Paroxetine (Paxil): Adult Uses, Side Effects and Warnings

What paroxetine is

Paroxetine is an antidepressant in the group called selective serotonin reuptake inhibitors, or SSRIs. Paxil and Paxil CR are brand names, and generic paroxetine is also sold. MedlinePlus says it comes as a tablet, a liquid suspension, an extended-release tablet and a capsule.

This page is general information from FDA labels and MedlinePlus. It does not replace the Medication Guide that comes with a prescription.

What paroxetine is approved for, and off-label uses

The Paxil label lists these approved uses, all in adults:

• Major depressive disorder.
• Obsessive-compulsive disorder (OCD).
• Panic disorder.
• Social anxiety disorder.
• Generalized anxiety disorder.
• Posttraumatic stress disorder (PTSD).

How the products differ, and the evidence for PTSD

Different paroxetine products have different labels. The Paxil CR label lists depression, panic disorder, social anxiety disorder and premenstrual dysphoric disorder in adults, and does not list OCD, generalized anxiety or PTSD. Brisdelle is a lower-dose paroxetine capsule approved only for hot flashes from menopause, and its label says it is not for any psychiatric condition.

For PTSD, the VA's National Center for PTSD says sertraline and paroxetine are the only medicines FDA-approved for it, and that the 2023 VA/DoD guideline recommends both. That describes the evidence and does not settle what suits one person.

MedlinePlus says paroxetine is also sometimes used off-label for chronic headaches, nerve pain or numbness from diabetes, and certain male sexual problems, and alongside other medicines for bipolar disorder. Off-label means a use not on the FDA label. The Paxil label warns that treating a depressive episode in bipolar disorder with an antidepressant may bring on a mixed or manic episode.

How paroxetine is thought to work

The label says the way paroxetine works is unknown, and is presumed to be linked to raising serotonin activity by blocking nerve cells from taking serotonin back up. Serotonin is a natural chemical messenger in the brain. MedlinePlus adds that there is not enough information yet to know how it works for hot flashes.

One more property shapes the warnings below. The label calls paroxetine a strong inhibitor of an enzyme called CYP2D6, which the body uses to process many other medicines. That is the reason behind several of its interaction warnings.

What taking paroxetine can be like

MedlinePlus says it may take several weeks or longer to feel the full benefit, and that people should keep taking it even when they feel well. The label asks for close watching on mood and behavior, especially early on and at dose changes. MedlinePlus also says the tablets should be swallowed whole.

Do not stop paroxetine suddenly. The label says stopping, particularly abruptly, can cause nausea, sweating, low or irritable mood, agitation, dizziness, electric-shock sensations, tremor, anxiety, confusion, headache, tiredness, trouble sleeping, ringing in the ears and seizures. It also describes physical dependence, meaning withdrawal signs after abrupt stopping or a large dose reduction. Talk with your prescriber first.

Side effects and warnings for paroxetine

Boxed warning: antidepressants increased the risk of suicidal thoughts and behaviors in pediatric patients and young adults in short-term studies. Everyone taking paroxetine should be watched closely for worsening or new suicidal thoughts. Paxil is not approved for pediatric patients. If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services. Our crisis resources can also help.

Common side effects on the label include weakness, constipation, decreased appetite, diarrhea, dizziness, dry mouth, trouble sleeping, nausea, nervousness, sleepiness, sweating, tremor, yawning and sexual problems such as lower sex drive and ejaculation problems.

Dangers and combinations named on the label:

• MAOIs: contraindicated with paroxetine, or within 14 days of stopping one, because of serotonin syndrome. This includes linezolid and intravenous methylene blue.
• Medicines that prolong the QTc heart interval and are also processed by CYP2D6: contraindicated. A known allergy to paroxetine or its ingredients is another contraindication.
• Pregnancy: the label warns paroxetine can cause harm to a developing baby, and links first-trimester exposure with heart malformations. If you are pregnant or planning to be, tell your prescriber.
• Tamoxifen: some studies suggest paroxetine may reduce how well tamoxifen works against breast cancer, while others do not. If you take tamoxifen, tell your prescriber.
• Serotonin syndrome, bleeding risk with aspirin, NSAIDs or warfarin, mania, seizures, angle-closure glaucoma, low sodium and a link with bone fractures.

Can paroxetine be managed online in Pennsylvania and New York

The Paxil label says paroxetine is not a controlled substance. A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine, treats anxiety, depression and trauma by secure video for people physically located in Pennsylvania or New York during each visit. See online psychiatry in Pennsylvania or in New York.

Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help, using our contact form. Please ask us about fees, insurance and the ages he sees as well. Our therapists do not prescribe, and they see clients in Pennsylvania, West Virginia, Arizona, Colorado and Florida, not New York. New York readers can get psychiatry here but not therapy here.