Paxil (Paroxetine Hydrochloride)
Also sold as: Paxil, Pari, Parox, Pexep, Rexapar
Pregnancy
Cat D
Lactation
Caution
Schedule
H
Forms
Tablet 10mg, 20mg, 25mg, 30mg, 40mg +2
Indications
- Major depressive disorder (MDD)
- Panic disorder with or without agoraphobia
- Social anxiety disorder (social phobia) — first-line
- Obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
- Generalised anxiety disorder (GAD)
- Premenstrual dysphoric disorder (PMDD)
Adult Dosing
MDD / GAD
Start 20 mg PO once daily (morning); increase by 10 mg/week to max 50 mg/day
CR: 25 mg OD — better GI tolerability
Panic disorder
Start 10 mg OD; target 40 mg/day (max 60 mg)
OCD
Start 20 mg OD; target 40-60 mg/day (max 60 mg)
Social anxiety
Start 20 mg OD; target 20-50 mg/day
PMDD
12.5-25 mg CR daily or luteal phase only
Pediatric Dosing
Use only under specialist supervision for specific indications (e.g., OCD) when alternatives have failed.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 30 mL/min | No adjustment |
| CrCl < 30 mL/min | Start 10 mg/day; max 40 mg/day |
Hepatic Adjustment
Start 10 mg/day; max 40 mg/day in hepatic impairment
Pregnancy & Lactation
Pregnancy: Category D
AVOID in pregnancy — associated with cardiac malformations (VSD/ASD) with 1st trimester exposure. Neonatal adaptation syndrome, PPHN with late exposure. Avoid if possible; switch to alternative SSRI if antidepressant needed.
Lactation: Caution
Low levels in breast milk — one of the better-studied SSRIs in lactation. Generally acceptable with monitoring.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| MAO inhibitors | CONTRAINDICATED — serotonin syndrome; 14-day washout | Major |
| Thioridazine / Pimozide | CONTRAINDICATED — QT prolongation (CYP2D6 inhibition increases levels) | Major |
| Tamoxifen | Paroxetine is potent CYP2D6 inhibitor — reduces tamoxifen active metabolite (endoxifen); AVOID in breast cancer patients on tamoxifen | Major |
| Warfarin | Increased bleeding risk (pharmacodynamic) | Moderate |
| NSAIDs / Aspirin | Increased GI bleeding risk | Moderate |
| Codeine / Tramadol | CYP2D6 inhibition — reduces analgesic effect of codeine; increases tramadol toxicity | Major |
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Side Effects
Common
- Nausea
- Somnolence
- Sexual dysfunction (most prevalent SSRI for this)
- Dry mouth
- Constipation
- Sweating
- Weight gain (long-term)
Serious / Discontinue If
- Severe discontinuation syndrome (worst among SSRIs — "electric shocks", dizziness, nausea on abrupt stop)
- Serotonin syndrome
- Hyponatraemia (SIADH)
- Suicidal ideation (under 25)
- Angle-closure glaucoma
- Neonatal cardiac defects (1st trimester)
Contraindications
- Concurrent MAO inhibitors
- Concurrent thioridazine or pimozide
- Pregnancy — especially 1st trimester (cardiac defects)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Pexep 20mg | Sun Pharma | 10 tab ₹65 |
| Pari 20mg | Mankind | 10 tab ₹52 |
| Parox 20mg | Lupin | 10 tab ₹58 |
| Paxil 20mg | GSK | 10 tab ₹185 |
Monitoring Required
- Serum sodium (SIADH — especially elderly)
- Suicidality (first 4-8 weeks)
- Sexual function (patient-reported)
- Weight (long-term)
Patient Counseling Points
- Take in the morning with food to reduce nausea
- Sexual side effects are common — discuss with doctor
- NEVER stop suddenly — very distressing discontinuation syndrome (electric shocks, dizziness); taper slowly over weeks
- If on tamoxifen for breast cancer — use a different antidepressant
- Avoid alcohol
- Takes 2-6 weeks for full effect
- Report any skin rash, suicidal thoughts, fever
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Clinically reviewed by: Dr. Ananya Krishnan, MD (Psychiatry), Senior Consultant
Last reviewed: 2026-04-01
References
- BNF — Paroxetine
- NICE Anxiety Guidelines 2011 (updated 2020)
- NICE OCD Guidelines
- CANMAT Depression 2023
- FDA Paroxetine Pregnancy Warning