Paroxetine: Uses, Side Effects, Dosages, and More

Nearly 60 millions adults in the United States live with some form of depression or anxiety disorder.

For these individuals, lifestyle changes like getting more exercise or reducing stress may help to improve their symptoms, but some people also benefit from treatment with a prescription medication. 

Paroxetine is an antidepressant drug that is commonly used for the treatment of many different mental health disorders.

Also sold under the brand name Paxil, the medication is only used for treatment in adults but has a wide variety of applications. 

What is paroxetine?

Paroxetine is a generic prescription medication that belongs to a newer class of antidepressants called selective serotonin reuptake inhibitors (SSRIs).

The first SSRI, Prozac, was approved by the U.S. Food and Drug Administration (FDA) in 1986, and since that time, a number of new drugs, including paroxetine, have been introduced. 

SSRIs have largely replaced older antidepressant medications, including tricyclic antidepressants and MAOIs, due to their lower incidence of severe side effects.

Other examples of SSRIs include fluoxetine (Prozac) and sertraline (Zoloft). 

Paroxetine is also sold under the brand name Paxil. Paroxetine is approved by the FDA for the treatment of many different common mental health conditions.

What conditions are treated with paroxetine?

Paroxetine is widely used to treat some of the most common mental health conditions, including major depressive disorder (also known as clinical depression) and several different types of anxiety.

Other conditions treated with paroxetine include obsessive-compulsive disorder (OCD), social anxiety disorder, post-traumatic stress disorder (PTSD), panic disorder, generalized anxiety disorder, bipolar disorder, and premenstrual dysphoric disorder (PTSD). 

Paroxetine can also be used in combination with other medications for the treatment of other mental health disorders that are not specified above.

Due to the wide range of applications for paroxetine, patients with multiple mental health issues may be able to find relief from just one prescription drug.

How much does paroxetine cost?

Paroxetine is a generic medication that is typically less expensive than its brand name version, Paxil. The following table compares the costs of a 30-day supply of paroxetine and Paxil.

Costs of a 30-Day Supply of Paxil and Paroxetine HCL


10 mg oral tablets

20 mg oral tablets




Paroxetine HCL



As a generic drug, paroxetine can be produced by a wide range of manufacturers.

The increased competition, as well as the lack of marketing and research and development costs, help lower the price of generic drugs like paroxetine. 

Generic medications contain the same active ingredients as their brand-name counterparts and are subject to the same rigorous standards and testing. 

Paroxetine is covered by most forms of commercial insurance, Medicare, and Medicaid, while brand name Paxil may not be covered unless it is medically necessary.

However, patients can save on the cost of paroxetine or Paxil regardless of their insured status with a free pharmacy discount card from 

How do I know which dose of paroxetine to take?

Your doctor will choose the best dose of paroxetine based on a variety of factors, including your age, which mental health condition the drug is being used to treat, the severity of your condition, your initial reaction to the medication, and other medical conditions that could affect how the drug is absorbed. 

Antidepressant medications like paroxetine affect each person slightly differently, so your dose may not be the same as the dose your friend takes.

It is common for patients to have their dose changed several times before finding the dose that helps them to feel their best while also minimizing side effects.

Adults under the age of 65 who take paroxetine for major depressive disorder will typically start at a dose of 20 mg per day of the immediate release version of the medication or 25 mg per day for the extended release dose.

Your doctor may incrementally increase your dose by 10 mg to a maximum of 50 mg per day for the immediate release version of the drug and by 12.5 mg per day to a maximum dose of 62.5 mg per day for the extended release version of the medication.

Adults ages 65 and older typically start at a lower starting dose of the medication that is about half of the dose for adults under age 65.

Adults using paroxetine for panic disorder typically start at a 10 mg dose of the immediate release tablet with a target dose of 40 mg per day and a maximum dose of 60 mg per day.

When using the extended-release tablet, the typically starting dose is 12.5 mg per day with a maximum dose of 75 mg per day. Seniors start at the same doses of the drug but have a maximum dose of 40 mg and 50 mg for the immediate release and extended release versions of the drug, respectively.

When taken for social anxiety disorder, adults take paroxetine at a typical starting dose of 20 mg per day with a maximum dose of 60 mg per day for the immediate release form of the drug.

The starting dose for the extended release form of the medication is 12.5 mg per day with a maximum dose of 37.5 mg per day.

Only the immediate release version of paroxetine is used to treat generalized anxiety disorder. The starting dose is 20 mg per day with a maximum dose of 50 mg per day.

When taken for post-traumatic stress disorder, only the immediate-release version of the drug is used. The starting dose of the medication is 20 mg per day with a maximum dose of 50 mg per day.

Paroxetine can also be used to treat premenstrual dysphoric disorder when taken in the extended-release form. The typical starting dose is 12.5 mg per day, typically taken in the morning. The maximum dose for the treatment of premenstrual dysphoric disorder is 25 mg per day.

What are the side effects associated with paroxetine?

SSRIs like paroxetine are known to cause a long list of side effects due to the way that they interact with the chemistry of the brain. The side effects associated with paroxetine are typically classified as either common and serious.

The more common side effects of paroxetine oral tablet that usually do not require medical attention include:

  • Weakness
  • Dizziness
  • Nausea
  • Sleepiness
  • Impotence
  • Sweating
  • Shaking
  • Anxiousness or sleeplessness
  • Delayed ejaculation or sexual dysfunction
  • Decreased sexual desire
  • Constipation
  • Infection
  • Loss of appetite
  • Dry mouth
  • Yawning

Mild iterations of the above common side effects of paroxetine typically disappear within a few days or weeks as your body adjusts to the medication. If your adverse effects continue for an extended period of time or become severe, talk to your doctor, a healthcare professional, or your pharmacist.

Some side effects associated with paroxetine are serious and can be potentially life-threatening. Make sure to call your doctor or 911 or seek medical attention right away if you think you may be experiencing a medical emergency. 

Serious side effects of paroxetine include: 

  • Changes in mood, anxiety or behavior, as evidenced by:
    • Thoughts of suicide or dying, especially in young adults
    • Attempts to commit suicide
    • New or worsened depression
    • New or worsened anxiety or panic attacks
    • Agitation, restlessness, anger, or irritability
    • Sleeplessness
    • Acting on dangerous impulses
    • Acting aggressive or violent
    • Increase in activity or talking more than what is normal for you
  • Serotonin syndrome, which most commonly occurs when the medication is taken with other drugs that influence the amount of serotonin in the brain. Symptoms of serotonin syndrome include:
    • Agitation, confusion, hallucinations, coma, and trouble thinking
    • Coordination problems or muscle twitching (overactive reflexes)
    • Racing heartbeat or increased heart rate
    • High or low blood pressure
    • Muscle rigidity
    • Fever
    • Sweating
    • Nausea, vomiting, or diarrhea
  • Eye problems, such as:
    • Eye pain
    • Swelling or redness in or around your eyes
    • Glaucoma
    • Changes in vision
  • Severe allergic reactions. Symptoms can include:
    • Trouble breathing
    • Joint pain
    • Rash
    • Hives (itchy welts)
    • Blisters
    • Swelling of your face, tongue, eyes, or mouth
    • Fever
  • Abnormal bleeding
  • Seizures or convulsions
  • Manic episodes. Symptoms can include:
    • Reckless behavior
    • Unusually grand ideas
    • Racing thoughts
    • Excessive happiness or irritability
    • Greatly increased energy
    • Severe trouble sleeping
    • Talking more or faster than usual
  • Changes in appetite or weight (either weight loss or weight gain)
  • Low sodium levels, as evidenced by:
    • Headache
    • Memory problems
    • problems concentrating or thinking
    • weakness or feeling unsteady
    • Confusion 
  • Increased risk of bone fracture, as indicated by:
    • Swelling
    • Bruising
    • Unexplained bone pain
    • Tenderness

Are there any risks associated with paroxetine?

Paroxetine is associated with several serious warnings and has a black box warning from the FDA; a black box warning is the highest level of warning from the FDA and alerts patients and doctors to certain dangerous effects of the drug.

Paroxetine, like other antidepressant medications, is known to cause an increased risk of suicidal thoughts or behaviors, particularly in the early months of treatment or when your dose changes.

Adults ages 24 and younger, as well as teenagers and children, are considered to be at the greatest risk of experiencing suicidal thoughts and behaviors.

Paroxetine can cause a life-threatening condition called serotonin syndrome when combined with other medications that alter the levels of serotonin in the brain or when taken on its own.

People experiencing serotonin syndrome may experience symptoms like agitation, confusion, coma, muscle twitching, hallucinations, trouble thinking, and coordination problems.

Paroxetine is thought to be safe in breastfeeding women, despite its secretion into breast milk. 

People who are taking paroxetine for depression may find that their symptoms get worse while using the drug.

If you notice symptoms like anxiety, panic attacks, irritability, acting on dangerous impulses, extreme mood swings, restlessness, sleeplessness, aggressiveness, or suicidal thoughts or behaviors, call your doctor.

Paroxetine can also cause withdrawal symptoms when used regularly for a period of four weeks or more. Use of paroxetine should not be stopped abruptly, and patients should not decrease their dose without speaking to their doctor first. 

Withdrawal symptoms of paroxetine include:

  • Anxiety
  • Restlessness
  • Headache
  • Nausea
  • Shaking
  • Irritability
  • Changes in sleep habits
  • Sweating
  • Dizziness
  • Confusion

What drugs interact with paroxetine?

Paroxetine is associated with a number of different drug interactions, some of which can be extremely dangerous. 

Paroxetine should not be taken with any of the following medications under any circumstances:

  • Thioridazine
  • Monoamine oxidase inhibitors (MAOIs) including isocarboxazid, phenelzine, and tranylcypromine
  • Linezolid and intravenous methylene blue
  • Pimozide
  • Tryptophan (when found in dietary supplements)

Patients are considered to be at an increased risk of experiencing side effects of paroxetine when the drug is taken in combination with certain medications. These medications include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve, Aspirin, and Advil
  • Lithium
  • Amphetamines
  • Risperidone
  • Antiarrhythmics
  • Tricyclic antidepressants
  • Triptans, including sumatriptan
  • Serotonergic drugs, including tramadol, fentanyl, and St. John’s wort
  • Theophylline
  • Cimetidine
  • Phenothiazines
  • Quinidine

Some medications can interact with paroxetine in a way that makes both medications less effective. These include:

  • Tamoxifen
  • Protease inhibitors like ritonavir and fosamprenavir
  • Phenytoin
  • Digoxin
  • Phenobarbital


Paroxetine, a generic prescription drug that is also sold under the brand name Paxil, is an SSRI antidepressant that is used for the treatment of a wide variety of mental health conditions, including major depressive disorder, panic disorder, generalized anxiety disorder, premenstrual dysphoric disorder, obsessive-compulsive disorder, social anxiety disorder, and post-traumatic stress disorder. 

The most common side effects associated with paroxetine include drowsiness, difficulty making decisions, slowed reaction times, difficulty thinking clearly, and nausea.

There are many other common and serious side effects associated with paroxetine, including an increased risk of suicidal thoughts and behaviors. 

Paroxetine can be purchased in either a generic or brand name form, but the cost of the generic drug is significantly cheaper. 

Speak to a healthcare provider before starting paroxetine, especially if you suffer from heart defects or have an increased risk of serotonin syndrome. 

You should also seek medical advice before the discontinuation of paroxetine, including the longer-acting paroxetine hydrochloride Paxil CR and the short-term Paxil. 

Regardless of whether or not your health insurance covers paroxetine, you can save on the cost of your prescription with a pharmacy discount card from 

References, Studies and Sources:

author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings

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