What Paxil is and what it is used for
- obsessive compulsive disorder (repetitive, obsessive thoughts with uncontrollable behaviour)
- panic disorder (panic attacks, including those caused by agoraphobia, which is a fear of open spaces)
- social anxiety disorder (fear or avoidance of social situations)
- post-traumatic stress disorder (anxiety caused by a traumatic event)
- generalised anxiety disorder (generally feeling very anxious or nervous).
Paxil is one of a group of medicines called SSRIs (selective serotonin re-uptake inhibitors). Everyone has a substance called serotonin in their brain. It is not fully understood how Paxil and other SSRIs work but they may help by increasing the level of serotonin in the brain, Treating depression or anxiety disorders properly is important to help you get better.
Before you take Paxil
Do NOT take Paxil
- If you are taking medicines called monoamine oxidase inhibitors (MAOIs, including moclobemide), or have taken them at any time within the last two weeks. Your doctor will advise you how you should begin taking Paxil once you have stopped taking the MAOI.
- If you are taking an anti-psychotic called thioridazine or an anti-psychotic called pimozide.
- If you are allergic (hypersensitive) to paroxetine or any of the other ingredients of this medicine (listed below).
- If any of these apply to you, tell your doctor without taking Paxil.
Take special care with Paxil
Check with your doctor.
- Are you taking any other medicines (see ‘Taking other medicines’)
- Do you have kidney, liver or heart trouble?
- Do you have epilepsy or have a history of fits or seizures?
- Have you ever had episodes of mania (overactive behaviour or thoughts)?
- Are you having electro-convulsive therapy (ECT)?
- Do you have a history of bleeding disorders, or are you taking other medicines that may increase the risk of bleeding (these include medicines used to thin the blood, such as warfarin, anti-psychotics such as perphenazine or clozapine, tricyclic antidepressants, medicines used for pain and inflammation called non-steroidal anti-inflammatory drugs or NSAIDs, such as acetylsalicylic acid, ibuprofen, celecoxib, etodolac, diclofenac, meloxicam)?
- Do you have diabetes?
- Are you on a low sodium diet?
- Do you have glaucoma (pressure in the eye)?
- Are you pregnant or planning to get pregnant (see ‘Pregnancy and breast-feeding’)?
- Are you under 18 years old (see ‘Use in children and adolescents under 18 years of age’)?
If you answer YES to any of these questions, and you have not already discussed them with your doctor, go back to your doctor and ask what to do about taking Paxil.
Use in children and adolescents under 18 years of age Paxil should normally not be used for children and adolescents under 18 years. Also, you should know that patients under 18 have an increased risk of side effects such as suicide attempt, suicidal thoughts and hostility (predominantly aggression, oppositional behaviour and anger) when they take this class of medicines. Despite this, you r doctor may prescribe Paxil for patients under 18 because he/she decides that this is in their best interests. If your doctor has prescribed Paxil for a patient under 13 and you want to discuss this, please go back to your doctor. You should inform your doctor if any of the symptoms listed above develop or worsen when patients under 18 are taking Paxil. Also, the long-term safety effects concerning growth, maturation and cognitive and behavioural development of Paxil in this age group have not yet been demonstrated.
In studies of paroxetine in under 18s, common side effects that affected less than 1 in 10 children / adolescents were an increase in suicidal thoughts and suicide attempts, deliberately harming themselves, being hostile, aggressive or unfriendly, lack of appetite, shaking, abnormal sweating, hyperactivity (having too much energy), agitation, changing emotions (including crying and changes in mood).These studies also showed that the same symptoms affected children and adolescents taking sugar pills (placebo) instead of paroxetine, although these were seen less often.
Some patients in these studies of under 18s had withdrawal effects when they stopped taking paroxetine, These effects were mostly similar to those seen in adults after stopping paroxetine (see section 3, ‘How to take Paxil’), In addition, patients under 18 also commonly (affecting less than 1 in 10) experienced stomach ache, feeling nervous and changing emotions (including crying, changes in mood, trying to hurt themselves, thoughts of suicide and attempting suicide).
Thoughts of harming yourself and worsening of your condition
People who are depressed and/or suffer from anxiety disorders can sometimes have thoughts of harming or killing themselves. These may be increased when you first start taking antidepressants, since these medicines all take time to work,
Certain groups of patients may be more likely to think like this:
- If you have previously had thoughts about killing or harming yourself.
- If you are a young adult, Information from clinical trials has shown an increased risk of suicidal behaviour in young adults (less than 25 years old) with psychiatric conditions who were treated with an antidepressant.
If you get thoughts of harming or killing yourself at any time, contact your doctor or go to a hospital straight away.
Yon may find it helpful to tell a relative or close friend that you are depressed or suffering from an anxiety disorder, and ask them to read this leaflet. You might ask them to tell you if they think your depression or anxiety is getting worse, or if they are worried about changes in your behaviour.
Important side effects seen with Paxil
Some patients who take Paxil develop something called akathisia, where they feel restless and feel like they can’t sit or stand still. Other patients develop something called serotonin syndrome, where they have some or all of the following symptoms: feeling confused, feeling restless, sweating, shaking, shivering, hallucinations (strange visions or sounds), sudden jerks of the muscles or a fast heartbeat. If you notice any of these symptoms, contact your doctor. For more information on these or other side effects of Paxil, see section 4, ‘Possible side effects’.
Taking other medicines
Some medicines can affect the way that Paxil works, or make it more likely that you’ll have side effects. Paxil can also affect the way some other medicines work. These include:
- Medicines called monoamine oxidase inhibitors (MAOIs, including moclobemide) – see ‘Do NOT take Paxil’
- Thioridazine or pimozide, which are anti-psychotics – see ‘Do NOT take Paxil’
- Acetylsalicylaic acid, ibuprofen or other medicines called NSAIDs (non-steroidal anti-inflammatory drugs) like celecoxib, etodolac, diclofenac and mebxicam that are used for pain and inflammation
- Tramadol, a painkiller
- Medicines called triptans, such as sumatriptan, used to treat migraine
- Other antidepressants including other SSRIs and tricyclic antidepressants like clomipramine, nortriptyline and desipramine
- A dietary supplement called tryptophan
- Medicines such as lithium, risperidone, perphenazine, clozapine (called anti-psychotics) used to treat some psychiatric conditions
- A combination of fosamprenavir and ritonavir, which is used to treat Human Immunodeficiency Virus (HIV) infection
- St John’s Wort, a herbal remedy for depression
- Phenobarbital, phenytoin, sodium valproate or carbamazepine used to treat fits or epilepsy
- Atomoxetine which is used to treat attention deficit hyperactivity disorder (ADHD)
- Procyclidine, used to relieve tremor, especially in Parkinson’s disease
- Warfarin or other medicines (called anticoagulants) used to thin the blood
- Propafenone, flecainide and medicines used to treat an irregular heartbeat
- Metoprolol, a beta-blocker used to treat high blood pressure and heart problems
- Rifampicin, used to treat tuberculosis (TB) and leprosy
- Linezolid, an antibiotic.
If you are taking or have recently taken any of the medicines in this list, and you have not already discussed these with your doctor, go back to your doctor and ask what to do. The dose may need to be changed or you may need to be given another medicine.
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription,
Taking Paxil with food and drink
Do not drink alcohol while you are taking Paxil. Alcohol may make you r symptoms or side effects worse. Taking Paxil in the morning with food will reduce the likelihood of you feeling sick (nausea).
Pregnancy and breast-feeding
If you are already taking Paxil and have just found out that you are pregnant, you should talk to your doctor immediately. Also if you are planning to get pregnant, talk to your doctor. This is because some studies have suggested an increase in the risk of heart defects in babies whose mothers received Paxil in the first few months of pregnancy. These studies found that less than 2 in 100 babies (2%) whose mothers received paroxetine in early pregnancy had a heart defect, compared with the normal rate of 1 in 100 babies (1%) seen in the general population.
When all types of birth defects are taken into account, there is no difference in the number of babies born with birth defects after their mothers took paroxetine while they were pregnant compared Do the overall number of birth defects that occur in the general population. You and your doctor may decide that it is better for you to change to another treatment or to gradually stop taking Paxil while you are pregnant. However, depending on your circumstances, your doctor may suggest that it is better for you to keep taking Paxil,
If you are taking Paxil in the last 3 months of pregnancy, let your midwife know as your baby might have some symptoms when it is born. These symptoms usually begin du ring the first 24 hours after the baby is born. They include not being able to sleep or feed properly, trouble with breathing, a blue-ish skin or being too hot or cold, being sick, crying a lot, stiff or floppy muscles, lethargy, tremors, jitters or fits. If your baby has any of these symptoms when it is born and you are concerned, contact your doctor or midwife who will be able to advise you.
Paxil may get into breast milk in very small amounts. If you are taking Paxil, go back and talk to your doctor before you start breast-fee ding. You and your doctor may decide that you can breast-feed while you’re taking Paxil.
Ask your doctor or pharmacist for advice before taking any medicine,
Driving and using machines
Possible side effects of Paxil include dizziness, confusion, feeling sleepy or blurred vision. If you do get these side effects, do not drive or use machinery.
How to take paroxetine
Always take Paxil exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.
Sometimes you may need to take more than one tablet or half a tablet. This table will show you how many tablets to take.
|Dose||Number of tablets to take|
|10 mg||Half a 20 mg tablet|
|20 mg||One 20 mg tablet|
|30 mg||One 30 mg tablet or one and a half 20 mg tablets|
|40 mg||Two 20 mg tablets|
|50 mg||One 20 mg tablet + one 30 mg tablet or two and a half 20 mg tablets|
|60 mg||Three 20 mg tablets or two 30 mg tablets|
The usual doses for different conditions are set out in the table below:
|Starting dose||Recommended daily dose||Maximum daily dose|
|Depression||20 mg||20 mg||50 mg|
|Obsessive compulsive disorder||20 mg||40 mg||60 mg|
|Panic disorder||10 mg||40 mg||60 mg|
|Social anxiety disorder||20 mg||20 mg||50 mg|
|Post-traumatic stress disorder||20 mg||20 mg||50 mg|
|Generalised anxiety disorder||20 mg||20 mg||50 mg|
Your doctor will advise you what dose to take when you first start taking Paxil. Most people start to feel better after a couple of weeks. If you don’t start to feel better after this time, talk to your doctor, who will advise you. He or she may decide to increase the dose gradually, 10 mg a time. Lip to a maximum daily dose.
Take your tablets in the morning with food.
Swallow them with a drink of water.
Do not chew.
Your doctor will talk to you about how long you will need to keep taking your tablets. This may be for many months or even longer.
The maximum dose for people over 65 is 40 mg per day.
Patients with liver or kidney disease
If you have trouble with your liver or severe kidney disease, your doctor may decide that you should have a lower dose of Paxil than usual.
If you take more Paxil than you should
Never take more tablets than your doctor recommends. If you take too many Paxil tablets (or someone else does), tell your doctor or a hospital straight away. Show them the pack of tablets.
Someone who has taken an overdose of Paxil may have any one of the symptoms listed in section 4 ‘Possible side effects’, or the following symptoms: being sick, fever, headache, uncontrollable tightening of the muscles.
If you forget to take Paxil
Take your medicine at the same time every day. If you do forget a dose, and you remember before you go to bed, take it straight away. Carry on as usual the next day. If you only remember during the night, or the next day, leave out the missed dose. You may possibly get withdrawal effects, but these should go away after you take your next dose at the usual time.
What to do if you’re feeling no better
Paxil will not relieve your symptoms straight away – all antidepressants take time to work. Some people will start to feel better within a couple of weeks, but for others it may take a little longer. Some people taking antidepressants feel worse before feeling better. If you don’t start to feel better after a couple of weeks, go back to your doctor who will advise you. Your doctor should ask to see you again a couple of weeks after you first start treatment. Tell your doctor if you haven’t started to feel better.
If you stop taking Paxil
Do not stop taking Paxil until your doctor tells you to. When stopping Paxil, your doctor will help you to reduce your dose slowly over a number of weeks or months – this should help reduce the chance of withdrawal effects. One way of doing this is to gradually reduce the dose of Paxil you take by 10 mg a week. Most people find that any symptoms on stopping Paxil are mild and go away on their own within two weeks. For some people, these symptoms may be most severe, or go on for longer.
If you get withdrawal effects when you are coming off your tablets your doctor may decide that you should come off them more slowly, If you get severe withdrawal effects when you stop taking Paxil, please see your doctor, He or she may ask you to start taking your tablets again and come off them more slowly. If you do get withdrawal effects, you will still be able to stop Paxil.
Possible withdrawal effects when stopping treatment
Studies show that 3 in 10 patients notice one or more symptoms on stopping paroxetine. Some withdrawal effects on stopping occur more frequently than others.
Common side effects, likely to affect up to 1 in 10 people:
- Feeling dizzy, unsteady or off-balance
- Feelings like pins and needles, burning sensations and (less commonly) electric shock sensations, including in the head, and buzzing, hissing, whistling, ringing or other persistent noise in the ears (tinnitus)
- Sleep disturbances (vivid dreams, nightmares, inability to sleep)
- Feeling anxious
Uncommon side effects, likely to affect up to 1 in every 100 people:
- Feeling sick (nausea)
- Sweating (including night sweats)
- Feeling restless or agitated
- Tremor (shakiness)
- Feeling confused or disorientated
- Diarrhoea (loose stools)
- Feeling emotional or irritable
- Visual disturbances
- Fluttering or pounding heartbeat (palpitations).
Please see your doctor if you are worried about withdrawal effects when stopping Paxil.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
Possible side effects
Like all medicines, Paxil can cause side effects, although not everybody gets them. Side effects are more likely to happen in the first few weeks of taking Paxil.
See the doctor if you get any of the following side effects during treatment.
You may need to contact your doctor or go to a hospital straight away.
Uncommon side effects, likely to affect up to 1 in every 100 people:
- If you have unusual bruising or bleeding, including vomiting blood or passing blood in your stools, contact your doctor or go to a hospital straight away.
- If you find that you are not able to pass water, contact your doctor or go to a hospital straight away.
Rare side effects, likely to affect up to 1 in every 1,000 people:
- If you experience seizures (fits), contact your doctor or go to a hospital straight away.
- If you feel restless and feel like you can’t sit or stand still, you may have something called akathisia. Increasing your dose of Paxil may make these feelings worse. If you feel like this, contact your doctor.
- If you feel tired, weak or confused and have achy, stiff or unco-ordinated muscles, this may be because your blood is low in sodium. If you have these symptoms, contact your doctor.
Very rare side effects, likely to affect up to 1 in every 10,000 people:
- Allergic reactions to paroxetine. If you develop a red and lumpy ski n rash, swelling of the eyelids, face, lips, mouth or tongue, start to itch or have difficulty breathing or swallowing, contact your doctor or go to a hospital straight away.
- If you have some or all of the following symptoms you may have something called serotonin syndrome. The symptoms include feeling confused, feeling restless, sweating, shaking, shivering, hallucinations (strange visions or sounds), sudden Jerks of the muscles or a fast heartbeat. If you feel like this contact your doctor.
- Acute glaucoma. If your eyes become painful and you develop blurred vision, contact your doctor.
Other possible side effects during treatment
Very common side effects,
likely to affect more than 1 in 10 people:
- Feeling sick (nausea).Taking your medicine in the morning with food will reduce the chance of this happening.
- Change in sex drive or sexual function, for example, lack of orgasm and, in men, abnormal erection and ejaculation.
Common side effects,
likely to affect up to 1 in 10 people:
- Increases in the level of cholesterol in the blood
- Lack of appetite
- Not sleeping well (insomnia) or feeling sleepy
- Feeling dizzy or shaky (tremors)
- Feeling agitated
- Feeling unusually weak
- Blurred vision
- Yawning, dry mouth
- Diarrhoea or constipation
- Weight gain
Uncommon side effects,
likely to affect up to 1 in every 100 people:
- A brief increase in blood pressure, or a brief decrease that may make you feel dizzy or faint when you stand up suddenly
- A faster than normal heartbeat
- Lack of movement, stiffness, shaking or abnormal movements in the mouth and tongue
- Dilated pupils
- Skin rash
- Feeling confused
- Having hallucinations (strange visions or sounds’:
- An inability to urinate (urinary retention) or an uncontrollable, involuntary passing of urine (urinary incontinence).
Rare side effects,
likely to affect up to 1 in every 1,000 people:
- Abnormal production of breast milk in men and women
- A slow heartbeat
- Effects on the liver showing up in blood tests of your liver function
- Panic attacks
- Overactive behaviour or thoughts (mania)
- Feeling detached from yourself (depersonalisation)
- Feeling anxious
- Pain in the joints or muscles.
Very rare side effects,
likely to affect up to 1 in every 10,000 people:
- Liver problems that make the skin or whites of the eyes go yellow
- Fluid or water retention which may cause swelling of the arms or legs
- Sensitivity to sunlight
- Painful erection of the penis that won’t go away
- Low blood platelet count.
Some patients may develop buzzing, hissing, whistling, ringing or other persistent noise in the ears (tinnitus) when they take Paxil.
If you have any concerns while you are taking Paxil, talk to your doctor who will be able to advise you. If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.
What Paxil contains
The active substance is paroxetine. Each film-coated tablet contains 20 or 30 mg paroxetine (as hydrochloride hemihydrate).
The other ingredients are calcium phosphate dibasic anhydrous, povidone K30, sodium starch glycolate (type A), magnesium stearate, titanium dioxide (E171), methylcellulose, macrogol 400 and polysorbate 80.
What Paxil looks like and contents of the pack
Paxil 20 mg Film-coated Tablets are white to off-white, round biconvex film-coated tablets, embossed with “20″ and scored on one side and with “PX” on the other side. The tablet can be divided into equal halves.
Paxil 30 mg Film-coated Tablets are white to off-white, round biconvex film-coated tablets, embossed with “30″ and scored on one side and with “PX” on the other side. The score line is only to facilitate breaking for ease of swallowing and not to divide into equal doses,
The 20 mg tablets are available in pack sizes of 14, 20, 23, 30, 50, 56, 60, 34 and 100 tablets.
The 30 mg tablets are available in pack sizes of 28, 30, 50, 56, 60 and 84 tablets.
Not all pack sizes may be marketed.