Paxil Side Effects

Anxiety disorders and depression are estimated to affect approximately 60 millions adults in the United States.

People who suffer from severe forms of anxiety and depression may be able to improve their symptoms by making certain lifestyle changes, such as cutting stress out of their lives and increasing their amount of exercise, but prescription drugs like Paxil can help to further reduce symptoms. 

Paxil is a prescription antidepressant that is commonly used for the treatment of many different mental health disorders.

Paxil is available in the generic form under the name of its active ingredient, paroxetine, and the medication is only used in adults. Paxil is used to treat a wide range of medical conditions. 

What is Paxil?

Paxil is a prescription antidepressant medication that is part of a class of drugs called selective serotonin reuptake inhibitors (SSRIs). 

SSRIs represent a newer class of antidepressants that were first introduced in the mid-1980s with the intention of replacing older antidepressants like MAOIs and tricyclic antidepressants. SSRIs are commonly associated with fewer side effects than older classes of antidepressants and are better tolerated by most patients. 

Sold under the generic name paroxetine, Paxil is approved by the U.S. Food and Drug Administration (FDA) for the treatment of many different common mental health conditions.

What conditions are treated with Paxil?

Paxil is an effective treatment option for some of the most common mental health conditions, including major depressive disorder (also known as clinical depression), premenstrual dysphoric disorder (PMDD) and multiple types of anxiety disorders.

Some of the types of anxiety disorders treated with Paxil include obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, post-traumatic stress disorder (PTSD),and generalized anxiety disorder. Paxil can also be combined with other drugs for the treatment of other mental health disorders that are not specified above. 

How much does Paxil cost?

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

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


10 mg oral tablets

20 mg oral tablets




Paroxetine HCL



Regardless of whether patients choose to use Paxil or paroxetine, they can save on the cost of Paxil or Paxil regardless of their insured status with a free pharmacy discount card from 

How do I know which dose of Paxil to take?

Several different factors influence which dose of Paxil you should take. While your doctor will prescribe the best starting dose of the medication for you, the decision will be made based on several factors, including: 

  • The age of the patient
  • The mental health condition being treated
  • The severity of the patient’s condition
  • How the patient responds to the first few doses of the drug
  • Other medical conditions that could affect how the drug is absorbed. 

Every person will respond to Paxil differently, so it is best not to compare your dose to the dose of someone else that you know who is taking the same drug. Also, your doctor may adjust your dose several times before settling on the right dose of the medication for you. 

When taken for major depressive disorder, adults under the age of 65 will typically start at a dose of 20 mg per day of the immediate release version of Paxil or 25 mg per day for the extended release dose of the drug. Your dose of the medication can be incrementally increased at your doctor’s discretion by 10 mg per day per week until reaching a maximum dosage 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 taking Paxil for social anxiety disorder typically start at a dose of 20 mg per day with a maximum dose of 60 mg per day for the immediate release form of the drug. When using the extended release version of Paxil, the starting dose is 12.5 mg per day with a maximum dose of 37.5 mg per day.

Post-traumatic stress disorder is only treated with the immediate-release version of Paxil. The starting dose of the medication for social anxiety disorder is 20 mg per day with a maximum dose of 50 mg per day.

Similarly, generalized anxiety disorder is also treated with only the immediate release version of Paxil. The starting dose is 20 mg per day with a maximum dose of 50 mg per day.

Panic disorder can be treated with either the immediate release or extended release version of Paxil. When using the immediate release tablet, adults under the age of 65 aim for a target dose of 40 mg per day and a maximum dose of 60 mg per day. When using the extended-release tablet, the starting dose is typically 12.5 mg per day with a maximum dose of 75 mg per day. 

Premenstrual dysphoric disorder is treated with the extended release version of Paxil. 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 Paxil?

Antidepressant SSRIs like Paxil are associated with a lengthy list of possible side effects due to their effects on the chemical balance in the brain. The side effects associated with Paxil are typically classified as either common and serious.

Common side effects of Paxil usually do not require medical attention. These side effects include: 

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

If you experience mild side effects from Paxil, as noted above, your symptoms will likely disappear over the course of a few days or weeks as your body starts to adjust to the effects of the medication. If you experience side effects over an extended period of time or your side effects start to feel severe, you should contact your doctor or pharmacist and consider seeking medical attention. 

Paxil is associated with potentially serious or life-threatening side effects in some patients. If you experience any of the following serious side effects, make sure to contact your doctor or call 911 and seek medical attention from a healthcare professional if you feel like you are experiencing a medical emergency. 

Serious side effects of Paxil include: 

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

Are there any risks associated with Paxil?

Paxil is associated with several serious warnings and has been assigned a black box warning from the FDA. Black box warnings are the strongest warning given by the FDA for medications and are intended to provide doctors and patients with information about the potentially serious effects of the drug.  

One of the most significant risks associated with the use of Paxil is the increased risk of suicidal thoughts or behaviors, especially in young adults. Patients are most likely to experience these adverse effects of paroxetine when they first begin treatment with Paxil or when they increase their dose of the medication. Adults ages 24 and younger, as well as teenagers and children, are particularly susceptible to experiencing suicidal thoughts and behaviors while taking Paxil.

Serotonin syndrome is a potentially life-threatening condition that can occur when levels of serotonin in the brain become elevated at a level that the body cannot tolerate. When combined with other medications that impact the levels of serotonin in the brain, Paxil can cause serotonin syndrome, but Paxil can also cause serotonin syndrome on its own.  People experiencing serotonin syndrome may experience symptoms like coma, muscle twitching, hallucinations, agitation, confusion, trouble thinking, and coordination problems.

Patients who are using Paxil for the treatment of major depressive disorder may find that use of the drug exacerbates their symptoms. Make sure to pay attention to your symptoms and let a friend, family member, or your healthcare provider know if they change. If you notice symptoms like extreme mood swings, restlessness, anxiety,  aggressiveness, panic attacks, irritability, acting on dangerous impulses, sleeplessness, or suicidal thoughts or behaviors, call your doctor.

Like many other types of antidepressants, Paxil can cause withdrawal symptoms due to its effects on the chemistry of the brain. Patients who have been taking Paxil for four weeks or more and who desire to stop or reduce their dose of the drug should not do so without first consulting a doctor. 

Withdrawal symptoms of Paxil include:

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

What drugs interact with Paxil?

Paxil can cause a number of different drug interactions. Some drug interactions can be potentially dangerous, while others can cause an increased risk of side effects or reduced effectiveness of both medications. 

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

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

When Paxil is taken with certain other medications, it can increase the risk of patients experiencing certain side effects. These medications include:

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

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

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


Paxil is a popular prescription SSRI antidepressant that is also sold under the brand name paroxetine. The drug is FDA-approved for the treatment of many common mental health conditions, including major depressive disorder, premenstrual dysphoric disorder, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, social anxiety disorder, and post-traumatic stress disorder. 

Side effects of Paxil most commonly include sleepiness, difficulty thinking clearly, difficulty making decisions, slowed reaction times, and nausea. Paxil is also associated with a long list of other common and serious side effects, including an increased risk of suicidal thoughts and behaviors. 

Seek medical advice to determine whether Paxil is right for you. 

Paxil is thought to be safe for breastfeeding mothers, despite being detected in breast milk. Pregnant women should consult with their doctor before starting Paxil, as it may be linked to heart defects in newborns.

Generic brand paroxetine hydrochloride can be sold as the short-term Paxil or in the long-acting Paxil CR. You can save significantly on the cost of your medication by choosing the generic drug. 

Regardless of whether or not your health insurance covers Paxil, 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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