ParoxetineParoxetine Hydrochloride

About Paroxetine

Paroxetine is presumed to work by blocking the reuptake of serotonin in the brain. Paxil tablets and the generic suspension are labeled for adults with major depressive disorder, OCD, panic disorder, social anxiety disorder, generalized anxiety disorder (GAD) and PTSD, and Paxil CR for major depressive disorder, panic disorder, social anxiety disorder and premenstrual dysphoric disorder (PMDD); neither is approved for children. Paxil is taken once each morning, starting at 20 mg (10 mg for panic disorder and GAD) and rising by 10 mg no more than weekly, up to 50 mg for depression, PTSD and GAD and 60 mg for OCD, panic disorder and social anxiety disorder. Paxil CR starts at 12.5 or 25 mg and rises by 12.5 mg no more than weekly; for PMDD it can be taken daily or only from 14 days before an expected period until it starts. Older adults and people with severe kidney or liver impairment start at 10 mg (12.5 mg of Paxil CR) and have lower maximums.

The boxed warning says antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies, and Brisdelle is not approved for any psychiatric condition or for pediatric and young adult patients. Paroxetine must not be taken with an MAO inhibitor or within 14 days of stopping one, including linezolid or intravenous methylene blue, or with thioridazine, pimozide or other drugs that prolong the QT interval and are broken down by CYP2D6, a liver enzyme it strongly blocks. Other warnings cover serotonin syndrome, harm to the fetus, bleeding, mania, discontinuation symptoms, seizures, angle-closure glaucoma, low sodium, sexual dysfunction, reduced tamoxifen effect and bone fracture. Common side effects include nausea, sleepiness, sweating, weakness, dizziness, insomnia, dry mouth, constipation, tremor and ejaculation problems.

Blocking CYP2D6 can also reduce the effect of tamoxifen, so the label advises considering an antidepressant with little or no CYP2D6 effect. The Paxil and Paxil CR labels revised in September 2026 contraindicate any drug that prolongs the QT interval and is broken down by CYP2D6, where earlier labels named thioridazine and pimozide, and the Paxil label now starts GAD at 10 mg rather than 20 mg. Meta-analyses link first-trimester exposure to a less than twofold increase in heart malformations, so for women planning pregnancy or in the first trimester it is started only after other treatments are considered, and Brisdelle must not be used in pregnancy. Breastfed infants are watched for agitation, irritability, poor feeding and poor weight gain.

Taking Paroxetine

How to take it

Paxil, Paxil CR and their generics once a day in the morning, with or without food; shake the suspension well before each dose. Swallow tablets whole, without chewing or crushing them. The 7.5 mg capsule is taken once a day at bedtime.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in the original, tightly closed container, away from excess heat and moisture (not in a bathroom), and out of reach of children.

Interactions to know about

Not with an MAO inhibitor, including linezolid and methylene blue, or with thioridazine, pimozide or other drugs that prolong the QT interval and are broken down by CYP2D6. It can reduce the effect of tamoxifen and raise levels of metoprolol, flecainide, risperidone, atomoxetine and other drugs broken down by CYP2D6, and fosamprenavir with ritonavir lowers its levels. Triptans, tricyclic antidepressants, fentanyl, tramadol, meperidine, methadone, lithium, buspirone, amphetamines, tryptophan and St. John’s wort raise the risk of serotonin syndrome, and aspirin, NSAIDs, clopidogrel and warfarin add to bleeding risk.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Paroxetine differs from pharmacy to pharmacy

Each pharmacy sets its own cash price for generic paroxetine from what it paid its supplier plus its own dispensing fee and markup, so quotes for the same tablets can differ. A prescription that names Paxil, Paxil CR or Brisdelle and does not allow substitution has to be filled with the brand.

The forms are not interchangeable: Paxil CR cannot be swapped for immediate-release tablets at the counter, and the 7.5 mg capsule and the suspension are separate products, so each quote is for the form written.

Ways to pay less for Paroxetine without insurance

• Ask for generic paroxetine in the form prescribed, and make sure the prescription does not block substitution.
• Ask whether paroxetine tablets are on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If extended-release tablets are prescribed, ask the prescriber whether immediate-release tablets would suit you, and compare quotes for both.
• Once your dose is stable, ask for a ninety-day supply, and do not let it run out, since it is not stopped suddenly.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Paroxetine

1. 1.Is my prescription for immediate-release tablets, extended-release tablets, the liquid or the 7.5 mg capsule?
2. 2.Does it interact with my tamoxifen, metoprolol or other medicines?
3. 3.What should I know if I am planning a pregnancy?
4. 4.How should my dose be lowered if I need to stop?

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