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Other Brand Names: Aropax (Argentina,
Australia, Belgium, Mexico, New Zealand, South Africa) Generic Name: paroxetine hydrochloride Other Forms: oral suspension What is Paxil and Paxil CR. Paxil and
Paxil CR are Antidepressants, specifically SSRI.
Major Depressive Disorder Obsessive-Compulsive Disorder Panic Disorder Social Anxiety Disorder General Anxiety Disorder Post Traumatic Stress Disorder (whether or not it's combat
PTSD is not specifically defined). The Controlled Release form of Paxil (Paxil CR) is approved for: Major Depression and Panic Disorder Premenstrual
Syndrome & Premenstrual Dysphoric Disorder (but
watch out for sexual side effects) What Else are Paxil and Paxil CR used for: Paxil and Paxil CR are prescribed
off-label for: Paxil's pros and cons: Pros: The data on the PI sheet for the immediate release version show it to be
moderately effective for just about everything under the sun, hence its official approval
for so many disorders instead of just off-label usage. The data for the CR version are
much more vague, and you'll note it isn't approved for as many disorders. Cons: Paxil and
Paxil CR (paroxetine hydrochloride) are the worst true SSRI to stop taking. SSRI discontinuation
syndrome for Paxil and Paxil CR (paroxetine hydrochloride) are worse by far than any
of the others. No, Effexor (venlafaxine) doesn't count, because
it isn't an SSRI. Paxil and Paxil CR also have the
worst sexual side effects, although the CR version tends to make the sexual side effects
less harsh, the CR version is also less effective for a lot of disorders, hence its lack
of approvals. Paxil and Paxil CR's Typical Side Effects: The usual for
SSRIs - headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or
constipation, weight gain, loss of libido. Everyone I've read on the subject of how long
side effects last (Dr. Stephen Stahl's Essential
Psychopharmacology: The Prescriber's Guide, Dr. Diamond's Instant
Psychopharmacology, Dr. Drummond's The
Complete Guide to Psychiatric Drugs , Preston et al.'s Consumer's
Guide To Psychiatric Drugs) agrees that everything but the weight gain and loss of
libido usually goes away within a couple of weeks. Paxil is notorious for having the
worst impact on your libido of all SSRIs. For tips on how to cope with these side effects, please see our side effects page. Paxil's Not So Common Side Effects: Motion sickness/vertigo, food tasting weird,
making the symptoms worse.
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US Brand Name: Paxil / Paxil CR
A link here will take you to the official website
for the drug.
Deroxat (France, Switzerland)
Paroxet (Peru)
Paxan (Colombia)
Paxetin (Iceland)
Paxtine (Australia)
Paxxet / פאקסט (
Serorat (Saudi Arabia)
Seroxat (Belgium, Denmark, Finland, Greece, Italy, Netherlands, Norway, Spain, Sweden,
Taiwan,
United Kingdom)
Paroxat (Austria, Czech
Republic, Germany)
XET (India)
パキシル/ Paxil (Japan)
Паксил / Paxyl (Russia)
Read up on these sections if you haven't done
so already, because they cover a lot of information about multiple medications that I'm
not going to repeat on many pages. I'm just autistic that way about not repeating
myself.
What are Paxil and Paxil CR Approved For.
The immediate release form (vanilla Paxil) has FDA approval for:
These may or may not happen to you don't, so don't be surprised one way or the other.
Paxil's Freaky Rare Side Effects: Complete loss of taste (like Gabitril (tiagabine) did to me),
enlargement of skin, reflexes increased (some people are just never happy), tongue
discoloration.
You aren't going to get these. I promise.
For all side effects, read the PI sheet.
Interesting Stuff Your Doctor Probably Won't Tell You: Paxil and Paxil CR (paroxetine hydrochloride) happen to be those types of meds that if you stop taking it and start up again, they won't work as well as it used to. Even if you stop for just a couple of days. You have to be totally med compliant with Paxil and/or Paxil CR (paroxetine hydrochloride) or it's pointless. Symptoms may even worsen, which may have something to do with the rash of suicidal acts and ideation amongst adolescents on Paxil / Seroxat, as teenagers are as bad as the bipolar when it comes to being med compliant. Obviously mileage varies, and I've even read a few accounts of people switching from one form to the other to get over the problem of Paxil no longer working. However, I've read far more accounts of people where any form of Paxil not working after they were non-compliant or had to switched to another med or ran out or whatever and then tried to start again.
On the subject of discontinuing antidepressants, it turns out that their withdrawal can trigger mania. So you always have to be careful when using them if you're bipolar.
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Paxil's Dosage, How and When to Take Paxil and Paxil CR: Immediate
release - the initial dose of Paxil (paroxetine hydrochloride) is 10mg for Panic Disorder
and 20mg for all other disorders, taken in the morning in any event. The dose is increased
10 mg a week, as required, until it reaches a maximum of 20mg for General Anxiety, 40mg
for PTSD, 50mg for Depression, and 60 mg for everything else. Controlled Release - start at 25mg in the morning and work up by 12.5mg a week, as required, until a maximum of 62.5mg a day is reached. As with all SSRIs I suggest staying at a fairly low dosage for the first four weeks. It sucks, but honestly, it will suck less that way. For the immediate release just start at 10mg for everything, go up to 20mg after a week if you need to. For depression you can go up to 30mg before your month is out, otherwise just hold where you are for a month, otherwise the discontinuation will suck for nothing. You'll know after a month if Paxil (paroxetine hydrochloride) will do anything for you or not, even at a lower dosage. For the controlled release, start at 12.5mg, move up to 25mg after a week if need be. For depression you can move up to 37.5mg a week after that if you think it will do you any good, otherwise just hold out for a month to see if it works. Dr. Stephen Stahl in Essential Psychopharmacology: The Prescriber's Guide writes that it is best to first try taking either Paxil or Paxil CR at bedtime, as often either form is sedating and it's easier to keep taking it daily when you take it at night. He also agrees that you should stick with the lowest dosage possible, 10mg for Paxil and 12.5mg for Paxil CR and waiting two weeks before increasing the dosage.
When will Paxil, Paxil CR start working: Like all SSRIs, Paxil or Paxil CR will take anywhere from a couple days to over a month to work. The generally accepted wisdom with all SSRIs is that if you don't feel any positive benefit after four to six weeks, then you should talk to your doctor about either another SSRI or trying a med that hits another neurotransmitter. Dr. Stephen Stahl in Essential Psychopharmacology: The Prescriber's Guide and Essential Psychopharmacology of Depression and Bipolar Disorder writes that you should be feeling some sort of positive effect within two weeks. If you don't feel any sort of relief for your depression and/or anxiety disorder at 20mg for Paxil or 25mg for Paxil CR, move on to something else. I'm going with that, because of Paxil's potency and the nasty discontinuation syndrome, if it's not working after two weeks, screw it. Days to Reach a Steady State: Good freaking luck pinning this one down. Seriously, this is a problem with Paxil (paroxetine hydrochloride), and is one of the reasons why the withdrawal is so bad. With the CR version you'll probably get a steady state in two weeks. With the immediate release Glaxo promises steady state in 10 days, but that was based on a study involving all of 15 men. When you're fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you'll have fewer valleys after this point. In theory anyway.
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Paxil's Half-Life & Average Time to Clear Out of Your System: For the CR version the mean average half-life is 15-20 hours. So it's out of your system in about 4-5 days.
Now, as for the immediate release version. I could not get a firm number on the half-life. The only information Glaxo published in the PI sheet came from a study of 15 men, and that gives a half-life of 21 hours. There's a shitload of contradictory information on the Internet ranging from 2-96 hours, with the consensus and the US Army agreeing on a 26-hour half-life. And we thought pinning down Lamictal's (lamotrigine) half-life was tough. But wait! 26 hours is the same as Lamictal's (lamotrigine) and Zoloft's (sertraline). Coincidence? Or did someone just pull a number out of their ass?
How to Stop Taking Paxil, Paxil CR: Your doctor should be recommending that you reduce your of the CR dosage by 12.5mg every four days. You should probably make it five days because Paxil's discontinuation syndrome is so harsh. That means putting up with the suck-ass side effects for longer, but trust me, it really sucks less this way. Based on the 15-20 hour half-life. If your doctor says something that's slower than that, go for it! I'm all for slower discontinuations. Four to five days is the fastest you can step down the dosage. For more information, please see the page on how to safely stop taking these crazy meds.
This is part of the reason why the discontinuation for Paxil sucks more ass than any
other SSRI (keep in mind that Effexor (venlafaxine) is not an
SSRI and it has the reputation for the worst discontinuation syndrome.). If you can't pin
down the half-life, you and your doctor can't work out an effective discontinuation
schedule, and if the half-life varies wildly it's possible that if you do everything right
on paper it's still going to suck when you actually discontinue Paxil! OK, so given the
21-26 hour half-life, that means for the immediate release version you are going to get a
pill splitter and you are going to step down by 5mg a week. If you're still having
problems with the last 5-10mg a day you can try switching to the oral suspension (the
liquid form) to try going down a milligram at a time. There's also the option to
switch to Prozac (fluoxetine) for a couple of weeks.
If you've worked your way up to a particular dosage, it's usually best to spend this many
days at the next lowest dosage before going down the next lowest dosage before that and so
forth. This is the least sucky way to avoid problems when stopping any psychiatric
medication. Presuming you have the option of slowly tapering off them.
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Comments: Be sure to read the
sections on antidepressants
and especially SSRIs if you
haven't done so already. Approved by the FDA to treat depression in December 1992, Paxil (paroxetine hydrochloride) is either the most potent or second most potent of the SSRIs, depending on which study you read (and including the one from A Primer of Drug Action Paxil wins three out of four). Hence its being approved for, and thus being reasonably effective for, just about everything SSRIs are thrown at. The thing I really liked about Paxil (The thing I really liked about Paxil (paroxetine hydrochloride) was that it completely eliminated my libido. It was gone. In a way I was eleven years old again. Nothing else has dealt with my bipolar hypersexuality so effectively. I was ready to brush up on my French and take the Trappist orders at l'Abbye de Scourmont for a life of contemplation and brewing the world's best beer. While it wasn't a complaint for me, that is an all-too-common occurrence for many people that can be problematic. Just to prove that anything is possible with these crazy meds, these case studies show how some SSRIs can be aphrodisiacs. Unfortunately the Paxil (paroxetine hydrochloride) also made my depression and anxiety vastly worse, so I wasn't able to get out of bed to do anything at all. But that's just me. Well, OK, that's a lot of people, as it can make the symptoms worse, but anything that affects my serotonin is just going to suck as far as I'm concerned. The fact that the immediate release form of Paxil (paroxetine hydrochloride) is approved for so many disorders shows that it's effective for at least 20% of the population with a variety of complaints, so it does something without making it too harsh to take.
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| You just have to be very strict with your med compliance, so Paxil (paroxetine
hydrochloride) and teenagers or anyone who is a flake don't mix. It works like
this: You skip a dose of Paxil (paroxetine hydrochloride). That starts the
discontinuation syndrome because the half-life can be so wacky. It also means when
you do take the med the next time it doesn't work quite as well as it did the first
time. So you don't feel all that right when it does work again. Which makes
you think something's wrong and makes you that much more likely to skip another
dose. Lather, rinse, repeat. See where that's going? After a few
iterations it's no wonder that teenagers, who really have much less of a clue about
something like SSRI
discontinuation syndrome are ready to kill themselves. They keep taking their
meds, not really but they take the meds on their schedule and that's all that matters, and
they feel worse! Hey, at least someone is officially recognizing that the discontinuation syndrome is especially bad, and that you may want to take some Prozac (fluoxetine) to take the edge off of the final stages of discontinuation. Everyone I've read who knows about these things (Dr. Preskorn's site for all things antidepressant, Dr. Stahl's Essential Psychopharmacology and Essential Psychopharmacology of Depression and Bipolar Disorder, and Dr Julien's A Primer of Drug Action) agree that Paxil (paroxetine hydrochloride) is the most potent of all the SSRIs you have to be sure that you're really depressed.as.fuck and feel like Whale Shit at the Bottom of the Ocean, or have similarly bad symptoms for the other disorders for which it's approved. Otherwise you may want to evaluate another medication first. But if things really are that bad, and serotonin reuptake is the answer, then Paxil (paroxetine hydrochloride) is the med to try, because per the same references, only Zoloft (sertraline) will come close in potency.
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Have questions about Paxil? Want to read about experiences other people have had with Paxil? Check out our Paxil Board.
Who Makes Paxil: Paxil and Paxil CR are manufactured by GlaxoSmithKline
Sample US Cost of Paxil: $91 for 30 30mg tablets of Paxil or 30
37.5mg tablets of Paxil CR
As of 11/03/2003. Full retail for the uninsured. Go ahead and gloat, citizens of civilized
countries and all of you with full medical coverage.
Sample Canadian Cost of Paxil: $67 for 30 30mg tablets of brand-name Paxil, $41 for 30 30mg tablets of generic paroxetine.
Remedy Find Rating of Paxil for Depression
Remedy Find Rating of Paxil for Anxiety/OCD/PTSD
Check for Drug-Drug Interactions
Full Patient/Prescribing/Physician Information Sheet - Immediate Release
Full Patient/Prescribing/Physician Information Sheet - Controlled Release
Canadian Monograph from Internet Mental Health
UK Seroxat SPC Sheet (What doctors get)
UK Seroxat PI Sheet (What patients get)
Patient Information Sheet for Serorat From a Saudi hospital. At least it's something in Arabic.
Japanese Paxil / パキシル PI Sheet (I'm guessing for doctors, as it's in way more Japanese than I can read)
Israeli Paxxet / פאקסט PIL (What patients get) In Hebrew, Arabic & English. The PDF document wouldn't let me copy the Arabic script for Paxxet over, only the Hebrew characters.
Russian Paxyl / Паксил PI Sheet from Recipe.ru (In Cyrillic for some audience)
Taiwanese Patient Information Leaflet for Seroxat in traditional Chinese characters. The Taiwanese PI sheets are the worst on the planet for the dearth of information they provide.
Please see the section on how to read these sheets. Don't freak out about every potential side effect. Look at the odds of something having happened during the clinical trials.
The Overlords of the 12 Zernox Galaxies have compelled me through messages in the Sunday Chronicle to beg you for funds to help squash the Arachnoid uprising. So if this site has been of use and/or amusement to you, we'd be grateful if you could donate some cash.
Visit the Support Page for how you can help if you don't have any money laying around. This includes reviewing Crazy Meds for Amazon.com and/or
There's also our Mental Mall, to purchase some books or t-shirts.
Crazy Meds Home Crazy Meds Talk About Antidepressants About SSRIs About Anticonvulsants / Mood Stabilizers About Atypical Antipsychotics About Benzodiazepines About Stimulants Finding a Doctor Sites with More Information Support Group Sites About Crazy Meds Visit my autistic - bipolar - epileptic blog
Obsessive-Compulsive Disorder in the News
Post Traumatic Stress Disorder in the News
Take care, and keep taking your crazy meds!
Jerod
If you still have unanswered questions about this or other medications, including which
one is, or combination of meds are the best for you, your best bet is to ask on razyTalk/index.php?">Crazy Meds Talk. Better
yet, if you want to let the world know how they worked out for you and want to help out
others in their quest for the correct meds, join the party.
If you
Hey, did you find this page all by itself through Google or some other search engine?
Great! But to really appreciate the entire site, you need to >
Dead tree references: Essential Psychopharmacology Stephen M. Stahl,
M.D., Ph. D. © 2000. Published by Cambridge
University Press Essential Psychopharmacology The Prescriber's Guide Stephen M.
Stahl, M.D., Ph. D. © 2005. Published by Cambridge
University Press Essential Psychopharmacology of Depression and Bipolar Disorder Stephen
M. Stahl, M.D., Ph. D. © 2001. Published by Cambridge University Press A Primer of Drug Action Robert M. Julien, M.D., Ph. D. © 2001. We use
the Ninth Edition. Sometimes that comes up on an Amazon search, usually it
doesn't. Published by Worth
Publishers Physicians' Desk Reference Edition 59
Healing Anxiety & Depression
Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam's Sons.
Instant Psychopharmacology 2nd Edition Ronald J. Diamond M.D. © 2002. Published by W.W. Norton
The Complete Guide to Psychiatric Drugs Edward Drummond, M.D. © 2000. Published by John Wiley & Sons, Inc.
Consumer's Guide to Psychiatric Drugs by John D. Preston Psy.D., John H. O'Neal, M.D. & Mary C. Talaga R.Ph., M.A. © 2000. Published by New Harbinger Publications.
Mosby's 2004 Drug Guide David Nissen PharmD, Editor.© 2004. An imprint of Elsevier. The edition we're using isn't listed on Amazon.
End of books used for this article.
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Created Friday, November 07,2003
Last updated Saturday, December 05, 2009
Copyright © 2003 - 2008 Jerod Poore. All rights reserved.
Almost all of the material on this site is copyright © 2002, 2003, 2004, 2005, 2006, 2007 and 2008 Jerod Poore. Except, of course, the PI sheets, those are the property of the drug companies who developed the drugs the sheets are about. And any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That's usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that's OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I'm cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won't necessarily happen to you. Nobody on this site is a doctor, therapist, or a pharmacist. We don't portray them either here or on TV. Only doctors can diagnose and treat an illness. Some doctors tend to get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don't be a cyberchondriac, thinking you have every disease you see a website about, or that you'll get every side effect from every medication. Self-prescribing is just as dangerous. All information on this site has been obtained through personal experience, the experiences of my friends, the experiences of people reported on online support groups, and from sources that are referenced throughout the site. Know your sources! As such the information presented here is not a substitute for real medical advice from your real doctor, just a compliment to it. No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. All brand names of the drugs listed in this site are the trademarks of the companies listed after them in the pages about the drugs, even though those companies may or may not have been acquired by other companies who may or may not be listed in this site by the time you read this. Always read the PI sheet that comes with your medications and never ever throw them away. If you didn't get a PI sheet, demand one. Loudly. Crazy Meds is not responsible for the content of sites we provide links to. We like them, or they're paid advertisements, or they're something you should read to make an informed decision about a particular med. Sometimes they're more than one of those things. But what's on those sites is their business, not ours. Very little information about visitors to this site is collected or saved. And from time to time I do look at search terms used to find it in an effort to make the information I present more relevant. Use only as directed. Void where prohibited.
"Everything is true, nothing is permitted." - Jerod Poore
