Paroxetine

Medically Reviewed by Harshi Dhingra, M.D.

Last Reviewed: Jun 20, 2022

Warnings

What are the risks of taking paroxetine (Paxil)?

Paroxetine can cause serious health problems, especially in certain high-risk patients. Some of the risks of paroxetine use include:

Suicide Risk: In a small number of people, especially those under the age of 24, antidepressant medications, including paroxetine, can increase the risk of suicidal thoughts and behaviors. The risk is highest when treatment starts and after changes in your paroxetine dose. Tell your doctor right away if you notice any unusual changes in mood or behaviors. Family members and caregivers should be aware of this risk and the need to observe any person under treatment with paroxetine closely.
Serotonin Syndrome: This is a rare but potentially life-threatening syndrome caused by dangerously high serotonin levels in the brain. The risk of this occurring is greater in people who take other drugs that can increase serotonin levels, such as lithium, triptans (used to treat cluster headaches and migraines), and St John’s Wort. Symptoms of serotonin syndrome include fever, confusion, muscle stiffness or spasms, sweating, and a fast or pounding heartbeat. Please seek immediate medical attention if you experience these symptoms.
Increased Risk of Bleeding: Paroxetine can increase the risk of bleeding and bruising. The risk is higher in people taking medications like blood thinners (warfarin) or NSAIDs (aspirin, ibuprofen, naproxen). Tell your doctor immediately if you notice any unexplained bruises, unusual bleeding, pink or red urine, or dark-colored stools.
Low Sodium Levels: In a very small number of people, paroxetine can cause a drop in blood sodium levels. The risk is higher in older adults, people who are dehydrated, and those who are also taking diuretics (water pills). Call your doctor immediately if you experience headaches, confusion, problems concentrating, memory difficulties, or weakness.
Mania: Depression is often the first symptom of bipolar disorder (a condition in which there are alternating episodes of depression and mania). If an individual with bipolar disorder presents with depression and is treated with an antidepressant such as paroxetine, it can bring on a manic episode. Contact your doctor right away if you notice abnormal excitement, delusions, euphoria, overactivity, or any unusual behaviors or moods.
Withdrawal Symptoms: Suddenly stopping paroxetine can cause withdrawal symptoms such as anxiety, agitation, flu-like symptoms, nausea, dizziness, and sleep problems. These symptoms usually appear within 3 days of stopping the medication. Do not stop taking paroxetine without talking to your doctor. Your doctor can help you safely come off paroxetine by gradually reducing the dose.
Worsening Glaucoma: Antidepressants like paroxetine can cause changes in the eyes. In people with narrow-angle glaucoma, paroxetine can cause worsening of this condition. Tell your eye doctor right away if you notice any vision changes or eye symptoms while taking this medication.
Risk During Pregnancy: Paroxetine can be harmful to an unborn baby. Before starting treatment with this medication, tell your doctor if you are pregnant or plan to become pregnant.
QT Prolongation: People who are taking a medication called thioridazine should not take paroxetine. This combination of medications can lead to a potentially life-threatening condition called prolongation of the QT interval, a heart rhythm abnormality. To avoid dangerous drug interactions, give your doctor a complete list of your medications, including prescription and non-prescription drugs.
Seizures: Rarely, seizures can occur while taking paroxetine. This risk is higher in people with a pre-existing seizure disorder. Let your healthcare provider know if you have ever had seizures before starting this medication.
Osteoporosis: Paroxetine can lead to a thinning of the bones (osteoporosis) and increase your risk of bone fractures. Tell your doctor if you experience any symptoms like bone or joint pain.
Akathisia: This is a condition in which a person has difficulty sitting still. It can develop during paroxetine treatment. Symptoms include fidgeting, restlessness, and anxiety while sitting still.
Reduced Effectiveness of Tamoxifens: Paroxetine can reduce the effectiveness of tamoxifen, which is a drug used in breast cancer patients. Talk to your doctor about other treatment options for depression or anxiety if you are on tamoxifen.
If you are at a high risk of complications from paroxetine use, your doctor or pharmacist can help you find other treatments for your condition.

What should I tell my doctor before starting paroxetine (Paxil)?

Tell your doctor if you have ever had an allergic reaction to paroxetine, any active or inactive ingredients in paroxetine preparations, other SSRIs, or any other medications. Your pharmacy can give you a list of ingredients.

Tell your healthcare provider about all your medical conditions. Paroxetine may not be right for people with certain medical conditions such as low sodium levels, seizures, heart disease, osteoporosis, angle-closure glaucoma, or bleeding problems. Tell your doctor if you or anyone in your family has a history of suicide attempts or bipolar disorder. Also, tell your doctor if you or a family member has ever had a prolonged QT interval (a rare heart condition).

Give your doctor a complete list of all your medications, including prescription drugs, over-the-counter medications, vitamins, dietary supplements, and herbal products, especially St. John’s Wort or tryptophan. This can help avoid serious drug interactions.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding. Paroxetine can cause heart defects if taken during early pregnancy and problems in a newborn baby after delivery if taken during the last few months of the pregnancy.

What precautions should I take while on paroxetine (Paxil)?

Keep all appointments with healthcare professionals while on paroxetine. Your doctor may want to see you often, especially when you begin treatment, to evaluate your response to the medication and adjust the dosage.

Paroxetine is available under different brand names to treat different conditions. Do not take more than one paroxetine-containing product at any given time.

Watch out for any unusual mood or behavioral changes. A small number of people, especially those under the age of 24, can experience unexpected mental health changes and suicidality while on paroxetine. Call your doctor immediately if you notice any unusual behaviors or moods.

Paroxetine can make you drowsy. Do not drive, operate heavy machinery, or do anything that requires focus before knowing how this medicine affects you. Remember that alcohol can make drowsiness worse.

Tell your doctor if you become pregnant while on paroxetine. This medicine can be harmful to the baby.

Paroxetine can cause closed-angle glaucoma (increased eye pressure). Your doctor may order an eye examination before you start taking this medication. Call your doctor immediately if you develop symptoms such as eye pain, vision changes, redness and swelling around the eyes, or nausea.

Tell your healthcare professionals you are taking paroxetine before undergoing surgery, including dental surgery.

What are paroxetine (Paxil) interactions?

Taking paroxetine with some other medications can affect how the medications work. Drug interactions can also increase the risk of serious adverse effects. Your physician may choose a different antidepressant for you, change the dose or frequency of one or both medicines, and/or closely monitor you for side effects if there are known interactions between paroxetine and your other medications.

You should not take paroxetine if you are taking or have taken within the last 14 days any monoamine oxidase (MAO) inhibitors. This family of medications includes linezolid (Zyvox), isocarboxazid (Marplan), methylene blue, selegiline (Eldepryl, Emsam, Zelapar), phenelzine (Nardil), and tranylcypromine (Parnate).

Taking paroxetine with the following medications is not recommended:

Thioridazine
Pimozide (Orap)

There can also be drug interactions between paroxetine and the following medications:

Anticoagulants or blood thinners like warfarin (Coumadin) and antiplatelet drugs like clopidogrel (Plavix) and dipyridamole (Persantine)
Other antidepressants like trazodone (Desyrel), amitriptyline (Elavil), clomipramine (Anafranil), amoxapine (Asendin), desipramine (Norpramin), imipramine (Tofranil), doxepin (Adapin, Sinequan), nortriptyline (Aventyl, Pamelor), trimipramine (Surmontil), and protriptyline (Vivactil)
Other SSRIs such as Celexa, Prozac, Sarafem, Luvox, Zoloft
Antihistamines
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) (Advil, Motrin, Aleve, Naprosyn)
ADHD medications like atomoxetine (Strattera)
Certain HIV medications like atazanavir (Reyataz) and fosamprenavir (Lexiva)
Diuretics (water pills)
Certain medications used to treat high blood pressure like timolol (Blocadren), metoprolol (Lopressor, Toprol XL), propranolol (Inderal)
Painkillers like celecoxib (Celebrex)
Opioid painkillers like fentanyl (Actiq, Duragesic, Fentora), tramadol (Ultram), methadone (Dolophine), meperidine (Demerol)
Benzodiazepines like diazepam (Valium)
Medications used to treat irregular heartbeat (Cordarone, Pacerone, Enkaid, Tambocor, Mexitil, Ethmozine, Rythmol, Quinidex)
Medications used to treat mental illness
Medications used to treat nausea, like ondansetron (Zofran)
Medications for migraine headaches (Axert, Relpax, Frova, Amerge, Maxalt, Imitrex, Zomig)
Medications used to treat tuberculosis (TB) such as isoniazid (INH, Nydrazid) and rifampin (Rifadin, Rimactane)
Medications used to treat seizures (Dilantin)
Chlorpromazine (Thorazine)
Cimetidine (Tagamet)
Codeine (found in many cough and pain medications)
Dextromethorphan (found in many cough medications; in Nuedexta)
Bromocriptine (Parlodel)
Dexamethasone (Decadron)
Digoxin (Lanoxin)
Dicloxacillin (Dynapen)
Lithium (Eskalith, Lithobid)
Haloperidol (Haldol)
Metoclopramide (Reglan)
Propoxyphene (Darvon)
Procyclidine (Kemadrin)
Risperidone (Risperdal)
Sibutramine (Meridia)
Terbinafine (Lamisil)
Tamoxifen (Nolvadex)
Ticlopidine (Ticlid)
Theophylline (Theobid, Theo-Dur)

This list does not describe all possible paroxetine interactions. Give your healthcare professionals a complete list of your medications, including prescription and non-prescription drugs, vitamins and dietary supplements, and herbal products. Also, tell your health care provider if you smoke, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications when used with prescription drugs.

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