Generic Paxil (Paroxetine): Doses, Overdose, Side Effects, Precautions

Product Overview
Generic Paxil (Paroxetine): Doses, Overdose, Side Effects, Precautions
Brand Name:
Paxil / Pari / Pexep / Parolin / Seroxat
Other Names:
Pexeva / Seroxat / Brisdelle / Rexetin
Active ingredient:
Dosages (mg):
10 / 20 / 30 / 40
Drug Class:
Serotonin Reuptake Inhibitors (SSRIs)
Depressive disorder

When Paxil Use

Paxil is a trade name of paroxetine – an antidepressant belonging to a group of selective inhibitors of serotonin, which has been used in treating major depression since 1992. Paroxetine can now be bought under different trade names – there are several generics that contain this active ingredient, and generic Paxil is one of these medications.

Paxil medication is prescribed in the following cases:

  • clinical or chronic depression;
  • social phobia;
  • panic attacks;
  • obsessive-compulsion disorders (compulsive actions and thoughts);
  • generalized anxiety disorder;
  • posttraumatic stress syndrome.

Chronic depression is a constant state of anxiety and anguish. It often brings problems with sleep, loss of libido, loss of interest in life, and to some people – even thoughts about suicide. Treatment based on psychotherapy is not always enough, because depression can be caused by insufficient serotonin levels, and in such cases Paxil and analogue antidepressants are used.

Besides depression, Paxil is used for treating different physical and mental aliments, among which the most common are posttraumatic stress syndrome, sociophoby, obsessive-compulsive disorder, and others.

Sometimes Paxil is prescribed to women who suffer from premenstrual dysphoric disorder, for easing their psychological and physical symptoms before the beginning of the menstruation cycle (migraines, etc.).

Paxil (paroxetine) is the most powerful among selective serotonin inhibitors. It has strong antianxiety action. It is in some degree similar to tricyclic antidepressants, while causing fewer side effects on central nervous system and vegetative nervous system. The clinical experience of using paroxetine shows that it does not impair cognitive or psychomotor functions (except for possible sleepiness).

Due to cholinergic effect the intake of Paxil leads to fast reduction of anxiety and insomnia, while causing less primary activating effect, and such side effects as nausea or diarrhea are not so pronounced. That’s why this antidepressant may be preferable in treating phobic anxiety disorders, worried depressions. But it will be tolerated worse if the depressive disorder includes pronounced psychic and movement inhibition.

Standard Recommendations and Individual Approach

Paxil tabs are taken orally with a glass of water, after a meal. The recommended initial dose is 20 mg once a day – in the morning. The dose should be gradually increased by adding 10 mg till receiving stable therapeutic effect.

The correct dose and the duration of treatment are determined by the doctor individually for each patient taking into account his or her clinical symptoms, during the first 2-3 weeks of therapy. Minimal dose is the lowest effective dose, which allows to reach the wanted results with minimal risk of adverse effects.

Mental disorders usually require long-term treatment, so the therapy may last for several months in case of depression; treatment of obsessive–compulsive disorders and panic disorder needs even more time.

The dose depends on the type of disorder and other factors. Thus, in case of depressive disorders, the doctors usually prescribe an initial dose of Paxil 20 mg, than move to 30 mg. The dosage can be usually adjusted once per week, not more. It may increase to 40 mg of paroxetine or sometimes higher (up to 60 mg). As the emotional condition becomes more stabilized, the medication intake is gradually decreased. The dosage can be usually adjusted once per week, not more.

The same situation with treating obsessive-compulsive disorders – the initial dose starts with 20 mg, increases once per week by 10 mg, stabilizes at maximum dose, and then gradually decreases when the wanted effect is reached.

In case of anxiety disorders and panic attacks the standard initial dose is 10 mg it increases incrementally once a week by 10 mg. In severe cases it may reach 60 mg maximum; but when treating panic disorders, physicians usually try to keep the dose at the lowest level possible.

When it comes to posttraumatic stress disorders, 20 mg tab of Paxil is prescribed, with the intention to stabilize the dosage at 40 mg a day. It rarely exceeds 50 mg.

The patients with social phobia usually start from Paxil 10 mg a day and gradually reach 50 mg, if it is necessary.

Paxil Withdrawal: No Need to Hurry

The medication's dosage has to be reduced gradually to minimize the possibility of negative effects that often accompany paroxetine withdrawal. If the patient stops taking Paxil too quickly, he may feel himself/herself very sick and uncomfortable. How long does Paxil withdrawal last? This will depend on the medical condition of the patient and other factors.

During the treatment the patient takes the drug every day and this provides certain levels of serotonin, and the body becomes dependent on its source. When the dosage is decreased gradually, the brain gets enough time to regulate serotonin production by the body. In other case the body experiences severe stress. Withdrawal effects can also take place when the dosage is decreased progressively, but it is considerably easier to bear them.

Some patients make a mistake by stopping the drug abruptly, when they feel better and think that the antidepressant is no longer necessary. The consequences can be severe, and this can set back the treatment program’s overall progress.

These are possible Paxil withdrawal symptoms:

  • fatigue;
  • headache;
  • racing heartbeat, seizures;
  • sleep disorders, nightmares, night sweats;
  • blurred vision;
  • disorientation;
  • hallucinations;
  • moodiness, irritability, suicidal thoughts;
  • panic attacks;
  • nausea, vomiting;
  • numbness in the extremities;
  • ringing of the ears;
  • dry mouth;
  • chills, fever;
  • diarrhea, constipation;
  • fainting;
  • cramping;
  • loss of libido.

Withdrawal symptoms can last up to 2 weeks after the stopped treatment or 1 month after started reduction of the medication’s dose. It is necessary to tell the prescribing physician about all negative effects and to follow all his/her recommendations.

Vital Question: Does Paxil Cause Weight Gain

Patients often worry about the issue of Paxil and weight gain. Yes, it is a common problem with selective serotonin reuptake inhibitors and some patients notice that they gain excess kilograms, but it doesn’t happen to everybody. The reason may be slowed down baseline metabolism. The patient’s physiology changes, and the metabolism of fat (and storage of excess fat) changes as well.

Fat processing and storage are significantly influenced by hormones, so the deficiency of some hormones can lead to weight gain. Hormonal imbalance may be caused by long-term consumption of Paxil.

Another possible reason may be increased cravings for unhealthy meals as a consequence of changed serotonin levels – so called emotional eating. People taking Paxil often tend to prefer unhealthy junk food and products with a lot of sugar and carbohydrates in general. Moodiness and anxiety makes people use food (especially fatty and sweet) hoping that it will help them feel better temporarily.

Sometimes antidepressants alter the taste bud receptors, thus making food seem to taste better, and the patients eat more than usually.

The patients, whose lost appetite because of the depression led to weigh loss, may gain more kilograms when the stabilization of serotonin levels increases their desire for food. It is normal, unless the appetite boost is uncontrollable.

One of the common side effects is fatigue, when the patient’s desire for physical activity is diminished. This can also lead to excess weight.

If the patient takes other drugs, their interaction with Paxil can amplify weight gain. For example, the combination of Paxil and Risperidone has been found to lead to a weight increase.

In the early stage of treatment with Paxil medication weight loss can take place. The opportunity of gaining weight increases in case of long-term Paxil consumption and in case of taking higher dosages. If you are on a short-term therapy and your dose is low, you are likely to not notice any weight changes.

Certain patients should be more careful – these are people at metabolic risk, who have something of these: abdominal obesity, impaired glucose tolerance, diabetes, genetic obesity, hyperlipidemia, hypertension, cardiovascular diseases, elevated body mass index.

If the weight gain is significant, but the patient gets great benefit from the medication, it is reasonable to continue the treatment. But in case of minor effects along with significant side effects including excess weight, it makes sense to replace the drug with another one that will work better for this person.

In general, this is very individual. Not all patients face the problem of excess weight. In large measure it depends on the proneness and on the lifestyle (active or sedentary, calm or stressful). The patient can always do something to become more well proportioned – keep to a healthier diet or do physical exercises. But for depressed patients physical activity and healthy way of life are often difficult because of lack of motivation and energy.

Alcohol: Interaction and Consequences

Paroxetine and alcohol are not a good combination, since Paxil is intended to have positive effect on mood, and alcohol acts in the opposite way. By adding alcohol, the patient reduces the drug’s ability to regulate the chemicals (such as serotonin) in the brain. Besides, the potential adverse effects of the medication might enhance.

Due to its stimulating effect, alcohol increases anxiety levels. By mixing it with Paxil, the patient causes stronger mood fluctuations and instability of the nervous system, since their mechanisms of action are opposite.

Alcohol is able to enhance paroxetine’s side effects, such as anxiety, fatigue, drowsiness, which can be dangerous, for example, when driving a car or operating some machinery. Sadness can turn into suicidal thoughts, irritability - into aggression. The long-term effectiveness of the treatment program can be damaged.

Interactions with Other Medications

Paroxetine is incompatible with tricyclic antidepressants, anticonvulsant agents, methylene blue, barbiturates, irreversible and reversible inhibitors of monoaminooxidase, warfarin, imipramine, bupropion, nortriptyline, tryptophan and trazodone. The interval between intake of monoaminooxidase inhibitors and paroxetine should be not less than 14 days.

Simultaneous paroxetine intake with phenothiazine derivatives (antidepressant) and the dosage has to be coordinated with the attending doctor.

Clinical trials have shown that pharmacokinetic properties of paroxetine are not impacted by antacidic agents, digoxin and food – the combination with them does not require dose correction.

Paxil can cause bleeding in patients who take anticoagulants, so their treatment has to be under careful control.

Paroxetine increases concentration of tricyclic antidepressants, anticonvulsant drugs, antiarrhythmic drugs and a range of other medications.

In some cases such ability is used on purpose, for example, to treat refractory depressions Paxil is sometimes used together with mirtazapinum, thus enhancing the effect of both these drugs.

The list of Paxil’s interactions with medications is extensive, to it is necessary to inform your psychiatrist what medicines you’re already taking.

Precautions and Contraindications

The medication is not used in pediatric practice in connection with high risk of undesirable outcome (aggressive behavior, strengthening of a depression). It is not recommended to take it during pregnancy and when planning a baby in connection with possible malformations of a fetus. Paxil can be prescribed to a pregnant woman only if the expected benefit for mother is higher than the potential risk for fetus. Anyway, another treatment method for pregnant or planning women should be considered.

The medication can be prescribed for older people, but the dosage is selected individually for each patient.

Patients with sick kidneys and liver should be treated under strict control of the doctor, and the dosage has to be minimum.

The instruction for application declares that the medicine is contraindicated in such cases:

  • Age under 18 years; Paxil is not used for treating children even in minimum dosages;
  • Lactation and breastfeeding (the medication gets into breast milk);
  • If the patients takes tryptophane, thioridazine, pimozide, monoaminooxidase inhibitors;
  • An increased individual sensitivity to paroksetin and other auxiliary components;
  • One has to be cautious in case of symptoms of kidneys or liver diseases.

Patients who take Paxil or its analogues should be cautious when driving the car or during the contact with any mechanisms.

It is not recommended to consume alcohol or products/medications containing ethanol.

Side Effects of Paxil

Like the majority of medications and antidepressants, Paxil may cause side effects. If you experience some negative reaction, please tell your doctor, maybe he or she will decide to change the therapy method.

It is important to know that during the first stage of treatment (or in case of dosage adjustment) many patients feel sick and experience some of these problems: intensification of depression/anxiety/suicidal thoughts, worry, panic attacks, irritability, hostility, impulsivity, or other changes of psychic condition.

In rare cases paroxetine may cause mania or hypomania in patients suffering from unipolar depressive disorder or bipolar affective disorder.

Pregnant women should avoid taking paroxetine (as well as fluoxetine), because it increases risk of disturbance of heart development in the fetus during the first trimester.

Those who have problems with relationships should know that some patients experience Paxil sexual side effects such as absence of sexual desire, frigidity or difficulty having an orgasm.

Below you can see the list of possible side effects.

Possible side effects on the central nervous system:

  • headache, dizziness;
  • disturbance of memory or concentration;
  • disturbance of thinking (rare);
  • depression;
  • nervosity, anxiety;
  • insomnia or sleepiness, nightmares;
  • agitation, stimulation;
  • emotional lability, euphoria, aggression;
  • autism, stupor;
  • tremor;
  • convulsions, orofacial dystonia;
  • epileptic attacks;
  • movement disorders: akinesia, hyperkinesia, ataxia;
  • paranoid reactions;
  • delirium;
  • hallucinations (rare);
  • extrapyramidal disorders (such as akathisia);
  • nystagmus.

Vegetative nervous system side effects:

  • dry mouth;
  • excessive sweating.

Respiratory system side effects:

  • respiratory disorders;
  • sinusitis;
  • rhinitis.

Gastrointestinal tract side effects:

  • nausea;
  • loss of appetite;
  • vomiting;
  • diarrhea or constipation;
  • clinically significant increase in weight;
  • hepatotoxic effect (rare): increase of transaminase level, cholestatic or hepatocellular impairment.

Cardiovascular and lymphatic system side effects:

  • hypertension, orthostatic hypotension;
  • tachycardia, bradycardia;
  • hematomas;
  • hypotonia;
  • anemia;
  • leykopeniye;
  • limfadenopatiya;
  • increased risk of bleedings, especially in case of simultaneous intake of aspirin, nonsteroid anti-inflammatory medicines, varfarin and or anticoagulants.

Sensory side effects:

  • accommodation disturbance;
  • eye pain, conjunctivitis;
  • pupillary dilation;
  • ear noise;
  • decrement in visual acuity (rare);
  • cataract, glaucoma, exophthalmos.

Side effects on reproductive and urinary system:

  • frustration of an urination;
  • sexual frustration (including impaired ejaculation and impotence);
  • lowered libido.

Other possible side effects:

  • allergic reactions;
  • swollen face;
  • fainting;
  • migraines;
  • neck pain;
  • fever;
  • general sickness.

Possible endocrine system side effect is hyperprolactinemia.

Some individuals face decrease in motivation because of Paxil, feel tired and lazy, avoid activity and lose interest in what was important for them. Some even may be unwilling to get out of bed at all.

An increased risk of suicide is typical of paroxetine among patients of different age categories – teenagers, youth and adults.

In rare cases (especially when simultaneously using triptans, lithium, tramadol, tryptophane, irreversible inhibitors monoaminooxidase or other drugs influencing serotonin) there is risk of potentially lethal side effect – serotonin syndrome.

Overdose and Its Therapy

It is important to take antidepressants only in the doses prescribed by the doctor!

The most frequent symptoms of overdose by Paxil tablets include:

  • drowsiness;
  • disturbance of heart rate;
  • nausea;
  • sharp falling or increase in arterial pressure;
  • maniacal state;
  • mydriasis;
  • dizziness;
  • comatose condition;
  • aggression;
  • urination delay;
  • liver failure (clinical symptoms of cirrhosis or hepatitis).

Simultaneous use of a paroxetine toxic dosage or its analogs with alcohol or psychotropic can lead to severe outcome.

In case of overdose symptomatic therapy is appointed, such as stomach pumping, intake of adsorbents (activated coal, etc.), artificially induced vomiting, and so on.

In severe cases treatment in a hospital is necessary, with detoxication therapy. Specific antidote doesn't exist. It is necessary to carry out control of heart rate, breathing (artificial ventilation of lungs) and other vital functions.

Alternatives – Similar Antidepressants

When necessary, Paxil can be replaced by other medications, which are prescribed depending on the medical condition of the patient and his needs. If anxiety is the main problem, tranquilizers (like Grandaxinum) can be used – during exams, public performance or an important event causing worry.

In case of prolonged and strong anxiety disorders sertraline can be prescribed. Sertraline (trade name – Zoloft) is another antidepressant, which has action similar to Paxil, but is not so strong. Both paroxetine and sertraline taken in high dosages are able to inhibit dopamine reuptake. But while sertraline has beneficial effect on the cognitive functions, paroxetine can cause cognitive impairment. Perhaps this is due to its pronounced cholinergic action and weaker influence on the dopamine receptors, compared to sertraline. When deciding on Paxil vs Zoloft the physician takes into account their appropriateness.

When an anxiety component is absent, new generation depressants are preferable that cause less side effects and influence both serotonin and noradrenalin: milnacipran (Ixel), duloxetine (Cymbalta).

There are also Paxil’s analogues with the same active ingredient, but different trade names: Paroxetine hydrochloride hemihydrate, Serestill, Rexetin, Plisil, Adepress.

At the moment here are a lot of medications with similar action. Among them are Prozac, Lexapro, Amitriptyline, and many others.

The patient should not replace the prescribed medication by another at own discretion, it is necessary to consult with the attending psychiatrist. A dilemma ‘Prozac vs Paxil’, ‘Lexapro vs Paxil’, and so on, can be resolved only by a professional doctor.