Paroxetine (Paxil)

Paroxetine - Use | Dose | Side Effects

Paroxetine (Paxil) is a medicine used in the treatment of depression and/or anxiety disorders in adults. Paroxetine (Paxil) is used in the following disorders:

  • Major depressive episodes (periods of depression)
  • Obsessive compulsive disorder (compulsive repetition of thoughts and/or execution of actions)
  • Panic disorder (panic attacks, including those caused by agoraphobia, or fear of open spaces)
  • Social anxiety disorder/social phobia (fear or avoidance of everyday social situations)
  • Post-traumatic stress disorder (anxiety caused by a traumatic event) and generalized anxiety disorder (general feeling of strong anxiety or nervousness)

Paroxetine (Paxil) belongs to the group of medicines designated as SSRIs (selective serotonin reuptake inhibitors). Brain contains a substance known as serotonin. People who are depressed or anxiety have lower serotonin levels than others. It is not entirely clear how paroxetine (Paxil) and other SSRIs work but they may achieve a therapeutic effect by increasing levels of serotonin in the brain. The application of appropriate treatment for depression or anxiety is important for you to feel better.

Do not take this medicine

  • You cannot use paroxetine (Paxil) if you are allergic to this medicine
  • If you use or have used at any time during the last two weeks monoamino oxidase inhibitors- MAO inhibitors (phenelzine, moclobemide) and if you are taking the medicine pimozide-antipsychotic medicine (ThorazineR)  beacuse this can cause serious cardiovascular problems!

If you have taken any of the above medicines please inform your doctor.

Tell your doctor if you have the following

  • Epilepsy or seizures
  • Liver or kidney problems
  • Diabetes
  • Bleeding disorders
  • If you have hyponatremia (low sodium)
  • If you are taking any other medicines
  • If you have any bleeding disorders
  • If you have glaucoma ( increased eye pressure)
  • If you are younger than 18
  • If you planning to become pregnant

Children and adolescents younger than 18 years

Paroxetine (Paxil) should not be used by children and adolescents younger than 18 years. You should know that patients under 18 have an increased risk of side effects such as suicide attempt, suicide ideation and hostility (mostly aggression, confrontation and anger) when taking medicines of this class. If a doctor prescribes paroxetine (Paxil) for patients younger than 18 years old, and you want to talk about it, please contact your doctor again. Tell your doctor if any of the below mentioned symptoms appear or worsen when patients under 18 years takes paroxetine (Paxil) tablets. Also. It is not proven long- term safety of this medicine related to the growth, maturation and cognitive development and behavior in this age group. In studies of the application of paroxetine (Paxil) in younger than 18 years, common side effects that have occurred in less than 1 in 10 children/adolescents were:thoughts of suicide and attempted suicide, intentional self-injury, hostility, aggressiveness or hostility, lack of appetite, tremors, abnormal sweating, hyperactivity (excess energy), agitation, changes in emotions (including crying and mood swings). These studies have also shown that the same symptoms emerge in children and adolescents who have received sugar pills (the placebo), instead of paroxetine (Paxil), although less frequently. Some patients in these studies, younger than 18 years, have experienced withdrawal effects when they stopped taking paroxetine (Paxil). These effect is generally similar to those that occur in adults after stopping treatment with paroxetine (Paxil). In addition, patients younger than 18 years frequently (less than 1 in 10) have a stomach ache, a feeling of nervousness and changes in emotional state (including crying, mood swings, attempted self-harm, suicidal thoughts and suicide attempts).

Reflections on suicide and worsening depression or anxiety disorders

People who are depressed and / or suffering from an anxiety disorder can sometimes think of suicide, and self-mutilation. This may be enhanced at the start of the therapy with antidepressants, these medicines because it takes time to start to act, usually two weeks or longer. More likely to be referred thoughts occur:

  • If you have previously thought of suicide or self-harm
  • If you are a young adult. Data from clinical trials have shown an increased risk of suicide-related behaviors in persons younger than 25 years with psychiatric problems treated with paroxetine (Paxil).

If you at any time such thoughts occur, contact your doctor immediately or go to the hospital.It may help if you tell a friend or relative that you are depressed or suffer from anxiety disorder. You can ask them to tell you if they find that your depression or anxiety getting worse, or if they were concerned about changes in your behavior.Some patients taking paroxetine (Paxil) appears the so-called akathisia, a sense of restlessness, inability of peaceful sitting or standing.For other patients may develop so-called serotonin syndrome, the occurrence of some or all of the following symptoms:feeling confused, feeling of restlessness, sweating, shaking, shiver, hallucinations (strange images or sounds), sudden jerks of a muscle or rapid heartbeat. If you notice any of these symptoms, contact your doctor.

Interactions (use with other medicines)

If you are using some of these medicines you notice that to your doctor:
  • MAO inhibitors (phenelzine, moclobemide)
  • Pimozide
  • Valporate
  • Tramadol
  • Antipsychotic medicines (clozapine, risperidone, nortriptyline, imipramine and other SSRi medicines such as sertraline, fluoxetine etc)
  • Phenytoin
  • Warfarin
  • Propafenone
  • Digitoxin
  • Tolbutamide
  • Aspirin, ibuprofen, diclofenac
  • Tamoxifen
  • St. John's Wort
  • Rifampin
  • Phenobarbital
  • Carbamazepine

Do not use alcohol while taking paroxetine (PaxilR). Alcohol can worsen your symptoms or side effects. Taking paroxetine (PaxilR) tablet in the morning with food will reduce the likelihood that you feel nauseated. Please note that this list is not complete! Inform your doctor if you are taking any other medicines!

Taking this medicine during the pregnancy

If you are already taking paroxetine (Paxil) and you've just discovered you are pregnant, you should immediately talk to your doctor. Also, if you are planning to become pregnant, talk with your doctor. In fact, some studies have shown that there is an increased risk of heart defects in babies whose mothers took paroxetine (Paxil) during the first months of pregnancy. These studies have revealed that they are less than 2 of the baby 100 (2 %), whose mothers had paroxetine (Paxil) in early pregnancy had a heart defect, compared with the normal frequency of 1 in 100 babies (1 %), which is encountered in the general population. When taking into account all types of congenital disorders, there is no difference in the number of babies are being born with congenital disorders after their mothers during pregnancy, taking paroxetine (Paxil) compared with the total number of congenital disorders that occur in the general population. Observed the occurrence of specific complications at birth (persistent pulmonary hypertension of newborns or PPHN) in babies whose mothers used SSRIs (including paroxetine (Paxil)) during pregnancy. PPHN increased risk  for very high blood pressure in the blood vessels of the heart and lungs from the baby. It has been reported that the increased risk in children of mothers who used an SSRI in late pregnancy was 4 to 5 times higher than the risk observed in the general population (incidence of 1 to 2 cases per 1 000 pregnancies). You and your doctor can decide that it is better for you to continue treatment with another medicine or to gradually discontinue the application of the medicine during paroxetine (Paxil) gestation. However, depending on the circumstances, your doctor may consider that is better for you to continue using the medicine paroxetine (Paxil). If you are taking paroxetine (Paxil) during the last 3 months of pregnancy, tell your doctor or midwife because your baby might have some symptoms at birth. These symptoms usually begin during the first 24 hours after birth. They include:the inability to fall asleep or proper food intake, difficulty breathing, bluish skin color, or feeling too much heat or cold, nausea, cries a lot, stiff or too loose muscles, lethargy, tremors, tremors or convulsions. If your baby has any of these symptoms after birth, and you are worried, contact your doctor or midwife who will be able to advise you. Paroxetine (Paxil) may be at very low levels in mature breast milk. If you are taking this medicine, talk to your doctor before you begin breastfeeding. You and your doctor can decide that you can breastfeeding a baby while you using paroxetine (Paxil) (if expected positive effects to the mother justifies the potential risk to the baby).

How to use this medicines

Apply the medication exactly as your doctor has prescribed. If you feel that the medicine is too strong or too weak, talk to your doctor or pharmacist. If you are not sure and have concerns related to the application of the medicine, consult your doctor or pharmacist! Most people start to feel better after a few weeks. If not then you start to feel better, talk to your doctor, who will advise you. It may decide to gradually increase with an increase in the dose of 10 mg, the maximum daily dose. Take your pills in the morning with food. Swallow them with water. Do not chew them. Your doctor will talk to you about how long it takes to take the tablets. This may be many months, or even longer. Elderly  people The maximum dose for people older than 65 years is 40 mg per day. Patients with liver or kidney disease If you have liver problems or if you have serious kidney disease, your doctor may give you a lower dose paroxetine (Paxil) than usual.

Overdose

If you apply more than the prescribed dose is, consult your doctor or pharmacist!

If you forget to take the medicine

If you forget to take medication on time, do not use double dose later. Simply continue to use the medicine according to the usual schedule. If you forget to take a dose, take the medication as soon as possible.

If you suddenly stop taking paroxetine (Paxil)

Do not suddenly stop taking this medication because it is possible to occur side effects such as: tremor, dizziness, anxiety, headache, restlessness, vertigo, insomnia. If you want to stop the use of paroxetine it is necessary to consult your doctor to help you gradually decreasing the dosage.

Side effects

Contact your doctor if you have any of this side effects:

  • If you encounter any unusual bruising or bleeding , including vomiting blood or blood in the stool
  • If you find that you are unable to urinate
  • If you encounter any convulsions (seizures)
  • If you feel discomfort and you are not able to sit or stand quietly, you may be suffering from something called akathisia
  •  If you feel that you are tired, weak or confused, and the muscles are painful, stiff or uncoordinated to be due to the fact that you have a low content of sodium in the blood
  • If you think of self-harm or suicide
  • If a rash appears on the skin as red seals, eyelid edema, face, lips, mouth or tongue, appears itching or difficult breathing or swallowing
  • If you experience some or all of the following symptoms you may be suffering from something called serotonin syndrome. Symptoms include a feeling of confusion, feelings of restlessness, sweating, shaking, shiver, hallucinations (strange images or sounds) or rapid heartbeat
  • If you experience eye pain and vision becomes blurred (acute glaucoma)

Very common side effects, which are likely to occur in more than 1 in 10 people:

  • Nausea. Taking the medicine in the morning with food will reduce the possibility for this to happen
  • Change in sexual function. For example, lack of orgasm in men abnormal erection and ejaculation

Common side effects, which are likely to occur in up to 1 in 10 people:

  • Increasing levels of cholesterol
  • Lack of appetite
  • Poor sleep (insomnia, nightmares) or sleepiness
  • Feeling dizzy or tremor
  • Headache
  • A sense of nervousness
  • A sense of unusual weakness
  • Dry mouth
  • Diarrhea or constipation
  • Increase in weight
  • Sweating

Occasional side effects, which are likely to occur in up to 1 in 100 people:

  • Short-term increase or decrease in blood pressure that can lead to feeling dizziness or fainting when standing up sharply
  • Rapid heart rate
  • Low mobility and abnormal movements of the mouth and tongue
  • Skin rash
  • Feelings of confusion
  • The occurrence of hallucinations ( strange images or sounds )
  • Inability to urinate ( urinary retention) or involuntary urination that can not control ( urinary incontinence)

Rare side effects, which are likely to occur in up to 1 in 1,000 people:

  • Excessive secretion of milk in men and women
  • Slow heartbeat
  • Effects on the liver, which can be observed in the laboratory functional tests of liver
  • Panic attacks
  • Overactive behavior or thoughts (mania)
  • A sense of detachment from oneself (depersonalization)
  • Feelings of anxiety
  • Continuous need for movement of the lower limbs (restless legs syndrome)
  • Pain in the muscles

Very rare side effects, that are likely to occur in up to 1 in 10,000 people:

  • Liver problems that cause yellow discoloration of the skin and the eyes
  • Fluid retention or water
  • Sensitivity to sunlight
  • Painful erection of the penis