Paxil

What is Paxil?

Paxil is a prescription medicine used to treat depression. It is important to talk with your healthcare provider about the risks of treating depression and also the risks of not treating it. You should discuss all treatment choices with your healthcare provider. Paxil is also used to treat:

• Major Depressive Disorder (MDD)
• Obsessive Compulsive Disorder (OCD)
• Panic Disorder
• Social Anxiety Disorder
• Generalized Anxiety Disorder (GAD)
• Posttraumatic Stress Disorder (PTSD)

Talk to your healthcare provider if you do not think that your condition is getting better with treatment using Paxil.

Description

PAXIL CR, contains paroxetine hydrochloride, an SSRI. It is the hydrochloride salt of a phenylpiperidine compound identified chemically as (-)-trans-4R-(4′-fluorophenyl)-3S-[(3′,4′-methylenedioxyphenoxy) methyl] piperidine hydrochloride hemihydrate and has the empirical formula of C19H20FNO3·HCl·1/2H2O. The molecular weight is 374.8 g/mol (329.4 g/mol as free base). The structural formula of paroxetine hydrochloride is:

Paroxetine hydrochloride is an odorless, off‑white powder, having a melting point range of 120° C to 138°C and a solubility of 5.4 mg/mL in water.

PAXIL CR tablets are intended for oral administration. Each extended‑release tablet contains 12.5 mg, 25 mg, or 37.5 mg paroxetine equivalent to 14.25 mg, 28.51 mg, or 42.76 mg of paroxetine hydrochloride, respectively. One layer of the tablet consists of a degradable barrier layer and the other contains the active material in a hydrophilic matrix.

Inactive ingredients consist of glyceryl behenate, hypromellose, lactose monohydrate, magnesium stearate, methacrylic acid copolymer type C, polyethylene glycols, polysorbate 80, polyvinylpyrrolidone, silicon dioxide, sodium lauryl sulfate, talc, titanium dioxide, triethyl citrate and the following colorants: D&C Red No. 30 aluminum lake (25 mg), D&C Yellow No. 10 aluminum lake (12.5 mg), FD&C Blue No. 2 aluminum lake (37.5 mg), FD&C Yellow No. 6 aluminum lake (12.5 mg), red ferric oxide (25 mg) and Yellow ferric oxide (12.5 mg and 37.5 mg).

 Mechanism of Action

The mechanism of action of paroxetine in the treatment of major depressive disorder (MDD), panic disorder (PD), social anxiety disorder (SAD), and premenstrual dysphoric disorder (PMDD) is unknown, but is presumed to be linked to potentiation of serotonergic activity in the central nervous system resulting from inhibition of neuronal reuptake of serotonin (5-HT).

What is the most important information I should know about Paxil?

Paxil and other antidepressant medicines may cause serious side effects, including:

1. Suicidal thoughts or actions:

• Paxil and other antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, or young adults within the first few months of treatment or when the dose is changed.
• Depression or other serious mental illnesses are the most important causes of suicidal thoughts or actions.
• Watch for these changes and call your healthcare provider right away if you notice:
  • New or sudden changes in mood, behavior, actions, thoughts, or feelings, especially if severe.
  • Pay particular attention to such changes when Paxil is started or when the dose is changed.

Keep all follow-up visits with your healthcare provider and call between visits if you are worried about symptoms.

Call your healthcare provider right away if you have any of the following symptoms, or call 911 if an emergency, especially if they are new, worse, or worry you:

• attempts to commit suicide
• acting on dangerous impulses
• acting aggressive or violent
• thoughts about suicide or dying
• new or worse depression
• new or worse anxiety or panic attacks
• feeling agitated, restless, angry, or irritable
• trouble sleeping
• an increase in activity or talking more than what is normal for you
• other unusual changes in behavior or mood

Call your healthcare provider right away if you have any of the following symptoms, or call 911 if an emergency. Paxil may be associated with these serious side effects:

2. Serotonin Syndrome or Neuroleptic Malignant Syndrome-like reactions. This condition can be life-threatening and may include:

• agitation, hallucinations, coma, or other changes in mental status
• coordination problems or muscle twitching (overactive reflexes)
• racing heartbeat, high or low blood pressure
• sweating or fever
• nausea, vomiting, or diarrhea
• muscle rigidity

3. Visual problems

• eye pain
• changes in vision
• swelling or redness in or around the eye

Only some people are at risk for these problems. You may want to undergo an eye examination to see if you are at risk and receive preventative treatment if you are.

4. Severe allergic reactions:

• trouble breathing
• swelling of the face, tongue, eyes, or mouth
• rash, itchy welts (hives), or blisters, alone or with fever or joint pain

5. Abnormal bleeding: Paxil and other antidepressant medicines may increase your risk of bleeding or bruising, especially if you take the blood thinner warfarin (Coumadin, Jantoven), a non-steroidal anti-inflammatory drug (NSAIDs, like ibuprofen or naproxen), or aspirin.

6. Seizures or convulsions

7. Manic episodes:

• greatly increased energy
• severe trouble sleeping
• racing thoughts
• reckless behavior
• unusually grand ideas
• excessive happiness or irritability
• talking more or faster than usual

8. Changes in appetite or weight. Children and adolescents should have height and weight monitored during treatment.

9. Low salt (sodium) levels in the blood. Elderly people may be at greater risk for this. Symptoms may include:

• headache
• weakness or feeling unsteady
• confusion, problems concentrating or thinking, or memory problems

Do not stop Paxil without first talking to your healthcare provider. Stopping Paxil too quickly may cause serious symptoms including:

• anxiety, irritability, high or low mood, feeling restless, or changes in sleep habits
• headache, sweating, nausea, dizziness
• electric shock-like sensations, shaking, confusion

Who should not take Paxil?

Do not take Paxil if you:

• are allergic to paroxetine or any of the ingredients in Paxil. See the end of this Medication Guide for a complete list of ingredients in Paxil.
• take a monoamine oxidase inhibitor (MAOI). Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI, including the antibiotic linezolid.
  • Do not take an MAOI within 2 weeks of stopping Paxil unless directed to do so by your physician.
  • Do not start Paxil if you stopped taking an MAOI in the last 2 weeks unless directed to do so by your physician.
  • People who take Paxil close in time to an MAOI may have serious or even life-threatening side effects. Get medical help right away if you have any of these symptoms:
    • high fever
    • uncontrolled muscle spasms
    • stiff muscles
    • rapid changes in heart rate or blood pressure
    • confusion
    • loss of consciousness (pass out)
• Take Mellaril (thioridazine). Do not take Mellaril together with Paxil because this can cause serious heart rhythm problems or sudden death.
• Take the antipsychotic medicine pimozide (ORAP) because this can cause serious heart problems.

What should I tell my healthcare provider before taking Paxil?

Ask if you are not sure.

Before starting Paxil, tell your healthcare provider if you:

• are pregnant, may be pregnant, or plan to become pregnant. There is a possibility that Paxil may harm your unborn baby, including an increased risk of birth defects, particularly heart defects. Other risks may include a serious condition in which there is not enough oxygen in the baby’s blood. Your baby may also have certain other symptoms shortly after birth. Premature births have also been reported in some women who used Paxil during pregnancy.
• are breastfeeding. Paxil passes into your milk. Talk to your healthcare provider about the best way to feed your baby while taking Paxil.
• are taking certain drugs such as:
  • triptans used to treat migraine headache
  • other antidepressants (SSRIs, SNRIs, tricyclics, or lithium) or antipsychotics
  • drugs that affect serotonin, such as lithium, tramadol, tryptophan, St. John’s wort
  • certain drugs used to treat irregular heart beats
  • certain drugs used to treat schizophrenia
  • certain drugs used to treat HIV infection
  • certain drugs that affect the blood, such as warfarin, aspirin, and ibuprofen
  • certain drugs used to treat epilepsy
  • atomoxetine
  • cimetidine
  • fentanyl
  • metoprolol
  • pimozide
  • procyclidine
  • tamoxifen
• have liver problems
• have kidney problems
• have heart problems
• have or had seizures or convulsions
• have bipolar disorder or mania
• have low sodium levels in your blood
• have a history of a stroke
• have high blood pressure
• have or had bleeding problems
• have glaucoma (high pressure in the eye)

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Paxil and some medicines may interact with each other, may not work as well, or may cause serious side effects.

Your healthcare provider or pharmacist can tell you if it is safe to take Paxil with your other medicines. Do not start or stop any medicine while taking Paxil without talking to your healthcare provider first.

If you take Paxil, you should not take any other medicines that contain paroxetine, including Paxil CR and Pexeva (paroxetine mesylate).

How should I take Paxil?

• Take Paxil exactly as prescribed. Your healthcare provider may need to change the dose of Paxil until it is the right dose for you.
• Paxil may be taken with or without food.
• If you miss a dose of Paxil, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of Paxil at the same time.
• If you take too much Paxil, call your healthcare provider or poison control center right away, or get emergency treatment.
• Do not stop taking Paxil suddenly without talking to your doctor (unless you have symptoms of a severe allergic reaction). If you need to stop taking Paxil, your healthcare provider can tell you how to safely stop taking it.

What should I avoid while taking Paxil?

Paxil can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly. You should not drive, operate heavy machinery, or do other dangerous activities until you know how Paxil affects you. Do not drink alcohol while using Paxil.

What are possible side effects of Paxil?

Paxil may cause serious side effects, including all of those described in the section entitled “What is the most important information I should know about Paxil?”

Common possible side effects in people who take Paxil include:

• nausea
• sleepiness
• weakness
• dizziness
• feeling anxious or trouble sleeping
• sexual problems
• sweating
• shaking
• not feeling hungry
• dry mouth
• constipation
• infection
• yawning

Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of Paxil. For more information, ask your healthcare provider or pharmacist.

Call your doctor for medical advice about side effects. you may report side effects to the FDA at 1-800-FDA-1088 or 1-800-332-1088.

General information about the safe and effective use of Paxil

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Paxil for a condition for which it was not prescribed. Do not give Paxil to other people, even if they have the same condition. It may harm them.

This Medication Guide summarizes the most important information about Paxil. If you would like more information, talk with your healthcare provider. You may ask your healthcare provider or pharmacist for information about Paxil that is written for healthcare professionals.

For more information about Paxil call 1-800-706-5575.

How should I store Paxil?

• Store Paxil tablets at room temperature between 59º and 86ºF (15º and 30ºC).
• Keep Paxil away from light.
• Keep bottle of Paxil closed tightly.

Keep Paxil and all medicines out of the reach of children.

What are the ingredients in Paxil?

Active ingredient: paroxetine hydrochloride

Inactive ingredients: dibasic calcium phosphate dihydrate, hypromellose, magnesium stearate, polyethylene glycols, polysorbate 80, sodium starch glycolate, titanium dioxide, and 1 or more of the following: D&C Red No. 30 aluminum lake, D&C Yellow No. 10 aluminum lake, FD&C Blue No. 2 aluminum lake, FD&C Yellow No. 6 aluminum lake.

Label

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