Paroxetine

For adults being treated for depression, the recommended starting dose is 20 mg taken once daily. This is also the dose that most people find effective. If necessary, your doctor may suggest you increase the dose slowly to a maximum of 50 mg daily.

For people being treated for obsessive-compulsive disorder, the usual starting dose of paroxetine is 20 mg taken once daily. Gradually, your doctor will have you increase the dose to the recommended dose of 40 mg daily. If necessary, the dose may be increased to a maximum of 60 mg daily.

For people being treated for panic disorder, the usual starting dose is 10 mg once daily. It should then be slowly increased to the recommended dose of 40 mg daily. If necessary, the dose may be increased to a maximum of 60 mg daily.

For social phobia (social anxiety disorder), generalized anxiety disorder and post traumatic stress disorder, the starting dose is 20 mg taken once daily. The maximum dose for treating any of these conditions is 50 mg daily.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones given here, do not change the way that you are taking the medication without consulting your doctor.

In all cases, Paroxetine is usually taken first thing in the morning. It may be taken with or without food. Swallow the tablet whole – do not chew or crush it.

It is important to take Paroxetine exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Paroxetine at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause dryness of the mouth; it may cause diarrhea; it may cause dizziness - use caution when getting up from a lying or sitting position and use caution if driving; it may cause either drowsiness or excitability - use caution until you know how you will react; it may cause nausea or, rarely, vomiting. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

10 mg
Each bright yellow, oval, biconvex, film-coated tablet, engraved "APO" on one side and "10" on the other, contains paroxetine HCl equivalent to 10 mg of paroxetine. Nonmedicinal ingredients: anhydrous lactose, hydroxypropyl cellulose, hydroxypropyl methylcellulose, magnesium stearate, polyethylene glycol 8000, sodium starch glycolate, titanium dioxide, D&C Yellow No. 10, and FD&C Yellow No. 6.

20 mg
Each pink, oval, biconvex, scored, film-coated tablet, engraved "APO" on one side and scored and engraved "20" on the other, contains paroxetine HCl equivalent to 20 mg of paroxetine. Nonmedicinal ingredients: anhydrous lactose, hydroxypropyl cellulose, hydroxypropyl methylcellulose, magnesium stearate, polyethylene glycol 8000, sodium starch glycolate, titanium dioxide, and D&C Red No. 30.

30 mg
Each blue, oval, biconvex, film-coated tablet, engraved "APO" on one side and "30" on the other, contains paroxetine HCl equivalent to 30 mg of paroxetine.Nonmedicinal ingredients: anhydrous lactose, hydroxypropyl cellulose, hydroxypropyl methylcellulose, magnesium stearate, polyethylene glycol 8000, sodium starch glycolate, titanium dioxide, and FD&C Blue No. 2.

Do not take paroxetine if you:

• are allergic to paroxetine or any ingredients of the medication
• are taking an MAO inhibitor (e.g., Phenelzine, Tranylcypromine, Moclobemide) or have taken a MAO inhibitor within the past 2 weeks (do not start treatment with an MAO inhibitor until at least 2 weeks after stopping paroxetine treatment)
• take the medication Pimozide
• take the medication thioridazine

There may be an interaction between paroxetine and any of the following:

• Abiraterone
• acetylsalicylic acid (ASA)
• alcohol
• Alfuzosin
• alteplase
• Amiodarone
• amphetamines (e.g., Dextroamphetamine, lisdexamphetamine, methamphetamine)
• antihistamines (e.g., Diphenhydramine, Hydroxyzine)
• antipsychotic medications (e.g., Chlorpromazine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• Apixaban
• Atomoxetine
• barbiturates (e.g., butalbital, pentobarbital, Phenobarbital)
• benzodiazepines (e.g., Alprazolam, Diazepam, Lorazepam)
• beta-blockers (e.g., Carvedilol, Metoprolol, Propranolol)
• Bromocriptine
• Bupropion
• Buspirone
• Cabergoline
• Captopril
• Celecoxib
• certain antiarrhythmic medications (e.g., Disopyramide, Flecainide, Propafenone)
• chloral hydrate
• chloroquine
• Cimetidine
• Cinacalcet
• clopidogrel
• Cobicistat
• Cyclophosphamide
• dabigatran
• Darifenacin
• Dasatinib
• Diabetes medications (e.g., chlorpropamide, glipizide, Glyburide, insulin, Metformin, Nateglinide, Rosiglitazone)
• Desmopressin
• Dextromethorphan
• dipyridamole
• dofetilide
• Domperidone
• Doxorubicin
• Dronedarone
• efavirenz
• ergot alkaloids (e.g., ergotamine, Dihydroergotamine)
• Galantamine
• general anesthetics (medications used to put people to sleep before surgery)
• glucosamine
• Heparin
• herbal products that affect blood clotting (e.g., cat's claw, chamomile, fenugreek, evening primrose, feverfew, garlic, ginger, ginseng, turmeric)
• Ifosfamide
• Irinotecan
• ketoconazole
• Levothyroxine
• Linezolid
• lithium
• Losartan
• low molecular weight heparins (e.g., Dalteparin, Enoxaparin, Tinzaparin)
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• MAO inhibitors (e.g., linezolid, moclobemide, phenelzine, Selegiline, tranylcypromine)
• Methadone
• methylene blue
• Metoclopramide
• metyrosine
• Mexiletine
• mifepristone
• Mirabegron
• Mirtazapine
• multivitamins/minerals
• muscle relaxants (e.g., Baclofen, Cyclobenzaprine, methocarbamol, orphenadrine, Tizanidine)
• narcotic pain relievers (e.g., Codeine, Fentanyl, methadone, Morphine, Oxycodone)
• nefazodone
• Nilotinib
• nonsteroidal anti-inflammatory medications (NSAIDs; Diclofenac, ibuprofen, naproxen)
• omega-3 fatty acids
• Olopatadine
• peginterferon Alfa-2b
• Pentoxifylline
• pimozide
• Pravastatin
• quinidine
• quinine
• quinolone antibiotics (e.g., levofloxacin, moxifloxacin)
• Rasagiline
• ritonavir
• Rivaroxaban
• scopolamine
• seizure medications (e.g., Carbamazepine, Clobazam, felbamate, Levetiracetam, phenobarbital, Phenytoin, primidone, Topiramate, Valproic acid, zonisamide)
• serotonin/norepinephrine reuptake inhibitors (SNRIs e.g., Desvenlafaxine, Duloxetine, Venlafaxine)
• other selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Sertraline)
• 5-HT3 antagonists (e.g., Granisetron, Ondansetron)
• St. John's wort
• Tamoxifen
• Tamsulosin
• Tapentadol
• terbinafine
• Tetrabenazine
• thiazide diuretics (e.g., Hydrochlorothiazide, Indapamide)
• Ticagrelor
• Ticlopidine
• Tolterodine
• Tramadol
• Trazodone
• tricyclic antidepressants (e.g., Nortriptyline, Amitriptyline, Imipramine, Desipramine)
• "triptan" migraine medications (e.g., Sumatriptan, Zolmitriptan, Rizatriptan)
• Tryptophan
• tyrosine kinase inhbitors (e.g., imatinib, Lapatinib, Pazopanib, Sunitinib)
• vitamin E
• warfarin
• Zolpidem
• Zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Paroxetine. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Paroxetine.

Abnormal bleeding: Paroxetine, like other similar medications, may cause abnormal bleeding, including bleeding in the stomach or intestines. People who have or have had a history of bleeding disorders should discuss with their doctor how Paroxetine may affect their medical condition, how their medical condition may affect the dosing and effectiveness of Paroxetine, and whether any special monitoring is needed.

Report any unusual bruising or bleeding to your doctor, especially if you are taking other medications that affect blood clotting. These medications include acetylsalicylic acid (Asa), Clopidogrel, Dipyridamole, nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., Ibuprofen or Naproxen), other anticoagulant medications (e.g., Warfarin), and certain antipsychotic medications.

Bone fracture: Paroxetine may increase the risk of bone fractures (breaks) when taking this medication. If you have Osteoporosis or any other illness that increases your risk for breaking bones, or are at risk for developing osteoporosis, discuss with your doctor how Paroxetine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Paroxetine, and whether any special monitoring is needed.

Drowsiness/reduced alertness: Although paroxetine is not known to cause drowsiness, it is advisable to avoid driving or operating hazardous machinery until you determine how paroxetine affects your ability to do these things safely.

Glaucoma: Paroxetine can cause an increase in the pressure in the eye, making symptoms of glaucoma worse. If you have narrow-angle glaucoma, discuss with your doctor how Paroxetine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Paroxetine, and whether any special monitoring is needed.

Heart disease: If you have heart disease, discuss with your doctor how Paroxetine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Paroxetine, and whether any special monitoring is needed.

Kidney function: People with Kidney Disease may need lower doses of Paroxetine. If you have kidney disease or reduced kidney function, discuss with your doctor how Paroxetine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Paroxetine, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause Paroxetine to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Paroxetine, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking Paroxetine.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Mania: Paroxetine may cause symptoms of mania to worsen or return. If you have a history of mania or bipolar disorder, discuss with your doctor how Paroxetine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Paroxetine, and whether any special monitoring is needed.

Seizures: There have been occasional reports of seizures occurring with paroxetine. If you have a history of seizures discuss with your doctor how Paroxetine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Paroxetine, and whether any special monitoring is needed. Anyone who develops seizures should seek immediate medical attention.

Serotonin syndrome: Severe reactions are possible when paroxetine is combined with other medications that act on serotonin, such as tricyclic antidepressants, "triptan" medications for migraine and some medications to treat nausea due to chemotherapy. These combinations should be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. Coma and death are possible.

If you are taking other medications that affect serotonin, discuss with your doctor how Paroxetine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Paroxetine, and whether any special monitoring is needed.

Stopping the medication: Stopping Paroxetine suddenly may lead to side effects such as dizziness, abnormal dreams, numbness or tingling sensations, agitation, anxiety, nausea, vomiting, sweating, or other symptoms. If you are thinking of stopping the medication, check with your doctor first. Your doctor may want you to decrease the dose of the medication gradually when it is time to stop taking paroxetine.

Suicidal or agitated behaviour: People taking Paroxetine may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These behavioural changes may be more likely to occur in children and adolescents, however they are possible for all age groups that use Paroxetine. These symptoms may occur within several weeks after starting Paroxetine. If you experience these side effects or notice them in a family member who is taking Paroxetine, contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking Paroxetine.

Pregnancy: Paroxetine should not be used during pregnancy unless the benefits outweigh the risks. Paroxetine has been reported to cause an increase in birth defects, primarily of the heart, in babies born to women who have taken it in the first trimester. It has also been reported that babies born to women who took medications of this kind during the last trimester of their pregnancy may experience adverse effects (such as breathing problems, seizures, trouble feeding, vomiting, low blood sugar, shaking, jitteriness, irritability, and constant crying) that result in an increase in the length of hospital stay. If you become pregnant while taking Paroxetine, contact your doctor immediately.

Breast-feeding: Paroxetine passes into breast milk. If you are a breast-feeding mother and are taking paroxetine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children and adolescents: The safety and effectiveness of paroxetine for those less than 18 years of age have not been established. The use of Paroxetine by children and adolescents less than 18 years old may cause behavioural and emotional changes, such as suicidal thoughts and behaviour.

Seniors: Seniors may need lower doses of Paroxetine, and they should be closely monitored by their doctor when taking paroxetine.

This medication is typically used only once a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Take it regularly and continuously to maintain its beneficial effects. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. It is not advisable to stop using this product suddenly, particularly if you have been on it for several weeks. If you are considering stopping the medication, talk to your pharmacist first. If you forget a dose, take it as soon as you remember -- unless it is almost time for your next dose. In that case, skip the missed dose. Do not double the next dose to catch up. This medication may be taken with or without food. Consuming alcohol may intensify the effect of this product. If you choose to drink alcohol, do so in moderation. Talk to your health care professional to find out exactly how much alcohol you can drink.