Medications Directory

Approved indications
Paroxetine is FDA‑approved in adults for major depressive disorder, obsessive-compulsive disorder, panic disorder (with or without agoraphobia), social anxiety disorder, generalized anxiety disorder, post‑traumatic stress disorder, and premenstrual dysphoric disorder.

Off‑label uses and evidence
Clinicians may use paroxetine off‑label for conditions such as premature ejaculation and certain other anxiety or mood disorders when alternative SSRIs are not suitable; evidence for these uses ranges from small randomized trials to clinical experience and guideline support, depending on the condition.

Efficacy expectations
Some improvement in sleep, energy, or anxiety may appear within 1–2 weeks, while full mood and anxiety benefits often take 4–6 (and sometimes up to 8–12) weeks at an effective dose. Many patients experience substantial symptom reduction and improved daily functioning, though some may need dose adjustments or a different antidepressant. Compared with other SSRIs, paroxetine has similar overall efficacy but may cause more weight gain, sexual side effects, and discontinuation symptoms, which can affect tolerability and long‑term adherence.

Typical dosing and how to take it
For most adult indications, paroxetine is started at 10–20 mg by mouth once daily (often in the morning) and may be increased gradually, usually to a range of 20–50 mg per day depending on the condition and response; some extended‑release or specialized indications may use slightly different starting and target doses. Tablets should be swallowed whole with water and can be taken with or without food, though taking with food may reduce stomach upset.

Special dosing instructions
Doses are usually adjusted in small steps at intervals of at least 1 week to monitor tolerability and benefit. In older adults, those with liver or kidney problems, or people taking interacting medicines, lower maximum doses may be recommended. Do not crush extended‑release tablets, and do not stop paroxetine suddenly without medical guidance, as this can cause discontinuation symptoms such as dizziness, flu‑like feelings, irritability, or sensory disturbances.

Missed dose guidance
If you miss a dose, take it as soon as you remember the same day; if it is almost time for the next dose, skip the missed dose and resume your regular schedule—do not double up to make up for a missed dose.

Overdose
In case of suspected overdose (for example, taking much more than prescribed or combining with other serotonergic or sedating drugs), seek emergency medical care or contact a poison control center immediately, even if there are no symptoms yet, because overdose can cause serious problems such as severe drowsiness, rapid heart rate, seizures, heart rhythm changes, or serotonin syndrome.

Common side effects
Common effects include nausea, dry mouth, drowsiness or fatigue, trouble sleeping, sweating, sexual dysfunction (low libido, delayed orgasm), headache, and mild weight gain; these often start in the first days to weeks of treatment and may lessen over time, though sexual and weight effects can persist in some people.

Serious or rare adverse effects
Seek urgent medical attention for symptoms of serotonin syndrome (agitation, confusion, fever, rapid heart rate, sweating, muscle stiffness or twitching), severe allergic reaction (rash, swelling of face or throat, trouble breathing), seizures, severe dizziness or fainting, uncontrolled bleeding or easy bruising, manic or unusually energetic behavior, or new or worsening suicidal thoughts or behavior, especially in younger adults early in treatment or after dose changes.

Warnings and precautions
Paroxetine carries a boxed warning for increased risk of suicidal thinking and behavior in children, adolescents, and young adults; it is not approved for pediatric use. Use caution in people with liver or kidney impairment, seizure disorders, bipolar disorder (risk of mania), bleeding risks, or low sodium levels. In pregnancy, paroxetine is generally avoided when possible due to possible risks (including certain birth defects and neonatal adaptation issues), and risks versus benefits must be carefully weighed; it passes into breast milk, so breastfeeding decisions should be individualized. Older adults may be more sensitive to side effects such as low sodium, falls, and drowsiness.

Relative safety compared with other drugs
Like other SSRIs, paroxetine does not cause dependence in the way that benzodiazepines or opioids do, but it has a higher tendency than many SSRIs to cause withdrawal (discontinuation) symptoms if stopped abruptly, as well as more sedation, weight gain, and sexual dysfunction for some patients.

Reporting side effects and safety updates
Patients and caregivers can report suspected side effects to the FDA MedWatch program and should review the current Medication Guide or FDA Drug Safety Communications, or consult their pharmacist or prescriber, for the latest safety information.

Drug and substance interactions
Paroxetine should not be used with or within 14 days of monoamine oxidase inhibitors (MAOIs), and combining it with other drugs that increase serotonin (such as other SSRIs or SNRIs, triptans, tramadol, linezolid, or St. John’s wort) raises the risk of serotonin syndrome. It can interact with blood thinners and antiplatelet agents (such as warfarin, aspirin, or NSAIDs) to increase bleeding risk, and with certain heart rhythm, seizure, or psychiatric medicines via liver enzyme effects. Alcohol can increase drowsiness and impair judgment, so it is generally best to limit or avoid alcohol while taking paroxetine.

Food, supplements, and procedure considerations
No specific foods must be avoided, but heavy alcohol use and unregulated supplements that affect mood or serotonin (such as St. John’s wort, tryptophan, or certain pre‑workout products) should be avoided unless cleared with a clinician. Paroxetine rarely affects imaging or diagnostic procedures directly, but always inform healthcare providers and dentists that you are taking it before surgeries or new prescriptions.

Precautions and when it may be unsafe
Use with caution or avoid in people with recent MAOI use, unstable epilepsy, a history of serotonin syndrome, uncontrolled bipolar disorder, significant liver or kidney disease, bleeding disorders, or those taking multiple serotonergic or QT‑prolonging medications. Dose adjustments or alternative treatments may be needed in these situations.

Monitoring needs
Clinicians often monitor mood, anxiety, and suicidal thoughts, especially in the first few months and after dose changes. Periodic checks of weight, blood pressure, and, in higher‑risk patients, blood sodium and other labs may be recommended. An ECG may be considered in people with significant heart disease or on other medicines that affect heart rhythm, based on clinical judgment.

Q: How long does it take for paroxetine to start working?
A: Some people notice better sleep or less anxiety within 1–2 weeks, but full improvement in mood and anxiety often takes 4–6 weeks or longer at a stable dose.

Q: Is paroxetine addictive or habit‑forming?
A: Paroxetine does not cause addiction in the way drugs like opioids or benzodiazepines do, but stopping it suddenly can cause withdrawal‑type (discontinuation) symptoms, so it should be tapered slowly under medical supervision.

Q: Can I drink alcohol while taking paroxetine?
A: Occasional small amounts may be tolerated for some people, but alcohol can increase drowsiness, impair judgment, and worsen mood, so many clinicians advise limiting or avoiding alcohol.

Q: What happens if I stop taking paroxetine too quickly?
A: Stopping abruptly may lead to dizziness, irritability, nausea, headache, "electric shock" sensations, or return of anxiety or depression symptoms; your dose should usually be reduced gradually over weeks or longer.

Q: Can I take paroxetine during pregnancy or while breastfeeding?
A: Paroxetine is generally avoided in pregnancy unless the benefits clearly outweigh the risks, and breastfeeding decisions are individualized; these choices should always be discussed in detail with your obstetric and mental health providers.