PaxilPagesIndex

Table of Contents (hide)

  1. 1. Names, Availability, Brand vs. Generic Issues, Forms
    1. 1.1 US brand name: Paxil
    2. 1.2 Available as Paxil in these countries1
    3. 1.3 Other trade name(s) for Paxil used in these countries1
    4. 1.4 Generic Name and Availability
    5. 1.5 paroxetine is available in these countries2
    6. 1.6 Branded generic names3
    7. 1.7 Specific generics with complaints, or preferred generics manufacturers
    8. 1.8 Generics with independently-tested bioequivalence
    9. 1.9 Forms and Classes
  2. 2. Approved and Off-Label Uses
    1. 2.1 US FDA approved use(s)
    2. 2.2 Paxil is approved elsewhere for
    3. 2.3 Common off-label uses
    4. 2.4 Less common/experimental off-label uses
    5. 2.5 Failed off-label uses
    6. 2.6 Potentially dangerous off-label uses
    7. 2.7 When / why you should take Paxil
    8. 2.8 When / why you should not take Paxil
  3. 3. Chances of Working & Comparisons with Other Meds
    1. 3.1 How long until Paxil starts working:
    2. 3.2 Likelihood Paxil will work for its approved indications:
    3. 3.3 For off-label applications:
    4. 3.4 Paxil versus other Antidepressants for approved treatments:
    5. 3.5 For off-label uses:
  4. 4. Dosage, Titration, and Discontinuation
    1. 4.1 Dosage and doses:
    2. 4.2 Best time / way to take Paxil:
    3. 4.3 Titration schedule:
    4. 4.4 How to discontinue Paxil:
    5. 4.5 Discontinuation symptoms:
    6. 4.6 Notes, tips, etc. about discontinuing Paxil:
  5. 5. Pros, Cons, and Interesting Information
    1. 5.1 Pros
    2. 5.2 Cons
    3. 5.3 Interesting stuff your doctor probably didn’t tell you:
  6. 6. Side Effects and Pregnancy Category
    1. 6.1 Typical side effects
    2. 6.2 Uncommon side effects
    3. 6.3 Potentially dangerous side effects:
    4. 6.4 Freaky rare side effects:
    5. 6.5 Ways to counter / minimize / mitigate / deal with some side effects
    6. 6.6 Pregnancy category

This is essentially everything we know about Paxil (paroxetine) on two big-ass pages. On this page is brand / trade names to odds of working and comparisons with other meds, or pretty much everything most people want to know. Page two is pharmacokinetics to the bibliography, or: I’m sure somebody wants to about 0.1% of people who read about a med look at it.

The titles for most sections link to the pages for those sections. While all the information is on these two comprehensive pages, the individual section pages go into a little more detail about what it all means.

1.  Names, Availability, Brand vs. Generic Issues, Forms

1.1  US brand name: Paxil

Just because a drug is available in one country doesn’t mean you can get it everywhere. Even if a medication is available elsewhere, it won’t necessarily have the same brand, or trade name everywhere it is sold.

1.2  Available as Paxil in these countries1

Immediate-release Paxil is available in: Canada, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Japan, Korea, Mexico, Nicaragua, Panama

Controlled-release Paxil CR is available in: Belize, Canada, Costa Rica, Dominican Republic, El Salvador, Guatemala, Haiti, Honduras, Japan, Korea, Mexico, Nicaragua, Panama

1.3  Other trade name(s) for Paxil used in these countries1

  • Aropax: Argentina, Australia, Belgium, Brazil, Mexico, New Zealand, Paraguay, South Africa, Uruguay
  • Aroxat: Chile
  • Paroxet: Peru
  • Paxan: Colombia
  • Paxetin: Iceland
  • Paxxet: Israel
  • Seroxat: Columbia, Ireland, Peru, UK, EU
  • Setine: Taiwan
  • Tagonis: Germany
  • パキシル: Japan
  • 팍실: Korea

1.4  Generic Name and Availability

A drug’s generic, or international nonproprietary name (INN) is how it is uniquely identified around the world. Or not. The generic version of a med is are often available in other countries long before they are in the US.

Generic name/INN:paroxetine
US Generic available?Yes

1.5  paroxetine is available in these countries2

Australia, Canada, EU, India, Ireland, New Zealand, South Africa, UK

1.6  Branded generic names3

  • Deparoc: South Africa
  • Deroxat: France
  • Divarius: France
  • Extine: Australia
  • Loxamine: New Zealand
  • Parax (anhydrous free base of paroxetine): South Africa
  • Paraxo (paroxetine mesylate): Australia
  • Paxtine: Australia
  • Pexeva (paroxetine mesylate): US
  • Serrapress: South Africa
  • XET: South Africa, India

1.7  Specific generics with complaints, or preferred generics manufacturers

In theory the generic version of a med is the same as the brand-name version. In practice that is usually, but not always the case. Especially with crazy meds. If we know of any problems with particular generics, or if some generics are better than others, we’ll let you know.

I found this case report: Adverse effects after switching to a different generic form of paroxetine: paroxetine mesylate instead of paroxetine HCl hemihydrate. That is the only instance, so far, of a generic using a different salt (mesylate instead of hydrochloride) that was a problem for someone. The pharmacokinetics of paroxetine HCl and paroxetine mesylate are somewhat different, and differences in pharmacokinetics are at the heart of the brand vs. generic controversy.

1.8  Generics with independently-tested bioequivalence

  • Apotex immediate release 10, 30, 40 mg tablets as of 2007.
  • Their controlled release is probably identical as well, since GSK sells Paxil to Apotex.

1.9  Forms and Classes

Available/supplied as:

  • Paxil immediate-release tablets:
    • Oval, film-coated, scored, with PAXIL on the front and the dosage on the back.
    • 10mg yellow, 20mg pink, 30mg blue, 40mg green.
  • Paxil CR controlled-release tablets:
    • Round imprinted with dosage and GSK or Paxil CR, 12.5-mg yellow, 25-mg pink,37.5 mg blue
  • Oral Suspension: Orange-colored, orange-flavored, 10 mg/5 mL.
Primary Drug Class:Antidepressants
Additional Drug Categories:
 Anxiolytics/Anti-anxiety Serotonin-Selective Reuptake Inhibitors

2.  Approved and Off-Label Uses

Drugs are officially approved to be used for certain things, and they may be approved for one thing in one country but something else entirely in another.4

2.1  US FDA approved use(s)

Immediate-Release Paxil (paroxetine) Indications:

  • Major Depressive Disorder (MDD)
  • Panic Disorder
  • Social Anxiety Disorder
  • Obsessive-Compulsive Disorder (OCD)
  • Generalized Anxiety Disorder (GAD)
  • Posttraumatic Stress Disorder (PTSD)

Paxil CR (controlled-release paroxetine) Indications:

  • Major Depressive Disorder (MDD)
  • Panic Disorder
  • Social Anxiety Disorder
  • Premenstrual Dysphoric Disorder (PMDD)

2.2  Paxil is approved elsewhere for

2.3  Common off-label uses

Meds are often prescribed for conditions or people they aren’t approved to treat. This is known as off-label prescribing. Some off-label prescribing is so common that lots of people think the medication is a first-line treatment for the condition it’s prescribed to treat.

Anxiety Spectrum Disorders

Miscellaneous Common/Significant Off-Label Uses

  • Headaches
  • Irritable Bowel Syndrome (IBS)
  • Tourette Syndrome
    • Premature ejaculation (I wonder why)

2.4  Less common/experimental off-label uses

When all else fails and you’ve run out of other options, the experimental use of some drug may be your best chance at treating something. Be careful! Otherwise safe meds can be downright dangerous when used for some things.

2.5  Failed off-label uses

2.6  Potentially dangerous off-label uses

MDD in children and adolescents. Anyone prescribing Paxil to someone under 24 should have their license to practice medicine revoked.

2.7  When / why you should take Paxil

Just because a medication is approved or commonly prescribed for a particular condition doesn’t necessarily mean you should be taking it for that condition. There could be a drug that might be better to try first, or at least talk to your doctor about trying first, or the condition you have isn’t bad enough to warrant medication at all.

2.8  When / why you should not take Paxil

  • You’re under 18.
  • You haven’t tried any medication to treat whatever you have.
  • Make that under 24.
  • OK, maybe you’re taking a benzodiazepine, but you can still leave your room without being drugged into a stupor.
  • Some people don’t have it together enough to take Paxil every day at the same time until they’re at least 25, if ever. So if you don’t have your shit together enough for that, don’t take Paxil.
  • Lexapro, Prozac, and/or Effexor work for you, but you can’t stand the sexual side effects or weight gain. If your doctor suggested Paxil in this case you might want to get a second opinion.

3.  Chances of Working & Comparisons with Other Meds

Two of the most important things to know when deciding on which med is the best for a particular condition5: how likely is it to work and how long will it take.
The odds of a med working for a particular condition and how long it generally takes to work should be fairly easy to nail down, and not need to be summed up by the Internet shorthand YMMV (Your Mileage May Vary). Unfortunately because no one is quite sure exactly what causes various conditions - further complicated when everything is a spectrum disorder - and they’re never really sure about how a med works in the first place, especially when there are lots of contradictory and/or questionable studies,6 we can only give you an idea somewhat less vague than support groups and PI sheets, but certainly more accurate than the implied “it fixes everything all the time!” promises of pharmaceutical advertising.
See our page on the tests researchers use to measure the efficacy of medications, including during clinical trials to get FDA approval.

3.1  How long until Paxil starts working:

Like all SSRIs two-to-four, sometimes even six weeks. For anxiety spectrum conditions you might start getting benefits within a couple of days.
If you don’t get any positive benefit from Paxil at 20mg a day and/or after six weeks, give up7. As this study shows it’s usually pointless to continue above that dosage/past that time if Paxil hasn’t done you any good.

3.2  Likelihood Paxil will work for its approved indications:

Unlike depression it’s usually pretty easy to find the clinical trials for other approved applications.

Generalized Anxiety Disorder (GAD)

For GAD the odds are pretty good Paxil will work.

  • Here the the results of one of the clinical trials for GAD. 61.7% of people taking 20mg 68.0% taking 40mg responded, compared with 45.6% of the placebo patients. Of those, 68% of people taking 20mg and 80% taking 40mg achieved response that made them “essentially indistinguishable from healthy counterparts”; compared with 52% of the people given a placebo.
Or: you have a 60% chance that Paxil will do some good, with about a 35% chance it will make your symptoms disappear.

Social Anxiety Disorder (SAnD)

For Social Anxiety Disorder the odds are also pretty good Paxil will work.

  • Paxil for social anxiety after 36 weeks. This is a follow-up trial GSK ran, testing how well Paxil is at preventing relapse. Not surprisingly those who stayed on Paxil fared a lot better than those who didn’t.

Panic Disorder

Premenstrual Dysphoric Disorder (PMDD)

For PMDD the odds are pretty damned good.

Quote:

71% of patients randomized to 25 mg of paroxetine CR and 67% of patients randomized to 12.5 mg paroxetine CR had a significant response to treatment (defined as ≥50% reduction from baseline VAS-Mood).

  • 85% of women responded to Paxil. This was a follow-up to the clinical trials - so GSK paid for it - and a high efficacy rate is to be expected. They were trying to determine if it made a difference to take Paxil all the time or only during certain phases in one’s cycle; and what, if any, symptoms are helped more than others by Paxil. Irritability seems to be the symptom helped the most. As for taking Paxil all the time or intermittently, that depends on symptoms. As women with other conditions were excluded from the trial there’s not a complete picture, but it makes a big difference for depression. You don’t want to be taking Paxil on and off for depression.

3.3  For off-label applications:

3.4  Paxil versus other Antidepressants for approved treatments:

For all Approved Applications

  • Zoloft vs. Paxil vs. Celexa - which is better for medication compliance? Getting people to stay on their meds is essential in getting them to work. That seems obvious, but all the clinical trials in the world don’t mean shit if someone won’t get a refill. This study looks at just that, which med gets the most first refills for approved treatments: depression, social anxiety, and PTSD. The winner: it’s a statistical tie between Zoloft and Celexa, with 54.70% and 54.49% of people taking them getting refills. Given the size of the study - over 14,000 people - Paxil’s first refill rate of 50.99% is significantly poorer, but isn’t overwhelmingly so.
  • Celexa vs. Paxil vs. Zoloft - which med do people stay on longer? This is an indicator of which one generally sucks the most, not which is the most successful, as this is for people who still needed treatment. 14,933 people with depression, PTSD, or social anxiety disorder all taking brand and not generics. The results: Paxil sucks the most, Celexa sucks the least.

Anxiety Spectrum Disorders

  • Paxil vs. Effexor XR vs. placebo for social anxiety. It’s a tie. They work equally well, they’re both better than placebo, and they both suck as much and in similar ways. Even though Wyeth funded this study, having authors who also do work for GSK helped to balance things out. I can’t find what they used for the placebo, because its adverse effects where almost as high as both meds!
  • Paxil vs. Lexapro vs. placebo for generalized anxiety disorder. Five, 10 & 20mg of Lexapro were compared with 20mg of Paxil and a placebo. The winner: 10mg a day of Lexapro. As two of the authors work for Lundbeck, who also sponsored the study and manufacture Lexapro, that’s not a particularly surprising result.
  • Lexapro vs. Paxil for Social Anxiety Disorder (SAnD). SAnD is an off-label use of Lexapro. This Lundbeck-sponsored study isn’t very fair, as it compares 20mg of the older, immediate-release Paxil against 5mg, 10mg, and 20mg of Lexapro. While 20mg of immediate-release Paxil is GSK’s recommendation for SAnD, it’s 25–37.5mg a day for the controlled-release flavor. While 10mg of Lexapro is equal to 10mg of Paxil, 20mg of Lexapro is more like 37.5mg of Paxil CR. So, once again, it’s not all that surprising that 20mg of Lexapro was more effective than 20mg of Paxil.
  • Paxil vs. Seroquel for GAD: Seroquel works better and faster than Paxil. You can take Seroquel and be fat, horny, lazy, and maybe shaky, or take Paxil and wait for it to work, and never want or be able to have sex.

Depression Spectrum Disorders:

  • Zoloft vs. Paxil vs. Prozac for depression. 573 people being treated by primary care physicians (PCPs) are randomly assigned one of the three SSRIs. If it didn’t work or suck too much ove the course of 9 months they got to switch to another med that isn’t one of these. The results: Zoloft wins, but is barely more effective and marginally sucks less. There is absolutely no difference between Paxil and Prozac.
  • Zoloft vs. Paxil vs. Prozac for anxious depression. 108 people with major depression with severe anxiety were randomly given one of the three meds for however long this study lasted. The results: a three-way tie. The only difference was Zoloft and Prozac started working in a week.
  • Zoloft vs. Paxil for depression with personality disorder. 176 people took Zoloft and 177 took Paxil for six months. The results: For one thing, taking SSRIs for six months works a hell of a lot better than taking them for only two or three months. Another useful piece of information (that shows up in other studies): if nothing at all happens in two weeks, you may as well forget whichever one you’re taking. Otherwise Zoloft was somewhat better and sucked noticeably less.
  • Zoloft vs. Paxil for delusional depression. A small, short study - 46 people and six weeks - but Zoloft kicked Paxil’s ass. Zoloft worked for 75% of people taking it, Paxil worked for only 46%, and 41% of people taking Paxil dropped out because of side effects.

3.5  For off-label uses:

4.  Dosage, Titration, and Discontinuation

One of the most important aspects of any medication is how to go about taking it. This includes:

  • how much to take (the dosage or dose)
  • when and how often to take it (dosing schedule or doses)
  • how much to start with and how to increase the dose/dosage until you’re taking the target amount (titration or titration schedule).

This information is always in the PI sheet, is usually in the information for patients leaflets, most doctors will give you some idea of what it will be like, and this is what every pharmacist is trained and paid to tell you.
We here at Crazymeds often disagree with the official schedules found in the PI sheets. We usually advocate starting at a lower dosage than recommended. One of our core philosophies is increasing the dosages as slowly as one’s condition allows, and staying at the dosage that works instead of a target dosage8. More and more doctors are agreeing with us9. You and your doctor can always discuss increasing the dosage when you need to in advance.

4.1  Dosage and doses:

One tablet, of whatever your current dosage is, once a day, at the same time every day.

4.2  Best time / way to take Paxil:

  • Never, ever split, chew, or crush Paxil CR, or the controlled/extended release version of any med. Just swallow it whole the way God and GSK intended.
  • GSK recommends taking Paxil in the morning. Unless SSRIs usually keep you awake, we suggest you should first try taking Paxil at night.
  • I cannot stress how important it is to take Paxil at the same time every day. Because of its short half-life and non-linear pharmacokinetics10 it’s easy to understand, or at least wrap your head around the concept of why some people can get SSRI discontinuation syndrome if they are a few hours late taking their dose.
    • With Pexeva and other branded generics that are paroxetine mesylate, you have some wiggle room. You can’t miss a day, like you can with Prozac or Abilify, but like Lexapro if you’re a few hours late you probably won’t notice anything.

4.3  Titration schedule:

First and foremost: if you don’t get any positive benefit from Paxil at 20mg a day and/or after six weeks, give up7. As this study shows it’s usually pointless. That could be the case for SSRIs in general. Paxil’s oddball pharmacokinetics are probably responsible, so there’s not much you can do about it.

Immediate Release

  • Major Depressive Disorder: The recommended initial dose is 20 mg/day. As with all drugs effective in the treatment of major depressive disorder, the full affect may be delayed. Some patients not responding to a 20-mg dose may benefit from dose increases, in 10-mg/day increments, up to a maximum of 50 mg/day. Dose changes should occur at intervals of at least 1 week.
    • Systematic evaluation of the efficacy of PAXIL has shown that efficacy is maintained for periods of up to 1 year with doses that averaged about 30 mg.
  • Obsessive Compulsive Disorder: The recommended dose of PAXIL in the treatment of OCD is 40 mg daily. Patients should be started on 20 mg/day and the dose can be increased in 10-mg/day increments. Dose changes should occur at intervals of at least 1 week. Patients were dosed in a range of 20 to 60 mg/day in the clinical trials demonstrating the effectiveness of PAXIL in the treatment of OCD. The maximum dosage should not exceed 60 mg/day.
  • Panic Disorder: The target dose of PAXIL in the treatment of panic disorder is 40 mg/day. Patients should be started on 10 mg/day. Dose changes should occur in 10-mg/day increments and at intervals of at least 1 week. The maximum dosage should not exceed 60 mg/day.
  • Social Anxiety Disorder: The recommended and initial dosage is 20 mg/day. While the safety of PAXIL has been evaluated in patients with social anxiety disorder at doses up to 60 mg/day, available information does not suggest any additional benefit for doses above 20 mg/day.
  • Generalized Anxiety Disorder: Usual Initial Dosage: The recommended starting dosage and the established effective dosage is 20 mg/day. There is not sufficient evidence to suggest a greater benefit to doses higher than 20 mg/day.
  • Posttraumatic Stress Disorder: Usual Initial Dosage: The recommended starting dosage and the established effective dosage is 20 mg/day.

--Paxil immediate-release PI sheet

We at Crazymeds suggest starting the immediate release at 5–10mg at day for everything, and increasing by 5–10mg a day per week only if you need to.

Controlled Release (Paxil CR)

  • Major Depressive Disorder: The recommended initial dose is 25 mg/day. Some patients not responding to a 25-mg dose may benefit from dose increases, in 12.5-mg/day increments, up to a maximum of 62.5 mg/day. Dose changes should occur at intervals of at least 1 week.
  • Panic Disorder: Patients should be started on 12.5 mg/day. Dose changes should occur in 12.5-mg/day increments and at intervals of at least 1 week. The maximum dosage should not exceed 75 mg/day.
  • Social Anxiety Disorder: Usual Initial Dosage: The recommended initial dose is 12.5 mg/day. If the dose is increased, this should occur at intervals of at least 1 week, in increments of 12.5 mg/day, up to a maximum of 37.5 mg/day.
  • Premenstrual Dysphoric Disorder: The recommended initial dose is 12.5 mg/day. In clinical trials, both 12.5 mg/day and 25 mg/day were shown to be effective. Dose changes should occur at intervals of at least 1 week

--Paxil controlled-release (Paxil CR) PI sheet

With Paxil CR your only go-slow option is starting at 12.5mg a day and increasing by that amount. That’s our suggestion.

4.4  How to discontinue Paxil:

One thing PI sheets and doctors infrequently discuss, and don’t go into enough detail about, is how to discontinue a medication. With some meds it’s not too bad, but with others it can be a nightmare.
Very, very slowly and very, very carefully. 5–10mg a day per week for the immediate release form and 12.5mg a day per week for the controlled release (Paxil CR) form.

4.5  Discontinuation symptoms:

4.6  Notes, tips, etc. about discontinuing Paxil:

Unlike the immediate-release form, the R&D people at GSK don’t have an average effective dosage of Paxil CR used to treat MDD. At least they have a guess and published it in the PI sheet:

Systematic evaluation of the efficacy of immediate-release paroxetine hydrochloride has shown that efficacy is maintained for periods of up to 1 year with doses that averaged about 30 mg, which corresponds to a 37.5-mg dose of PAXIL CR, based on relative bioavailability considerations.--Paxil controlled-release (Paxil CR) PI sheet

5.  Pros, Cons, and Interesting Information

Every med has its good points and its bad points. This is what we think those are.
Doctors don’t have the time to tell you everything about a drug. Patient information leaflets leave out a lot. Even if the PI sheet covers everything the language is so dense and obtuse that the good stuff is often lost in information overload. Most meds have something interesting about them.

5.1  Pros

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

5.2  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. Paxil also has the worst sexual side effects of any SSRI, maybe of any crazy med.

5.3  Interesting stuff your doctor probably didn’t tell you:

For some people that includes stopping for just a couple of days, experiencing the hell of SSRI discontinuation syndrome, and then going back on Paxil. You have to be totally med compliant with Paxil or it could be a pointless waste of time, money and suffering.

6.  Side Effects and Pregnancy Category

Potential side effects are used as a rationalization to not take a medication. Many people will stop taking an otherwise working drug because of one or more relatively minor, or often temporary side effects. There may even be ways to counter or mitigate side effects.
It all comes down to a very important question: which sucks less?
No matter what crazy med you take, it will probably make you feel spacey and generally out of it for the first few days (i.e. don’t operate heavy machinery), as well as make you drowsy. Even stimulants can make you drowsy. Paxil will probably affect your dreams as well, and there’s no way to tell if that will be a temporary or permanent side effect. Don’t be surprised if your stomach and/or other parts of your GI system complain for at least the first few days.

6.1  Typical side effects

Most everyone gets at least one or two of these.
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
  • assorted sexual dysfunctions, including, but not limited to:
    • decreased libido
    • erectile difficulties (can’t get it up with a forklift)
      • All the way up tocomplete impotence
    • anorgasmia (can’t climax)
    • ”abnormal ejaculation”11
    • and the ever-popular libidoectomy (total elimination of sex drive), which can be so bad with Paxil (paroxetine) that it has tarred the entire SSRI class of antidepressants, and even antidepressants in general, with the reputation of being chemical chastity belts.
  • For some reason people with agoraphobia are more likely to have sexual side effects.
    • Which I can confirm. And as someone with periods of intense agoraphobia and social avoidance I considered the elimination of my sex drive to be a feature, not a bug.

Most of these side effects go away, or become bearable, within a couple of weeks. The constipation may not leave, but it usually gets better. Weight gain and, unless you’d rather they stick around, sexual side effects tend to stay.

6.2  Uncommon side effects

You may or may not get one or more of these.

  • Motion sickness/vertigo
  • Food tasting weird
  • Because Paxil (paroxetine) is so potent it is more likely to interfere with dopamine than most other SSRIs. In addition to causing sexual side effects, this can result in a variety of side effects usually associated with antipsychotics such as:
    • additional sexual side effects
    • gynecomastia (man boobs)
    • galactorrhea (leaky tits, regardless of gender)
    • akathisia
    • EPS, TD, and NMS

6.3  Potentially dangerous side effects:

If you have these, call your doctor ASAP. Or now. Or get the hell off of the Internet and go to the ER. NOW!

  • Some of those anti-dopaminergic side effects can be dangerous.
  • Serotonin syndrome is possible, highly unlikely, but possible under the right circumstances12:
    • You’re taking a high dosage (above 40mg a day) of Paxil
    • You’re taking a high dosage of another serotonergic drug that, like Paxil, is both a potent inhibitor of CYP2D6 and is metabolized by (is a substrate of) CYP2D6. Those would be:

6.4  Freaky rare side effects:

You won’t get these. Unless you already have and that’s why you’re here.

If that’s not the makings for a highly-paid, if rather highly-specialized sex worker, I don’t know what is.13

6.5  Ways to counter / minimize / mitigate / deal with some side effects

6.6  Pregnancy category

D-Will probably harm your baby Expanded pregnancy category explanation.


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Paxil Index


1 EU: European Union. Currently Austria, Belgium, Bulgaria, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the United Kingdom. Not all drugs approved in any one EU country are approved in all, but most crazy meds approved in several EU countries are at least obtainable in all EU countries on the European mainland. I'm not sure about Britain, Cyprus, Ireland, and Malta.
The UK and Ireland are listed separately because we're a primarily English-language site. Plus the UK tends to be more independent on more matters than any other EU member state, so it should probably be listed separately no matter what language a site like this is in.
While the EU is moving toward one brand name for the same med, that's not going to happen overnight. And people will still refer to meds by old brand names. So we'll list old brand names until they vanish.

2 Generic availability isn't fully harmonized in the EU. Sometimes a drug is available everywhere as a generic, sometimes it's available only in a few member states. We'll provide the best information we have.

3 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin**, and they are owned by Pfizer***, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions. We'll note if any preferred generics are manufactured by the pioneering company's subsidiary.

4 Before Cymbalta (duloxetine) was approved as an antidepressant in the US it was already approved in the EU, but only for stress urinary incontinence and sold under the trade name Yentreve. Duloxetine is now sold in the EU as an antidepressant under the trade name Cymbalta.
A better known, if slightly different example is bupropion. According to the 2007 edition of Mosby's Drug Consult, in the US, Canada and Singapore you can get both Wellbutrin (bupropion) as an antidepressant or Zyban (bupropion) to stop smoking. In Korea, Thailand and most of South America (but not Brazil) you can get bupropion (under various trade names) only as an antidepressant. In Brazil, the EU & UK, Israel, India, Australia and New Zealand it's only available as Zyban to help you stop smoking.

5 Assuming you were correctly diagnosed in the first place.

6 Keep in mind that according to one study, most drug studies will skew in favor of the med made by the company that sponsored the study.***** That's one of my favorite "no shit Sherlock" studies, although it did help in getting conflicts of interest showing up on papers.
Two additional papers along similar lines are Why Current Publication Practices May Distort Science******* and Why Most Published Research Findings Are False********. So in addition to the books we use as source material, this is why we also factor a lot of anecdotal evidence (personal experience, experiences of people we know, case reports, what people have sent us in e-mail, and what is posted all over the Internet) into our conclusions regarding the likelihood of meds working, the prevalence of various side effects, etc.
While the drug companies are getting a lot more transparent and publishing more data in the PI sheets regarding the results of the clinical trials, they still don't publish how many times a drug failed a clinical trial.********

7 Unless you know for sure you're an ultra-rapid metabolizer of CYP2D6 substrates.

8 Although not everyone has the luxury of stopping at a dosage when the symptoms abate and not increasing it unless the return. Sometimes you just have to keep going up until you reach that target dosage. E.g. you have a history of seizures that haven't yet responded to several medications.

9 Most notably Dr. Edward Faught, founder and Director of the Epilepsy Center, and vice chairman of the Department of Neurology, at the University of Alabama School of Medicine in Birmingham. His article on new antiepileptic drugs in Volume 7 issue 1 of Peer Review in Review stressed starting at low dosages, doing a slow titration, and stopping at the dosage where symptoms were under control. In Topiramate in the treatment of partial and generalized epilepsy****, the one free, full-text article I could find (that's not about geriatric patients), he again stresses the low and slow approach to avoid or lessen most side effects, while still achieving seizure control in the same amount of time.

10 The controlled-release version has a shorter half-life than the immediate release. How messed up is that?

11 No explanation of what "abnormal ejaculation" means. Squirting bucketfuls when you used to just drizzle a little? Or the other way around? Odd color, taste, or smell?

12 Or wrong circumstances, depending on how you look at these things.

13 Unless you include the freaky rare side effects of several other crazy meds.

Date created {{$$newlycreated}} Page Creator: JerodPoore Last edited by: JerodPoore on 2013–09–22


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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.
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.
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.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
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!

‘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 Crazymeds. 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]

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