Paroxetine - EM Doctors

1. About paroxetine

Paroxetine is a type of antidepressant known as an SSRI (selective serotonin reuptake inhibitor).

It's often used to treat depression and also sometimes for obsessive compulsive disorder (OCD), panic attacks, anxiety or post-traumatic stress disorder (PTSD).

Paroxetine helps many people recover from depression, and it has fewer unwanted effects than older antidepressants.

Paroxetine is available on prescription. It comes as tablets and as a liquid that you swallow.

2. Key facts

It usually takes 4 to 6 weeks for paroxetine to work.
Side effects such as feeling sick or sexual problems are common. They are usually mild and go away after a couple of weeks.
If you and your doctor decide to take you off paroxetine, your doctor will probably recommend reducing your dose gradually to help prevent extra side effects.
Paroxetine is also called by the brand name Seroxat.

3. Who can and can't take paroxetine

Paroxetine can be taken by adults aged 18 and over.

Check with your doctor before starting to take paroxetine if you:

have had an allergic reaction to paroxetine or any other medicines in the past
have a heart problem - as paroxetine can speed up or change your heartbeat
have ever taken any other medicines for depression - some rarely used antidepressants can interact with paroxetine to cause very high blood pressure, even when they have been stopped for a few weeks
are trying to become pregnant, are already pregnant or you are breastfeeding
have an eye condition called glaucoma because paroxetine can increase the pressure in your eye
have epilepsy or are having electroconvulsive treatment - as paroxetine may increase your seizures

If you have diabetes, paroxetine can make it more difficult to keep your blood sugar stable. Monitor your blood sugar more often for the first few weeks of treatment with paroxetine and adjust your diabetes treatment if necessary.

4. How and when to take it

Take paroxetine once a day, in the morning. It's best to take it with food so it doesn't upset your stomach.

Paroxetine tablets come in different strengths ranging from 10mg to 30mg.

How much will I take?

The dose of paroxetine that you're prescribed depends on why you are taking it. Most people will start with 10mg or 20mg. This might be gradually increased until you and your doctor agree that you have found a dose that suits you.

The maximum recommended dose of paroxetine is 50mg or 60mg, depending on why you are taking it. If you are 65 or older the maximum recommended dose is 40mg a day. If you have problems with your liver or kidneys, you may be asked to take a lower dose than usual.

With paroxetine liquid, 10ml is equivalent to a 20mg tablet.

What if I forget to take it?

If you occasionally forget to take a dose of paroxetine, don't worry. If you remember before bed, take your paroxetine straight away. If you remember during the night, or the next day, leave out the dose completely. Never take 2 doses at the same time to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

The amount of paroxetine that can lead to an overdose varies from person to person.

Urgent advice: Call your doctor straight away if:

You've taken too much paroxetine by accident and experience symptoms such as:

being sick (vomiting)
shaking
feeling sleepy
fast heart rate
seizures
fever

If you need to go to a hospital accident and emergency (A&E) department do not drive yourself - get someone else to drive you or call for an ambulance.

Take the paroxetine packet, or the leaflet inside it, plus any remaining medicine with you.

5. Side effects

Like all medicines, paroxetine can cause side effects in some people, but many people have no side effects or only minor ones. Some of the common side effects of paroxetine will gradually improve as your body gets used to it.

Common side effects

Common side effects happen in more than 1 in 100 people. Keep taking the medicine but tell your doctor or pharmacist if these side effects bother you or don't go away:

feeling sick (nausea)
headaches
being unable to sleep
diarrhoea
feeling tired or weak

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

Go to A&E immediately if you get:

chest pain or pressure or shortness of breath
painful erections that last longer than 4 hours - this may happen even when you're not having sex
any bleeding that is very bad or that you can't stop such as cuts or nosebleeds that don't stop within 10 minutes

Tell a doctor straight away if you get:

constant headaches, long lasting confusion or weakness, frequent muscle cramps - these can all be signs of low sodium levels in your blood. In severe cases low sodium levels can lead to seizures.
thoughts about harming yourself or ending your life
vomiting blood or dark vomit, coughing up blood, blood in your pee, black or red poo - these can be signs of bleeding from the gut
bleeding from the gums or bruises that appear without a reason or that get bigger

Book an appointment with your doctor if you experience:

restlessness or can't sit still
blurred vision
weight gain or loss without trying
changes in your periods such as heavy bleeding, spotting or bleeding between periods

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to paroxetine.

Immediate action required: Call 999 or go to A&E if:

you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
you're wheezing
you get tightness in the chest or throat
you have trouble breathing or talking
your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of paroxetine. For a full list see the leaflet inside your medicines packet.

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

feeling sick (nausea) - try taking paroxetine with or after food. It may also help to stick to simple meals and avoid rich or spicy food.
headaches - make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking paroxetine. Talk to your doctor if they last longer than a week or are severe.
being unable to sleep - take paroxetine first thing in the morning
diarrhoea - drink plenty of water or other fluids to avoid dehydration. Signs of dehydration include peeing less than usual or having dark strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
feeling tired or weak - if paroxetine makes you feel tired or weak, stop what you're doing and sit or lie down until you feel better. Do not drive or use tools or machinery if you're feeling tired. Do not drink alcohol as it will make you feel worse. If these symptoms don't go away after a week or two, ask your doctor for advice.

7. Pregnancy and breastfeeding

It's important for you and your baby that you stay well during your pregnancy. If you become pregnant while taking paroxetine speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.

Paroxetine has been linked to a very small increased risk of problems for your unborn baby. However, if your depression is not treated during pregnancy this can also increase the chance of problems.

You may need to take paroxetine during pregnancy if you need it to remain well. Your doctor can explain the risks and the benefits, and will help you decide which treatment is best for you and your baby.

For more information about how paroxetine can affect you and your baby during pregnancy, read the leaflet about the best use of medicines in pregnancy (BUMPS).

Paroxetine and breastfeeding

If your doctor or health visitor says your baby is healthy, paroxetine can be used during breastfeeding. It has been used by many breastfeeding mothers without any problems.

Paroxetine passes into breast milk in very small amounts, and has been linked with side effects in very few breastfed babies.

It is important to continue taking paroxetine to keep you well. Breastfeeding will also benefit both you and your baby.

If you notice that your baby isn't feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your health visitor or doctor as soon as possible.

Non-urgent advice: Tell your doctor if you're:

trying to get pregnant
pregnant
breastfeeding

8. Cautions with other medicines

Some medicines and paroxetine can interfere with each other and increase the chances of you having side effects.

Tell your doctor if you're taking these medicines before you start paroxetine:

any medicines that affect your heartbeat - as paroxetine can speed up or change your heartbeat
any other medicines for depression - some rarely used antidepressants can interact with paroxetine to cause very high blood pressure even when they have been stopped for a few weeks
any medicines for schizophrenia - some rarely used medicines for schizophrenia can interact with paroxetine to cause heart problems

Mixing paroxetine with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you are being treated with paroxetine as this will increase your risk of side effects.

Important

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

9. Common questions

How does paroxetine work?

When will I feel better?

How will it make me feel?

Antidepressants like paroxetine help to jump start your mood so you feel better. You may notice that you sleep better and get on with people more easily because you're less anxious. You will hopefully take little things that used to worry you in your stride.

Paroxetine won't change your personality or make you feel euphorically happy. It will simply help you feel like yourself again.

Don't expect to feel better overnight though. Some people feel worse during the first few weeks of treatment before they begin to feel better.

How long will I take it for?

Once you're feeling better it's likely that you will continue to take paroxetine for several more months to prevent the symptoms returning.

You'll need to discuss with your doctor the pros and cons of carrying on taking paroxetine for longer than a few months. The decision will depend on the type and severity of your symptoms, whether it's a one-off problem or one that keeps coming back, how well paroxetine works for you and whether you've had any bad side effects.

How do I come off paroxetine?

If you've been feeling better for 6 months or more, your doctor may suggest coming off paroxetine.

Your doctor will probably recommend reducing your dose gradually over several weeks - or longer, if you have been taking paroxetine for a long time.

This is to help prevent any extra side effects you might get as a reaction to coming off the medicine. These include:

dizziness
feeling sick
numbness or tingling in the hands or feet
trouble sleeping
feeling agitated or anxious
headaches
shaking

Important

Do not stop taking paroxetine suddenly, or without talking to your doctor first.

Is it safe to take it for a long time?

For most people, paroxetine is safe to take for a long time.

A few people may get sexual side effects, such as problems getting an erection or a lower sex drive. In some cases these can continue even after stopping the medicine. Speak to your doctor if you are worried.

Taking paroxetine for more than a year has also been linked to a small increased risk of getting diabetes. But you will be regularly checked for this.

Otherwise there don’t seem to be any lasting harmful effects from taking paroxetine for many months and years.

Is paroxetine better than other antidepressants?

Paroxetine isn't any better or worse as a treatment than other SSRIs.

Some side effects are more common with paroxetine than other SSRIs, like sweating or feeling sleepy. But overall, paroxetine doesn't seem any better or worse than other SSRIs when it comes to side effects.

Sometimes people respond better to one SSRI than to another. Talk to your doctor if you aren't feeling any better after 6 weeks.

Will it affect my fertility?

There's some evidence that paroxetine can reduce the quality of sperm. This should reverse once you stop taking the medicine.

It isn't known, however, whether this reduces male fertility. Talk to your doctor if you're concerned.

There's no firm evidence to suggest that taking paroxetine will reduce fertility in women. However, speak to a pharmacist or your doctor if you're trying to get pregnant, as they may like to review your treatment.

Will I gain or lose weight?

Can I drive or ride a bike with it?

Will it affect my contraception?

Will it affect my sex life?

The good effects of paroxetine may, after a while, improve your sex life as your mood lifts and you become interested in life and relationships again. Some of the possible negative effects include:

men getting painful erections, problems with getting an erection and problems with ejaculating
women having some vaginal bleeding and might not reach orgasm the same way as before
a lower sex drive

Sexual side effects usually pass after the first couple of weeks. However, very rarely, they can be long lasting and may not get better even after stopping the medicine.

If these happen and are a problem for you, go back to your doctor to see if there's another treatment you can try.

Can I drink alcohol with it?

Is there any food or drink I need to avoid?

Are there other treatments that will help?

Antidepressants, including paroxetine, are just one of several approaches to treating depression or anxiety. Other potential treatments for depression include:

talking therapy (such as cognitive behavioural therapy)
exercise programmes
help to get a good night's rest if sleep is a problem

Other potential treatments for anxiety include:

talking therapy (such as cognitive behavioural therapy)
joining a self-help group
using relaxation techniques

Choosing a treatment that's most suitable for you depends on:

how long you've had depression or anxiety
your symptoms
whether previous treatment has worked
how likely you are to stick with your treatment
the potential side effects and your preferences and priorities. If you're interested in any of these treatments, talk to your doctor.

Will recreational drugs affect it?

Cannabis with paroxetine can give you a fast heartbeat. Cannabis can also make drowsiness worse with paroxetine, especially in people who have just started taking it.

Methadone can increase the risk of side effects in people taking paroxetine. It can be potentially dangerous to take paroxetine with:

stimulants like MDMA (ecstasy) or cocaine
hallucinogens like LSD
novel psychoactive substances (which used to be known as legal highs) like mephedrone

Important

Paroxetine has not been properly tested with recreational drugs. Talk to your doctor if you think you might use any recreational drugs while taking paroxetine.