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Paroxetine (Paxil): Dosage, Usage and Side Effects

Depression can be a frightening thing — both to you and the people who love you the most. You don’t feel like yourself and you don’t act like yourself, and sometimes it can be difficult to even get yourself out of bed. 

At its worst, depression can make life feel hopeless. 

Despite how it makes you feel, depression may be more common than you think. As much as 6.7 percent of the U.S. population has major depressive disorder — just one type of depression — according to the Anxiety and Depression Association of America

Many of them, no doubt, are receiving help for their affliction. And so can you.

Paroxetine is just one solution available to people diagnosed with depression, anxiety, and a number of other mental health conditions. 

Read on to learn what you should know before talking with your healthcare provider about this medical option.

What Is Paroxetine (Paxil)? 

Paroxetine — also known under the brand name Paxil — is an antidepressant drug in the selective serotonin reuptake inhibitor (SSRI) class of medications. 

Paroxetine (generic Paxil) is approved by the Food and Drug Administration (FDA) to treat several mental health conditions in men, including: major depressive disorder, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder and panic disorder.

Paroxetine is not FDA approved in children under the age of 18 although sometimes prescribed off-label to treat obsessive-compulsive disorder and social anxiety disorder in children and adolescents, dysthymia, separation anxiety, body dysmorphic disorder, malignancy-related pruritus, and premature ejaculation.

The United States Library of Medicine states that paroxetine comes in tablets, liquids, long-acting tablets and capsules, and is obtained with a prescription.

What are Selective Serotonin Reuptake Inhibitors? 

According to the National Institute of Health, SSRIs work by influencing how much of the neurotransmitter serotonin is available in your brain. 

By blocking the reabsorption (or reuptake) of serotonin, there is more of it available. 

This is good for people with mental health afflictions such as depression and anxiety, as serotonin plays an important role in mood regulation. 

It’s believed serotonin imbalances or deficiencies can cause mood problems, so SSRIs target this chemical to combat them. 

In addition to paroxetine (Paxil®), other SSRIs approved by the FDA include: sertraline (Zoloft®), fluoxetine (Prozac®), escitalopram (Lexapro®) and citalopram (Celexa®).

What is Paroxetine (Paxil) Used For​​​? 

Paroxetine has been approved by the FDA for the treatment of many mental health conditions. 

The FDA says that paroxetine may be right for you if you’ve been diagnosed with one of the following conditions: 

  • Generalized anxiety disorder 
  • Major depressive disorder 
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder 
  • Social anxiety disorder
  • Premenstrual dysphoric disorder (PMDD)
  • Premature ejaculation

However, if you have not yet received a diagnosis, that doesn’t necessarily mean you don’t have a mental health condition that could be helped by paroxetine. 

The first step in knowing whether any prescription drug is right for you is talking with a healthcare professional and getting sound medical advice. 

Because this medication is approved for the treatment of multiple mental health disorders, the many potential symptoms are too many to list. 

That said, here are some of the symptoms of the above-listed diagnoses that could be aided by paroxetine: 

  • Severe depression and feelings of hopelessness 
  • Sudden attacks of extreme fear and worry, also known as panic attacks
  • Fear of interacting with others 
  • Obsessive thoughts and behaviors that won’t go away
  • Anxiety or excessive worry that doesn’t go away 
  • Disturbing psychological experiences related to a traumatic experience

Paroxetine (Paxil) Dosage 

According to the FDA, Paroxetine capsules and oral suspension (liquid) are prescribed in several different doses. 

Depending on your symptoms and diagnosis, you can expect a paroxetine dosage to range from 10MG to 60 MG per day.

Adult Paroxetine Dosage

The typical starting and maximum doses of paroxetine for the following mental health disorders are:

  • Major Depressive Disorder (MDD): Starting Dose is 20mg, Maximum Dose is 50mg
  • Obsessive-Compulsive Disorder (OCD): Starting Dose is 20mg, Maximum Dose is 60mg
  • Panic Disorder (PD): Starting Dose is 10mg, Maximum Dose is 60mg
  • Post Traumatic Stress Disorder (PTSD): Starting Dose is 20mg, Maximum Dose is 60mg
  • Generalized Anxiety Disorder (GAD): Starting Dose is 20mg

Senior Paroxetine Dosage

Compared to young adults, older adults or adults with renal or hepatic impairment may be prescribed a lower dose. 

The starting dose for all disorders is 10mg with a maximum of 40 mg daily.

After taking the recommended starting dose, your healthcare provider will work with you to determine if you are experiencing positive effects. 

Your daily dose of paroxetine may need to be increased if you are not experiencing improvement, or you may need to try another mental health medication. 

If you are experiencing bothersome side effects, your healthcare provider may lower your dosing. 

To discontinue paroxetine, the daily dose should be gradually reduced under the direction of your healthcare provider. 

Children should only be prescribed paroxetine under close supervision and at a dose determined by the child's healthcare provider due to an increased risk of suicidal thoughts in pediatric and adolescent patients.

How to Take Paroxetine

You should take paroxetine exactly as prescribed by your healthcare provider. Typically, you should take paroxetine once a day, at the same time of day (usually in the morning). 

You can take paroxetine with or without food, however, taking paroxetine with food may help minimize any nausea. Follow any other prescribing information that comes with your paroxetine medication.

Paroxetine (Paxil) Side Effects

As with any medication, side effects are possible with paroxetine. Most common side effects of paroxetine decrease as your body becomes accustomed to the medication. They may include

  • Infection
  • Nausea
  • Drowsiness and yawning
  • Weakness
  • Anxiety or insomnia (trouble sleeping)
  • Sexual dysfunction
  • Shaking and sweating
  • Dizziness
  • Loss of appetite
  • Constipation
  • Dry mouth

Serious, but rare adverse effects of paroxetine warrant a conversation with your healthcare provider or a call to 911 if they represent an emergency, as they could signal a very serious complication. These serious side effects may include

  • Increased suicidal thoughts or behaviors
  • Aggressive or violent behavior
  • New or worsening depression or anxiety symptoms 
  • Manic behavior 
  • Dangerous risk-taking
  • Hallucinations
  • Racing heart rate or high blood pressure 
  • Sweating or fever 
  • Eye pain or changes in vision
  • Trouble breathing 
  • Seizures
  • Severe allergic reaction including rash, swelling of face or tongue

It’s important to note, paroxetine is considered safe for most people, and many people obtain positive results when using the drug as prescribed. 

As with all drugs, though, understanding paroxetine side effects is important. 

One final warning: Do not stop taking paroxetine without first informing your healthcare provider. 

Short-term use of paroxetine, or abruptly stopping paroxetine, can cause withdrawal symptoms such as nausea, dizziness, nightmares, vomiting, headaches, prickling or tingling of skin, and irritability.

Paroxetine (Paxil) Interactions & Warnings

Before starting paroxetine, you should share any prescription or over-the-counter medications you take with your healthcare provider. 

There are a number of prescription drugs and supplements that can interact negatively with paroxetine.

Interactions that Increase Serotonin Syndrome Risk

The following medications may increase your risk of serotonin syndrome, which is when your body produces too much serotonin. 

This can cause serious complications, like seizures, kidney failure, coma or even death without treatment. Taking any of the following medications can increase your risk of serotonin syndrome:

  • Monoamine oxidase inhibitors (MAOIs)
  • Selegiline
  • Tranylcypromine
  • Isocarboxazid
  • Phenelzine
  • Linezolid
  • Methylene blue 
  • Other SSRIs or SNRIs
  • Triptans
  • Tricyclic antidepressants
  • Fentanyl
  • Lithium
  • Tramadol
  • Tryptophan
  • Buspirone
  • St. John’s Wort

If you take any of these medications, work with your healthcare provider to find another medication option.

Other Drug Interactions

These medications may cause life-threatening adverse effects, increase your risk of side effects from paroxetine or make paroxetine less effective

If you take any of the following medications, either prescription or over-the-counter, talk to your healthcare provider.

  • Thioridazine and Pimozide: Taking these medications with paroxetine can cause serious heart problems
  • NSAIDs, such as ibuprofen
  • Aspirin
  • Clopidogrel
  • Heparin
  • Warfarin
  • Propafenone
  • Flecainide
  • Atomoxetine
  • Desipramine
  • Dextromethorphan
  • Metoprolol
  • Tolterodine
  • Venlafaxine
  • Risperidone
  • Tamoxifen
  • Fosamprenavir
  • Ritonavir

Paroxetine Warnings

If you have any other medical conditions, talk to your healthcare provider before starting paroxetine. 

Certain medical conditions might increase your risk of adverse effects. The following medical conditions have known warnings for paroxetine:

  • Glaucoma
  • Bipolar disorder
  • Kidney or liver disease
  • Pregnancy or breastfeeding

If you have one of these medical conditions, talk to your healthcare provider about an alternative way to help your mental health.

FAQs About Paroxetine

How Long Does it Take Paroxetine to Work?

You may start to feel better after one to two weeks of taking paroxetine, but it takes paroxetine one to two months (4-6 weeks) to take full effect. 

For this reason, keep taking the medication even if you do not immediately feel the positive effects of the medication. 

If you do not feel better after 6 weeks, talk to your healthcare provider to discuss a medication or dosage change.

How Will I Feel While Taking Paroxetine?

After a few weeks of taking paroxetine, you may start to feel more like yourself, with fewer anxiety and depression symptoms. 

You may find that your low mood lifts or that you have fewer anxious thoughts. However, paroxetine will not give you a “high” or change your personality.

When Should I Stop Taking Paroxetine?

If you have achieved significant recovery with your mental health disorder and want to discontinue your paroxetine medication, talk to your healthcare provider about stopping paroxetine. 

Your healthcare provider will likely want you to take the medication for a few months after you feel better to ensure that you do not experience a recurrence of symptoms. 

When you stop taking paroxetine, your healthcare provider will guide you through the steps of gradually decreasing your dosage to minimize any withdrawal effects. 

Is it Safe to Take Paroxetine For a Long Time?

For most people, paroxetine is safe to take for a long time. If you have concerns or are experiencing side effects, discuss these with your healthcare provider. 

Can I Drink Alcohol With Paroxetine?

You can drink alcohol, in moderation, while taking paroxetine. Drinking alcohol while taking paroxetine may make you drowsy. 

It’s best to discuss your alcohol use with your healthcare provider before taking paroxetine. 

Is Paroxetine The Same Thing as Brisdelle and Pexeva?

Paroxetine is the active ingredient in Brisdelle and Pexeva. Brisdelle is paroxetine in a 7.5mg dose that is used to treat symptoms of menopause, such as hot flashes. 

Pexeva is a slightly different form of the paroxetine medication, paroxetine mesylate, but is used to treat many of the same mental health conditions as Paxil, such as major depressive disorder and generalized anxiety disorder.

Alternatives to Paroxetine (Paxil)

If paroxetine isn’t right for you, talk to your healthcare provider. There are a number of mental health medications available and you can work with your healthcare provider to find the right one for you.

You can also talk to your healthcare provider about trying therapy, if paroxetine alone does not provide the relief you need. 

You can see an online psychiatrist or online counselor today through our platform.

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This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.