Paroxetine (Paxil): Dosage, Usage and Side Effects

Depression can be a frightening thing, both for you and for the people who love you most. You may not feel or act like yourself, and simple things such as getting out of bed may start to feel as if they’re almost impossible. At its worst, depression can make life feel hopeless. 

Like many other forms of mental illness, depression is common. In fact, research suggests that around 7.8 percent of American adults experienced a major depressive episode during 2019.

The good news is that almost all cases of depression, including major depressive disorder, can be treated with medication and other approaches. 

Paroxetine, available as a generic medication and as Paxil®, is an antidepressant that’s used to treat depression. It’s one of several medications your healthcare provider may prescribe if you’re affected by a form of depressive illness. 

Like other antidepressants, paroxetine is effective, but it needs to be used safely to provide real benefits.

Below, we’ve explained what Paroxetine is and how it works as a treatment for mental illnesses such as clinical depression. We’ve also discussed the side effects and potential interactions that you should be aware of before using paroxetine.

Finally, we’ve answered several common questions that you may have before using paroxetine to treat depression or other forms of mental illness.

What is Paroxetine?

Paroxetine is an antidepressant. It belongs to a class of medications called selective serotonin reuptake inhibitors, or SSRIs.

As an antidepressant, paroxetine is typically prescribed to treat depressive disorders, such as major depressive disorder. However, it’s also approved by the FDA as a treatment for several other mental illnesses, including:

• Generalized anxiety disorder (GAD)

• Social anxiety disorder (SAD)

• Panic disorder

• Post-traumatic stress disorder (PTSD)

• Obsessive-compulsive disorder (OCD)

• Premenstrual dysphoric disorder (PMDD)

Sometimes, medications are used off-label to treat conditions for which they haven’t received FDA approval. Paroxetine is occasionally prescribed off-label to treat the following conditions:

• Dysthymia

• Separation anxiety

• Body dysmorphic disorder

• Postpartum depression

• Premature ejaculation

Paroxetine may also be used off-label to treat some of the conditions listed above in children and teenagers.

Like other antidepressants, paroxetine comes in several forms. It’s available as short-acting or extended-release tablets, as capsules and as a liquid solution.

You can purchase paroxetine as a generic medication. It’s also available under several different brand names, including Paxil, Paxil® CR, Pexeva® and Brisdelle®. All forms of paroxetine are only available with a valid prescription from a licensed healthcare provider. 

How Does Paroxetine Work?

Paroxetine is one of several depression medications referred to as selective serotonin reuptake inhibitors. It works by increasing levels of serotonin, an important neurotransmitter, in your brain and body.

Serotonin is a naturally-occurring chemical that your body uses for communication between the brain and other parts of your nervous system.

As a neurotransmitter, serotonin is responsible for regulating certain aspects of your moods and feelings. Research has linked serotonin to happiness and anxiety. High levels of serotonin may reduce feelings of arousal, while low levels of serotonin are associated with depression.

Serotonin also affects other aspects of your health, including your sleep-wake cycle, your wound healing abilities and certain parts of your digestive system function.

As an SSRI, paroxetine increases serotonin levels and changes your mental balance. This can help to improve your moods and make many symptoms of depression, anxiety and other mental illnesses less severe.

Other SSRIs work in the same way. These medications include fluoxetine (sold under the brand name Prozac®), fluvoxamine (Luvox®), escitalopram (Lexapro®), citalopram (Celexa®) and sertraline (Zoloft®).

When Should You Consider Paroxetine?

Paroxetine isn’t available over the counter, meaning you’ll need to talk to a healthcare provider before you can purchase and use it. 

It’s best to talk to your healthcare provider about medication like paroxetine if you’ve started to notice the symptoms of depression or anxiety. 

Common symptoms of depression include a persistent sad or empty mood, feelings of guilt or hopelessness, irritability, a reduced level of interest in hobbies and activities, difficulty focusing and remembering things, as well as changes to your sleep, appetite and energy levels.

Symptoms of anxiety include feeling restless or on-edge, being irritable, finding it difficult to fall asleep or relax, as well as physical symptoms such as a rapid heartbeat, shaking, trembling or sweating in certain situations.

Paroxetine (Paxil) Dosages

Because paroxetine is used to treat several mental health disorders, there’s no one-size-fits-all dosage that’s suitable for everyone. Instead, your healthcare provider will prescribe paroxetine at a dosage that’s appropriate for you based on your health, symptoms and personal needs.

For adults, the typical starting and maximum doses of paroxetine are as follows:

• Major depressive disorder. As a treatment for major depressive disorder, paroxetine is prescribed at a typical starting dose of 20mg per day, taken in the morning either with or without food. Over time, this may be adjusted to 10 to 50mg per day.

• Obsessive compulsive disorder. To treat obsessive compulsive disorder, paroxetine is usually prescribed at an initial dose of 20mg per day, which is slowly increased to 40mg per day. The maximum dosage of paroxetine for OCD is 60mg per day.

• Panic disorder. For panic disorder, paroxetine is prescribed at an initial dosage of 10mg per day, which is adjusted to a target dosage of 40mg per day over the course of several weeks. The maximum dosage of paroxetine for panic disorder is 60mg per day.

• Generalized anxiety disorder. To treat generalized anxiety disorder, paroxetine should be prescribed at a dosage of 20mg per day.

• Social anxiety disorder. For social anxiety disorder, paroxetine is usually prescribed at an initial dosage of 20mg per day.

• Posttraumatic stress disorder. For posttraumatic stress disorder, paroxetine should be prescribed at a dosage of 20mg per day.

If you are elderly, have a physical health issue or suffer from renal or hepatic impairment, you’ll likely be prescribed paroxetine at a reduced dosage. 

The typical starting dosage of paroxetine for elderly adults or adults with hepatic or renal health issues is 10mg per day. This may be adjusted over time to a maximum of 40mg per day based on your needs and response to paroxetine. 

Your healthcare provider may increase your dosage of paroxetine if you aren’t experiencing any improvements from the medication at a standard dose, or reduce your dosage if you experience side effects or health issues. 

Paroxetine (Paxil) Side Effects

Paroxetine may cause side effects. While most side effects of paroxetine gradually improve over time, some may be severe or persistent. 

Common side effects of paroxetine include:

• Dizziness

• Headaches

• Weakness

• Nervousness

• Forgetfulness

• Dry mouth

• Sweating

• Yawning

• Nausea and vomiting

• Stomach pain and/or indigestion

• Confusion

• Difficulty concentrating

• Gastrointestinal issues

• Decreased appetite

• Sleepiness and a feeling of being “drugged”

• Weight loss or gain

• Increased sensitivity to light

• Muscle and/or joint pain, swelling or tightness

• Unusual dreams

• Changes in sex drive

• Reduced sexual performance

• Other sexual side effects

• Sore teeth and/or gums

If these adverse effects are persistent, or if they interfere with your quality of life, it’s important to inform your healthcare provider. 

In rare cases, paroxetine can cause more serious adverse reactions. These 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 and swelling of the face and/or tongue

If you experience severe side effects from paroxetine, seek help from your healthcare provider or, in the case of an emergency, call 911. 

While the potential side effects of paroxetine may sound alarming, it’s important to keep in mind that most people successfully use paroxetine without any major issues.

It’s also important to understand that it’s normal to try several antidepressants before finding the medication that works best for you, or to adjust your dosage over time to achieve the best mix of positive effects and tolerable side effects. 

Paroxetine (Paxil) Interactions & Warnings

Paroxetine can interact with other medications. In some cases, these interactions may result in severe reactions that could be harmful to your health. 

Interactions that Increase Serotonin Syndrome Risk

When taken with paroxetine, some medications may cause a dangerous increase in serotonin levels referred to as serotonin syndrome. This can potentially be harmful or life-threatening. 

Without treatment, serotonin syndrome can cause serious complications, like seizures, kidney failure, coma and even death. Using any of the following medications can increase your risk of serotonin syndrome from paroxetine:

• Medications that inhibit serotonin uptake, such as other antidepressants, as well as certain antiemetics, opiates, drugs of abuse, and over-the-counter products such as St. John’s wort and some cold remedies.

• Medications that inhibit serotonin metabolism, such as buspirone, triptans and other medications used to treat depression and anxiety.

• Medications that can increase serotonin synthesis, such as triptans and weight loss medications.

• Medications that increase serotonin release, including many of the above drugs and some medications used to treat Parkinson’s disease.

• Medications that activate serotonin receptors, such as certain anxiety medications, medications used to control migraines, opiate-based painkillers, prokinetic agents and mood stabilizing medications such as lithium.

• Medications that inhibit drug metabolism, such as antidepressants, pain medications, antifungal medications, cough suppressants and others.

Many of these medications may be used to treat other mental health conditions, such as anxiety, depression and bipolar disorder. Others include common medications sold over the counter.

Before you start taking paroxetine, it’s important to fully inform your healthcare provider about all prescription or over-the-counter medications you currently use or have recently used. 

How to Take Paroxetine Safely

Using paroxetine is simple. Make sure to follow your healthcare provider’s instructions and use your medication as prescribed. Most of the time, you’ll be instructed to take paroxetine at about the same time every day.

To use paroxetine safely, make sure to:

• Take paroxetine as prescribed by your healthcare provider. Only ever paroxetine at the prescribed dosage. Paroxtine is typically prescribed for use in the morning, although your healthcare provider may provide specific instructions for you to follow.

• Avoid using other serotonergic medications or supplements. These can potentially interact with paroxetine and cause dangerous effects. Make sure to tell your healthcare provider about all medications and supplements you use or have recently used.

• If you feel nauseous, take paroxetine with food. Paroxetine can be taken on its own or with food. Taking paroxetine with food may help to prevent nausea or other digestive system issues.

• Don’t abruptly stop taking paroxetine. Like other SSRIs, paroxetine can cause drug withdrawal symptoms when treatment is stopped abruptly. These symptoms are often referred to as antidepressant discontinuation syndrome.If you no longer want to use paroxetine, talk to your healthcare provider before making any changes to your medication use. Do not suddenly stop taking paroxetine -- instead, follow your healthcare provider’s instructions to safely lower your dosage over time.

• Store paroxetine properly. Paroxetine should be stored at room temperature inside its original container.  Store paroxetine away from excess heat and moisture (for example, not inside the bathroom). 

If you forget to take paroxetine, take the missed dose as soon as you remember. However, if it’s close to time for your next dose of paroxetine, you should skip the missed dose and follow your normal medication schedule. In no cases should you take a double dose of paroxetine. 

Paroxetine Warnings 

If you have any other medical conditions, make sure to inform your healthcare provider before using paroxetine. Some medical conditions, including bipolar disorder, glaucoma, liver disease, heart disease and kidney disease, may increase your risk of developing side effects.

It’s also important to inform your healthcare provider if you have ever taken illicit drugs, abused prescription medications, have a low blood sodium level or have recently suffered a heart attack or other cardiovascular event. 

Frequently Asked Questions About Paroxetine

How Long Does it Take Paroxetine to Work?

Antidepressants such as paroxetine are effective, but their effects aren’t immediate. It may take several weeks before you start to notice improvements, and you may experience improvements in your sleep, concentration and appetite before your mood starts to change.

Most antidepressants start to produce noticeable effects after two to four weeks. It’s important to continue using paroxetine even if you don’t notice any initial improvements.

How Will You Feel While Taking Paroxetine?

After a few weeks of taking paroxetine, you may notice that many of your depression or anxiety symptoms become less severe. Some symptoms may improve early, while others may begin to improve after using paroxetine for several weeks. 

You may find that your low mood begins to lift or that you have fewer anxious, negative thoughts during the day. However, paroxetine will not give you a “high” or change your personality. 

When Should You Stop Taking Paroxetine?

You should continue using paroxetine even after you notice improvements in your general mood and other symptoms. Stopping treatment with paroxetine too early may lead to a return of your depression or anxiety symptoms. 

When you feel you’ve achieved significant recovery with your mental health disorder and want to stop using paroxetine, you should consult your mental health provider before you make any changes to your use of medication. 

Stopping paroxetine abruptly can cause discontinuation symptoms, as well as a potential return of your depression or anxiety. Your mental health provider will help you to slowly and safely stop using paroxetine by gradually tapering your dosage to avoid withdrawal effects.

Is it Safe to Use Paroxetine for a Long Time?

Many people use antidepressants such as paroxetine for long periods of time without significant side effects or other issues. If you have concerns or are experiencing side effects, it’s important to discuss these with your healthcare provider.

Can I Drink Alcohol With Paroxetine?

Drinking alcohol with paroxetine isn’t recommended. Paroxetine can cause sleepiness or affect your ability to think clearly and make decisions. These effects may become more severe after drinking alcohol. Drinking alcohol may also worsen your depressive symptoms.

If you normally drink alcohol as part of your daily routine, or if you have an alcohol use disorder, make sure to inform your healthcare provider before using paroxetine.

Is Paroxetine The Same Thing as Brisdelle® and Pexeva®?

Paroxetine is the active ingredient in Brisdelle and Pexeva. Brisdelle is a form of 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. However, it’s used to treat the same mental health conditions as Paxil, such as major depressive disorder and generalized anxiety disorder.

Alternatives to Paroxetine (Paxil)

Paxil is an effective antidepressant for most people. However, it’s common and normal to try several antidepressants before finding one that treats your symptoms without significant side effects of other issues. 

SSRIs similar to paroxetine include fluoxetine (Prozac®), citalopram (Celexa®), escitalopram (Lexapro®), sertraline (Zoloft®) and others. Our full list of antidepressants provides additional information about how these medications work to treat depression and anxiety disorders.

Get Help With Your Mental Health

Depression and anxiety disorders are very common, with tens of millions of American adults affected every year. 

We offer paroxetine and other antidepressants online, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate. You can connect with a provider using our online psychiatry services. 

You can also learn more about successfully dealing with depression, anxiety and other mental health problems with our free online mental health resources.