side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more

> Paxil (paroxetine ) Overview


Paxil Article Index | Brand and Generic Availability

Brand & Generic Names; Drug Class

US brand name: Paxil
Generic name: paroxetine
Drug Class: Antidepressants
Learn More about Paxil’s Generic & Worldwide Availability

Paxil’s Approved & Off-Label Uses (Indications)

US FDA Approved Treatment(s)

Both forms: Major Depressive Disorder (MDD), Panic Disorder, Social Anxiety Disorder, Obsessive-Compulsive Disorder (OCD), and Generalized Anxiety Disorder (GAD). Immediate Release only: Posttraumatic Stress Disorder (PTSD).Controlled Release only: Premenstrual Dysphoric Disorder (PMDD)

Popular Off-Label Uses

Using the controlled release version for OCD, GAD, and PTSD. Headaches. Irritable Bowel Syndrome (IBS). Tourette Syndrome.

Learn More about Paxil’s Approved & Off-label Uses

How Long Until Paxil Starts Working (Onset of Action)

Like all SSRIs two-to-four, sometimes even six weeks.

Likelihood of Working

That all depends on what you’re taking it for. It’s not really that great of an antidepressant, but a pretty decent med for the alphabet soup of anxiety and is especially good for GAD, SAnD (though not as good as Zoloft), PMDD, and panic disorders without agoraphobia. Learn how Paxil Compares with Other Drugs

How to Take Paxil

Immediate Release (IR)

The initial dosage is 10mg for Panic Disorder and 20mg for everything else. For GAD, PTSD, and Social Anxiety Disorder 20mg a day is the target dosage. For OCD and Panic Disorder it’s 40mg a day. There is no target dosage for MDD, just a maximum of 50mg a day and that 30mg a day was the average effective dosage in the clinical trials.

The dose is increased 10mg a day per week, until you reach the target dosage and/or something that works. You take it once a day, usually in the morning.

Controlled release (CR)

The initial dosage is 25mg a day for MDD, 12.5mg a day for everything else. The is no target dosage for any condition, which is highly unusual, albeit extremely sane for any crazy med. The maximum dosages are: 62.5mg a day for MDD, 75mg a day for Panic Disorder, 37.5mg a day for Social Anxiety Disorder, and 25mg a day for PMDD.

We at Crazymeds suggest starting at 5–10mg (IR) or 12.5mg (CR) a day for everything, and increasing by 5–10/12.5 mg a day per week only if you need to.
Unless SSRIs usually keep you awake, we suggest you should first try taking it at night.


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How to Stop Taking Paxil (Discontinue, Withdrawal)

Very, very slowly and very, very carefully. Regardless of how quickly you increased your dosage (titrated), the tapering (discontinuation schedule) we suggest is at the same rate as our suggested titration: 5–10mg a day per week for the immediate release form and 12.5mg a day per week for the controlled release form. So if you’re taking 37.5mg a day of Paxil CR you should take 25mg a day one week, 12.5mg a day the next week, and with any luck you should be OK to stop taking it all together by the end of week two. While most people should have only mild, if any, discontinuation symptoms using that schedule, plenty of people will still have problems. Before you begin, talk to your doctor about a short prescription of 5 & 10 mg IR tablets even if you take Paxil CR, and a week’s worth of Prozac. Learn More about Taking and Discontinuing Paxil



Paxil’s Pros and Cons

Pros

As the most potent SSRI on the US market, Paxil can be just the thing for severe conditions in the anxiety spectrum.

Cons

As the most potent SSRI on the US market Paxil has the absolute worst SSRI discontinuation symptoms of any SSRI, and gives the SNRIs a run for their money in discontinuation syndrome suckage. It also has the worst sexual side effects of any SSRI, maybe of any crazy med.

Interesting Stuff your Doctor Probably didn’t Tell You about Paxil

Paxil one of those meds that if you stop taking it and start up again, it won’t work as well as it used to. For some people that includes stopping for just a couple of days, experiencing the hell of SSRI discontinuation syndrome, and then swearing you’ll never, ever stop taking your meds again. You have to be totally med compliant or it could be a pointless waste of time, money and suffering.
Paxil is less likely to work / doesn’t work as well for post-menopausal women. Which just figures, because it’s also pregnancy category D.

Best Known for

Giving you a libido-ectomy, followed by the SSRI discontinuation syndrome from Hell.
In-Depth Pros & Cons

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Paxil’s Side Effects (Adverse Reactions)

Typical Side Effects

The usual for SSRIs - headache, nausea, dry mouth, sweating, sleepiness or insomnia (it’s a coin toss), constipation - pretty bad for some people, feature and not bug for anyone with IBS - weight gain and assorted sexual dysfunctions. 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.

Uncommon Side Effects

Motion sickness/vertigo, food tasting weird (taste perversion), making the symptoms worse.

Because Paxil is so potent the amount of extra serotonin you get, and where you get it, can interfere with dopamine. That can result in a variety of side effects usually associated with antipsychotics, such as gynecomastia (man boobs), galactorrhea (leaky tits, regardless of gender), and movement disorders such as: akathisia, EPS, TD, and NMS. See the page on drug-induced movement disorders for more information about those scary, but easily fixed (you stop taking the med) side effects.

Freaky Rare Side Effects

Enlargement of skin, pathological laughter, and vaginal anaesthesia. You could have quite a career in freaky fetish porn with those.

Learn More about Paxil’s Side Effects.
TMI at times


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What You Really Need to be Careful About

Taking Paxil every day at the same time. As with Effexor, some people have experienced the beginnings of SSRI/SNRI discontinuation syndrome if they’re even an hour late with their dose.

Paxil’s Black Box and Other Warnings, Pregnancy Category, etc.

Pharmacology

paroxetine ‘s Half-Life & How Long Until It Clears Your System

Plasma half-life: Immediate release: Half-life 21 hours, clearance 4–5 days. Controlled release: Half-life 15 to 20 hours, clearance 4 days.

paroxetine ‘s Pharmacokinetics Information Overload

Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream, so there’s nothing swimming around to attach itself to your brain and start doing stuff1. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what2, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood. If we’ve found the complete clearance, or how to calculate it if it requires things like your weight and what your piss looks like, you’ll find that on paroxetine ‘s pharmacokinetics page.

How paroxetine Works

the current best guess at any rate
As a potent SSRI your neurons get to marinate in a lot more serotonin for far longer than they otherwise would. It may also affect sigma-1 receptors like Zoloft and Luvox do, which would further enhance its anti-anxiety effects. Paxil could also have enough norepinephrine reuptake inhibition properties to make some kind of difference, but that’s probably just enough to be a factor - along with a half-life of less than a day - in making the discontinuation syndrome so hellish.

Learn More than You Probably Ever Wanted to Know about How paroxetine Works
AKA mechanism/method of action, pharmacodynamics


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Ratings, Reviews, Comments, PI Sheet, and More

Paxil Comments

Loved by those for whom it works, loathed by those who had to stop taking it and/or whose sex life vanished, Paxil is one of the top meds people love to hate. Usually better for anxiety than depression. Because it is so potent you shouldn’t consider it as the first med to try, unless you’re too anxious to leave your house without being drugged stupid with a benzodiazepine.
Extended Comments
As if I didn’t go on long enough already.

Paxil Ratings & Reviews, and Consumer Comments & Experiences

Rate Paxil

Give your overall impression of Paxil on a scale of 0 to 5. Detailed ratings and reviews are available on the Paxil Ratings & Reviews Page.

Get all critical about Paxil

3.5 stars Rating 3.1 out of 5 from 143 criticisms.
Vote Distribution: 29 – 12 – 10 – 13 – 29 – 50


Rate this article

If you’re still feeling judgmental as well as just mental3, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Paxil (paroxetine ) Overview

4 stars Rates 3.7 out of 5 from 55 value judgments.
Vote Distribution: 8 – 1 – 2 – 2 – 15 – 27


Discussion board

Consumer experiences with and questions about Paxil on Crazymeds Paxil discussion board. Sign up for a free account to post your own.

More Allegedly Useful Links. Mostly official sites, PI sheet-equivalents4 from countries other than the US, and reviews from other consumer review sites.


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It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.



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References

  1. Paxil’s Full US Prescribing Information
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.

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Paxil Article Index | Brand and Generic Availability

1 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady stage if they can't get, or won't provide a number for that.

2 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.

3 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!

4 These include: Canada's Product Monographs (PM), New Zealand's Medicine Data Sheets (MDS), the EU's European Public Assessment Reports (EPAR), and the Summary of Product Characteristics (SPC) used in Britain, Ireland, and many other places.


If you have any questions not answered here, please see the Crazymeds Paxil discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)


Last modified on Thursday, 25 September, 2014 at 17:56:32 by JerodPoorePage Author Date created April 08, 2011, at 05:11 PM
“Paxil (paroxetine ): a Synopsis for the Educated Consumer.” by Jerod Poore is copyright © 2011 Jerod Poore Published online 2011/04/08
Citation options to copy & paste into your article:
Plain text:Poore, Jerod. “Paxil (paroxetine ): a Synopsis for the Educated Consumer.” Crazymeds (crazymeds.us). (2011).
with Microdata: <span itemprop='citation'>Poore, Jerod. "Paxil (paroxetine )." <em>Crazymeds (crazymeds.us)</em>.(2011).</span>
Linked:<a href="http://scholar.google.com/citations?user=5rkux7sAAAAJ&hl=en&oi=sra">Poore, Jerod</a>. <a href='http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/Paxil'>"Paxil (paroxetine ): a Synopsis for the Educated Consumer."</a>. <a href="http://www.crazymeds.us/pmwiki/pmwiki.php/Main/HomePage"> <em>Crazymeds (crazymeds.us)</em></a>. (2011).
with Microdata:<span itemprop='citation'> <a href="http://scholar.google.com/citations?user=5rkux7sAAAAJ&hl=en&oi=sra">Poore, Jerod</a>. <a href='http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/Paxil'>"Paxil (paroxetine ): a Synopsis for the Educated Consumer."</a>. <a href="http://www.crazymeds.us/pmwiki/pmwiki.php/Main/HomePage"> <em>Crazymeds (crazymeds.us)</em></a>. (2011).</span>

Paxil, and all other drug names on this page and used throughout the site, are a trademark of someone else.

will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




Page design and explanatory material by Jerod Poore, copyright © 2004 - 2014. All rights reserved.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 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 something along the lines of following disclaimer, I’m usually cool with it.



All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or 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. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still 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 medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you 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. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
Crazymeds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!

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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas? I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

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