Paxil - Paroxetine - Medication Profile

Bipolar Medications Library

Paxil, manufactured by SmithKline Beecham, is an antidepressant in the same family as Prozac (fluoxetine), Zoloft (sertraline), Luvox (fluvoxamine) and Celexa (citalopram). All these are selective serotonin reuptake inhibitors (SSRIs); however, Paxil is chemically unrelated to the others and to other types of antidepressants. Paxil comes in tablets and does not have to be taken with food.

Clinical trials of Paxil produced several cautions:

• Elderly patients should take the lowest effective dose.
• Use of Paxil in patients with impaired liver function should be undertaken with extreme caution, since the liver is involved with metabolizing the drug.
• Caution is also indicated for patients with kidney problems.
• A very small percentage of patients given Paxil in trials developed seizures. Treatment should be discontinued if seizures develop, and used very cautiously in patients with a history of seizures.
• Paroxetine should be administered with great caution to patients receiving oral anticoagulants. Preliminary data suggest that an interaction between paroxetine and warfarin (Coumadin) may result in increased bleeding.

Paroxetine should not be combined with with MAO inhibitors (including Nardil, Parnate and others) or within 2 weeks of stopping MAOI treatment. After two weeks have past, start Paxil at a low dosage and increase gradually until an effective level is reached. Similarly, wait two weeks after stopping Paxil before starting to take any MAO inhibitor.

During clinical testing in depressed patients, approximately 1% of patients experienced manic reactions. For bipolar patients, the incidence of mania was just over 2%. As with all antidepressants, paroxetine should be used with caution in patients with a history of mania.

The most common side effects associated with the use of paroxetine are nausea, drowsiness/sleepiness, sweating, tremor, asthenia (weakness or loss of strength), dizziness, dry mouth, insomnia and male sexual dysfunction (primarily ejaculatory delay). About twice as many patients reported back pain on placebo as on Paxil, and half again as many experienced chest pain on placebo. This could be attributed to Paxil's anti-anxiety effects.

To avoid withdrawal syndrome, Paxil should be tapered off rather than sharply discontinued. Avoid alcohol, as Paxil can cause drowsiness. The risk of fatal overdose is very small with Paxil. As with all SSRIs, long-term use can lead to weight gain.

Disclaimer: This profile is not intended to be all-inclusive or to replace information provided by your doctor or with the prescription from the manufacturer.