Part 1: Indications, efficacy, dosage, titration, discontinuation, pros and cons, adverse events, availability and how supplied.

> Paxil (paroxetine) Review


The Paxil (paroxetine) Overview is a briefer, more consumer-friendly version of this article. The information in this article comes from twelve separate pages, with more explanatory material, to which the overview links. The title of each section on both pages of this article is also a link to each of those pages.

Click here for Part 2: Warnings, clinical pharmacology, interactions, additional comments and consumer experiences

Abstract

Consumers need more information than what is provided in the patient information literature, but are intimidated by, or have no desire to read all of, the prescribing information for a drug. This review of the drug Paxil (paroxetine) provides what the educated consumer wants, highlighting its use as, and comparing it with other {{$$drugclass2}}. Also discussed are off-label uses, efficacy, adverse events and how to mitigate them, titration and discontinuation schedules, clinical pharmacology, other aspects of using Paxil (paroxetine), and consumer experiences.

Classification

Primary Drug Class

Paxil (paroxetine) is in the Antidepressants class of medications.

Additional Drug Categories

Anxiolytics/Anti-anxiety Serotonin-Selective Reuptake Inhibitors

Indications

A review of Paxil’s prescribing information, the literature, and consumer experience. Regarding off-label applications: if something is to be considered as “clinically significant” there need to be large, double-blind studies or clinical trials in addition to lots of consumer experiences, otherwise it will still be considered as experimental.

FDA-Approved Indications

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)

Drugs sometimes have different approvals in different countries.1 Consumers want to know this if they are running out of treatment options; or if they are researching their treatment options they may wish to know if, and why, a medication is approved for something in the US but not anywhere else.

Approved Uses Outside of the US

Clinically Significant or Otherwise Common Off-Label Uses

!!!!Anxiety Spectrum Disorders

Miscellaneous Common/Significant Off-Label Uses

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

Less Common/Experimental Off-Label Uses

Failed off-label uses

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.



Efficacy & Comparisons with Other

A review of prescribing information, the literature and consumer experiences. In addition to review sites, which don’t skew as negative as one would think, consumer experiences with medications are frequently reported on social media sites that have nothing to do with medications or illnesses. There is such a consistent overlap in many demographics (e.g. women with bipolar 2 and/or migraines and scrapbooking) to provide a great deal of data on efficacy and adverse reactions from a very natural environment where consumers discuss their conditions and how to treat them that is free of almost all prejudices regarding medications and other treatment options.

Onset of Action

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 up2. As this study shows it’s usually pointless to continue above that dosage/past that time if Paxil hasn’t done you any good.

Efficacy 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.

For Off-Label Applications

Paxil versus Other Antidepressants for Approved Indications

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.

For Off-Label Uses

These are not prescribing guidelines per se. For consumers they are an antidote to the direct-to-consumer marketing phrase “Talk to your doctor about…” regarding the advertised drug. For physicians they are likewise an antidote to drugs being pushed on them by pharm reps.

A synthesis of the literature and consumer experiences can provide good rules of thumb as to when consumers should and should not talk to their doctors, and when doctors should and should not talk to their patients, about particular drugs the first time they discuss treatment options. If at all.

Why/When Paxil (paroxetine) Should Be Recommended

Why/When Paxil (paroxetine) Should Not Be Recommended

  • You’re under 18.
    • Make that under 24.
    • 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, Do. Not. Take. Paxil.
  • You haven’t tried any medication to treat whatever you have.
    • OK, maybe you’re taking a benzodiazepine, but you can still leave your room without being drugged into a stupor.
  • 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. From a real doctor.


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Dosage, Titration, and Discontinuation

A review of Paxil’s prescribing information, the literature, and consumer experience. We have found that for most consumers in an out-patient situation the titration schedule published in the prescribing information is often too aggressive. Many would often be better served by starting at a dosage lower than recommended by the manufacturer and, instead of a fixed target dosage, the dosage where symptoms are controlled within a given range is the goal. Patients could adjust their dosage as needed without having to schedule an appointment with their prescriber.

Dosage and Doses

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

Dosing Schedule

  • 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 pharmacokinetics3 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.

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 up2. 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.

One aspect of taking a medication that is frequently missing from patient information, as well as prescribing information, is how to stop taking it. Consumers are left with nothing more than the warning to not stop taking their medication without first talking to their doctor. Circumstances do not always allow for that. Many consumers feel better if they have the knowledge about what they should do.

How to Discontinue

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.

Discontinuation Symptoms

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



Pros, Cons, and Interesting Information

Even though they want more information than the patient information literature provides, consumers also want a very high-level synopsis. A synthesis of the prescribing information, the literature, and consumer experience provides the pros and cons of using Paxil (paroxetine) for its approved indications and clinically-significant or otherwise common off-label uses.

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

When doing their own research about a medication, the educated consumer, and perhaps medical students and healthcare professionals may find interesting pieces of information that are rarely discussed in a prescriber-patient setting. Such information may be rarely discussed because it is trivial, but many people tend to remember interesting, albeit trivial information about something along with other information associated with it. There may be something here to get a patient to remember a more important point about a medication. The other side of that mnemonic coin is what a medication is best known for, something a drug-naïve consumer might not know. While prescribers don’t always assume their patients are aware of a drug’s trait that is “common knowledge,” consumers who do some research don’t want to feel like idiots. They want to know something that isn’t misinformation. Prescribers can always couch questions about well-known traits in forms like “You’re aware that Panacea can cause significant giddiness, right?”

Interesting Things Doctors Rarely Tell Their Patients

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.

What Paxil (paroxetine) is Best Known for

Giving you a libido-ectomy, followed by the SSRI discontinuation syndrome from Hell.

Noted Traits & Effects



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Adverse Events

A review of prescribing information, the literature, and consumer experiences. One thing this review has found is no matter which neurological/psychiatric drug someone takes, one or more of these adverse events will happen and usually be gone, or at least will diminish to the point where they are barely noticed, within a week or two.

  • Headache
  • Drowsiness/fatigue - even when taking stimulants in some circumstances.
  • Insomnia, instead of or alternating with the drowsiness.
  • Nausea
  • Assorted other minor GI complaints (constipation, diarrhea, etc.)
  • Generally feeling spacey / out of it
    • Which can all add up to the ever-helpful ”flu-like symptoms” listed as an adverse event on the PI sheet of practically every medication on the planet used to treat almost any condition humans and other animals could have.
  • Will affect dreams. There is no way of telling if that will be good or bad, the extent of the change, let alone if this side effect is permanent or temporary.

Potential side effects are often used as a rationalization to not take a medication, and that is a valid reason why prescribers don’t like their patients looking up medications on The Internet. It’s a delicate balancing act between providing too little or too much information about side effects. What may be contrary to popular belief, reports of side effects from consumers on sites run by either medical professionals or consumers themselves are generally not too far outside what is published in the literature after a drug has been on the market.

Common Adverse Events

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”4
    • 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.

Uncommon Adverse Events

  • 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

Potentially Dangerous Adverse Events

  • Some of those anti-dopaminergic side effects can be dangerous.
  • Serotonin syndrome is possible, highly unlikely, but possible under the right circumstances5:
    • 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:

Never underestimate the value of gallows humor when confronted with a condition that comes with the dual stigmata of having a mental illness or other neurological disorder and treating it with a medication that everyone from family members to movie stars and other misinformed celebrities say is worse than the condition itself. It’s not for all consumers, but those who have been using the Internet most of their lives generally appreciate it.

Freaky Rare Side Effects:

If that’s not the makings for a highly-paid, if rather highly-specialized sex worker, I don’t know what is.6

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

Names, Availability, Brand vs. Generic Issues, Forms

Consumers not only travel, they often live in other countries for extended periods. Thus they need to know if the medications they take are available in those countries, what trade names are used, and if the less-expensive generic version is available.

Available as Paxil in these countries

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

Other trade name(s) for Paxil used in these countries

  • 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

Generic Name and Availability

US Generic name/INN:paroxetine
US Generic available?Yes

paroxetine is available in these countries7

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

Branded Generic Names8 & Transcribed or Transliterated INN/Generic Name9

  • 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


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Not all generic medications are created equal. Consumers have noted differences in the quality of medications produced by different manufacturers. See the article on on the differences between brand and generic medications for more information.

Specific generics with complaints, or preferred generics manufacturers

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.

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.

How Supplied

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
  • 10mg/5 mL Orange-colored, orange-flavored
Paxil 20 mg tablets
Paxil 20 mg Tablets

Shelf Life

Tablets: 3 years. Oral solution: 2 years (1 month after opening).

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Click here for Part 2: Warnings, clinical pharmacology, interactions, additional comments and consumer experiences




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References

  1. Hughes, Shannon, and David Cohen. “Can online consumers contribute to drug knowledge? A mixed-methods comparison of consumer-generated and professionally controlled psychotropic medication information on the internet.” Journal of medical Internet research 13.3 (2011).
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
  3. Paxil’s Full US Prescribing Information
  4. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 ISBN:978-0323040587
  5. Article I, Section 8 of the US Constitution
  6. Greenstone Pharmaceuticals’ Product List. Greenstone LLC Last accessed 04 July 2014
  7. History of Pfizer and Warner-Lambert; 2000 to Present. Pfizer.com Last accessed 04 July 2014

{{$$bigbiblio}}


1 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, and my highly-skilled Google-fu, in the US, Canada and Singapore you can get both Wellbutrin (bupropion) as an antidepressant or as 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.

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

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

4 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?

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

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

7 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.

8 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.

9 In some countries the INN / generic name is transcribed into a local phonetic equivalent. In Spanish it's often so close as to be redundant (e.g. topiramato vs. topiramate). In Finnish it's close to being a different drug (e.g. escitalopram vs. essitalopraami). I can understand the need to transliterate the INN / generic name into another alphabet (topiramate becomes топирамат in Russian), but giving a med a different generic name using the Latin alphabet just makes it difficult to find.


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 Sunday, 22 September, 2013 at 14:49:30 by JerodPoorePage Author Date created
“Paxil (paroxetine): a Synopsis for the Educated Consumer.” by Jerod Poore is copyright © Jerod Poore Published online 2011/04/08
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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.
Keep up with Crazymeds and and/or my slow descent into irreparable madness boring life. Pick your preferred social media target(s):

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!

‘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? 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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