side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more
Table of Contents (hide)
- 1. Brand & Generic Names; Drug Class
- 2. Approved & Off-Label Uses (Indications)
- 3. Usual Onset of Action (when it starts working)
- 4. Likelihood of Working
- 5. How to Take
- 6. How to Stop Taking (discontinue / withdrawal)
- 7. Pros and Cons
- 8. Side Effects
- 9. What You Really Need to be Careful About
- 10. Half-Life & Clearance
- 11. How paroxetine Works
- 12. Ratings, Reviews, Comments, PI Sheet, and More
|US brand name: Paxil|
|Generic name: paroxetine|
|Drug Class: Antidepressants|
|Generic & Worldwide Availability Details|
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)Using the controlled release version for OCD, GAD, and PTSD. Headaches. Irritable Bowel Syndrome (IBS). Tourette Syndrome.
Like all SSRIs two-to-four, sometimes even six weeks.
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.
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.
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 Crazy Meds 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.
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.
Taking and Discontinuation Details
As the most potent SSRI on the US market, Paxil can be just the thing for severe conditions in the anxiety spectrum.
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.
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.
Giving you a libido-ectomy, followed by the SSRI discontinuation syndrome from Hell.
In-Depth Pros & Cons
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.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.Enlargement of skin, pathological laughter, and vaginal anaesthesia. You could have quite a career in freaky fetish porn with those.
Side Effect Details. TMI at times.
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.
Immediate release: Half-life 21 hours, clearance 4–5 days. Controlled release: Half-life 15 to 20 hours, clearance 4 days.
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 the pharmacokinetics page.
the current best guess at any rateAs 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.
More than You Probably Ever Wanted to Know about How a Drug Works. AKA mechanism/method of action, or pharmacodynamics.
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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.
An overall zero-to-five rating is absolutely useless information regarding medications. It is little more than a purely emotional and subjective value judgment on a med that has no bearing on how effective a drug is or, more importantly, if it is the right drug for you. So why do I have it? Mainly because it’s cathartic for anyone who is taking or has taken a drug3. Love it? Hate it? Here’s your chance to let everyone know. You don’t need to be a forum member or anything like that. You get all of one vote which can’t be changed, so make sure it’s what you want.
Get all judgmental about Paxil
Rating 3.1 out of 5 from 52 criticisms
Vote Distribution: 5 – 9 – 6 – 3 – 13 – 16
Extended Comments As if I didn’t go on long enough here.
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.
If you have any questions not answered here, please see the Crazy Meds’ Paxil discussion board. I rarely answer questions about meds via e-mail.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 At some point I may have multiple one-to-ten ratings for individual aspects of medications, such as efficacy and side effects. That could be potentially useful.
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.
|Date created April 08, 2011, at 05:11 PM||Page Author: JerodPoore||Last modified on Saturday, 07 December, 2013 at 17:31:51 by JerodPoore.|
Paxil is a trademark of someone else. Look on the the PI sheet 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.
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The information on Crazy Meds 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.
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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.
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 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.
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‘Everything is true, nothing is permitted.’ - Jerod Poore
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?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]