Warnings & Dangers

Suicidal Thoughts or Actions

The FDA doesn’t recommend Paxil for younger users. Studies have found that antidepressants can increase the risk of suicidal thoughts or actions in children and adolescents.

In 2004, the FDA asked manufacturers to include a boxed warning about Paxil’s suicidal tendency risk. In 2006, the FDA extended the warning to young adults up to 25 years old.1, 4, 6

Doctors can still prescribe Paxil for OCD and social anxiety disorder in children and adolescents.

A woman taking Paxil for hot flashes may also develop suicidal thoughts or actions. This usually happens at the start of treatment or if/when the dosage changes.4

Pregnancy and Breastfeeding 

Pregnant people should not take Paxil. Studies suggest that infants can be negatively affected if exposed to Paxil during pregnancy. For example, taking Paxil during the first trimester of pregnancy may result in the infant developing congenital disabilities. 

Some studies suggest that Paxil can also pass into breast milk, which may affect breastfeeding babies.1, 3, 4 Other sources say that it is safe for lactation.

Sexual Dysfunction

Sexual dysfunction affects 30 to 70% of people taking Paxil and other SSRIs. Although these effects are usually reversible, rare cases last for months or years.1 

Tell your doctor if you experience sexual dysfunction. This includes decreased sex drive, impotence, abnormal ejaculation, and difficulty achieving orgasm.

What Drugs Shouldn’t Mix With Paxil?

Some drugs may interact with Paxil and cause adverse effects. They include:3, 4, 5 

  • Monoamine oxidase inhibitors (MAOIs): Both MAOIs and Paxil increase serotonin levels. Too much serotonin can lead to serotonin syndrome.
  • Thioridazine and pimozide: Paxil may block the breakdown and increase blood levels of these antipsychotic drugs. High levels of thioridazine and pimozide may cause irregular heartbeat.
  • Pravastatin: This is a cholesterol-lowering drug. Paxil and pravastatin may interact and spike blood sugar levels.
  • Tamoxifen: This drug is used in an attempt to stop breast cancer cells from multiplying and growing. Paxil can inactivate tamoxifen.
  • Tricyclic antidepressants (TCA): Paxil blocks TCA metabolism, leading to possible TCA toxicity.

You should never mix Paxil with other serotonin-boosting drugs. These include stimulants, opioids, and certain medicines for mental illness and migraine headaches.5

Be cautious if you take cimetidine, phenobarbital, phenytoin, and supplements like St. John's wort and tryptophan.3, 4

Other Warnings

Before taking Paxil, tell your healthcare provider if you have any of the following conditions:4, 5

  • Heart disease, stroke, or hypertension
  • Bleeding or blood clotting disorder
  • Kidney or liver disease
  • Bipolar disorder
  • Drug addiction
  • Seizures or epilepsy
  • Low sodium levels
  • Narrow-angle glaucoma

Paxil can make you drowsy. Don’t operate machinery or drive a car until you know the full effects Paxil has on you.4

Overdose

A person who overdosed on Paxil may experience the following symptoms:3, 4

  • Dizziness
  • Blurred vision 
  • Nausea
  • Vomiting
  • Tremors
  • Fast, pounding, irregular, or slow heartbeat
  • Fainting
  • Confusion
  • Seizures
  • Coma
  • Extreme tiredness
  • Unusual bleeding or bruising

In case of Paxil overdose, immediately seek medical attention or call the poison control center. Emergency medical personnel will examine the person’s airway, oxygenation, and ventilation. 

Supportive care is also an integral part of overdose treatment.3

Withdrawal

People who take Paxil and suddenly stop may experience withdrawal symptoms like:3, 4

  • Depression
  • Anxiety
  • Irritability
  • Abnormally elevated mood or energy
  • Dizziness
  • Confusion
  • Headache
  • Tingling sensations
  • Lethargy
  • Nausea
  • Vomiting
  • Fever
  • Chills
  • Unusual dreams
  • Dyskinesia
  • Sweating
  • Difficulty falling or staying asleep

If you need to stop taking Paxil, talk to your healthcare provider about how to stop safely. A  tapering schedule is often provided to gradually and safely decrease your dose.  

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Resources

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  1. Nevels, Robert, et al. “Paroxetine-The Antidepressant from Hell? Probably Not, But Caution Required.Psychopharmacology bulletin vol. 46,1 : 77-104.
  2. Overview - Selective serotonin reuptake inhibitors (SSRIs).NHS. 
  3. Shrestha, Prabina, et al. “Paroxetine.” In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
  4. AHFS Patient Medication Information. “Paroxetine.MedlinePlus. Updated September 15, 2018. 
  5. Thornton, Philip. “Paxil.Drugs.com. 
  6. PAXIL CR.DailyMed.

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