Paroxetine (Paxil)

Paroxetine belongs to a class of drugs known as selective serotonin reuptake inhibitor (SSRI) antidepressants and is used to treat mental depression, obsessive-compulsive disorder (OCD), panic disorder, generalized anxiety disorder (GAD), social anxiety disorder (also known as social phobia), premenstrual dysphoric disorder (PMDD), and post-traumatic stress disorder (PTSD). SSRI-type drugs, such as it, may work by increasing the activity of the chemical serotonin in the brain. Side effects associated with the use of paroxetine include acid or sour stomach, belching, decreased appetite, decreased sexual desire, gas, heartburn, nervousness, pain or tenderness around the eyes and cheekbones, and sleepiness, among others.

Depression, panic disorders with or without agoraphobia, obsessive-compulsive disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder (PTSD), premenstrual mood disorders.

Attention deficit/hyperactivity disorder (ADHD), alcoholism (cravings and dependence), Alzheimer's disease, chronic fatigue syndrome, diabetic neuropathy, fibromyalgia, menopausal symptoms, nocturnal enuresis, premature ejaculation, pruritus, stuttering, vasovagal syncope.

Avoid combination

• Furazolidone: Increased risk of serotonin syndrome.
• MAOI's (isocarboxazid, phenelzine, tranylcypromine): Increased CNS serotonergic effects have been associated with severe or fatal reactions with this combination.
• Selegiline: Sporadic cases of mania and hypertension.
• Thioridazine: Increased plasma thioridazine concentrations; increased risk of ventricular arrhythmias.

Use only under specific circumstances

• Dexfenfluramine, Fenfluramine: Duplicate effects on inhibition of serotonin reuptake; inhibition of dexfenfluramine metabolism (CYP2D6) exaggerates effect; both mechanisms increase risk of serotonin syndrome.
• Tryptophan: Additive serotonergic effects.

Minimize risk

• Alpha-blockers (metroprolol, propranolol, sotalol): Inhibition of metabolism (CYP2D6) leads to increased plasma concentrations of selective alpha-blockers and potential cardiac toxicity; atenolol may be safer choice.
• Cimetidine: Increased plasma paroxetine concentrations.
• Cyproheptadine: Serotonin antagonist may partially reverse antidepressant and other effects.
• Dextromethorphan: Inhibition of dextromethorphan's metabolism (CYP2D6) by paxil and additive serotonergic effects.
• Diuretics, loop (bumetanide, furosemide, torsemide): Possible additive hyponatremia; two fatal case reports with furosemide and Paxil.
• Haloperidol: Inhibition of haloperidol's metabolism (CYP2D6) may increase risks of extrapyramidal symptoms.
• Lithium: Neurotoxicity (tremor, confusion, ataxia, dizziness, dysarthria, and absence seizures) reported in patients receiving this combination; mechanism unknown.
• Phenobarbital, Phenytoin: Decreased plasma paxil concentrations.
• Sumatriptan (and other "triptans"): Increased incidence of adverse effects, including serotonin syndrome.
• Theophylline: Elevated theophylline levels have been reported.
• Tramadol: Increased risk of serotonin syndrome.
• Tricyclic antidepressants (clomipramine, desipramine, doxepin, imipramine, nortriptyline, trazodone): Marked increases in tricyclic antidepressant levels due to inhibition of metabolism (CYP2D6).
• Warfarin: Increased risk of bleeding.

Alcohol.

Valerian, St. John's wort, SAMe, kava kava.

FDA Pregnancy Risk Category D. Excreted in breast milk. Not recommended during breast-feeding.

There are three patient reports documenting the use of this drug for stuttering. Stuttering symptoms were characterized by repetitions of words/phrases and sounds/syllables in all sentence positions. After a few days of paroxetine treatment, improvement was seen. Some patients completely stopped stuttering after one month. No adverse drug reactions were reported. Paxil may be helpful in patients who stutter and who have depression or other mood disorders.

Paroxetine antidepressant is a prescription drug that comes in 10 mg, 20 mg, 30 mg, 40 mg tablets. It is available on prescription only as tablets for oral use, but the online pharmacy, will sell Paroxetine without prescription. You may be able to order Paxil from them online and save the local pharmacy markup.

This drug inhibits the reuptake of serotonin at the neuron, increasing the levels of serotonin in the body and in the brain.

Brand name
Paxil

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Generic name
Paroxetine

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Chemical class
Phenylpiperidine derivative

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Therapeutic class
Antidepressant (selective serotonin reuptake inhibitor)

Tablets - Oral 10 mg, 20 mg, 30 mg, 40 mg.

ADULT
Depression: PO 20 mg qd in am; after 4 wk if no clinical improvement is noted, dose may be increased by 10 mg/day qwk to desired response, not to exceed 50 mg/day.

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Generalized anxiety disorder: PO 20 mg qd, increase by 10 mg/day q wk prn; usual dose 20-50 mg/day.

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Obsessive-compulsive disorder: PO 20 mg qd, increase in 1 wk increments by 10 mg/day; usual dose requirement 40 mg/day, maximum 60 mg/day.

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Panic disorder: PO 10 mg qd, increase by 10 mg/day qwk prn; max 60 mg/day.

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Posttraumatic stress disorder: PO 20 mg qd, increase by 10 mg/day q wk prn; usual dose 20-50 mg/day.

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Social anxiety disorder: PO 20 mg qd; max 60 mg/day.

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Elderly, severe renal or hepatic impairment: PO 10 mg qd initially, increase by 10 mg/day q wk as indicated; Doses should not exceed 40 mg/day.