Paroxetine CR
PAXIL CR
Pronunciation: pa-ROX-e-teen (PAX-il)
“Pear rocks a teen (Paxil Rose)”
Crimson roses → antimuscarinic effects
What it isControlled-release serotonin reuptake inhibitor with antimuscarinic activity (PAXIL CR, 1999); depression and PMDD.
Why this oneIts enteric Geomatrix tablet has a gentler GI onset, and the CR label carries PMDD.
What limits itDiscontinuation is especially severe if stopped abruptly. Sexual dysfunction, weight gain, and CYP2D6 inhibition often govern choice.
FDA-approved for
- depression (1999)
- PMDD (2003)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Major depressive disorder | adults | 25 mg QD | 25 mg QD | 62.5 mg QD |
| Panic disorder | adults | 12.5 mg QD | titrate to response | 75 mg QD |
| Social anxiety disorder | adults | 12.5 mg QD | titrate to response | 37.5 mg QD |
| Premenstrual dysphoric disorder | adults | 12.5 mg QD (continuous or luteal-phase) | 12.5 mg QD | 25 mg QD |
Titration Increase in 12.5 mg/day increments at intervals of at least 1 week.
Renal Severe impairment: start 12.5 mg/day; max 50 mg/day (MDD, PD) or 37.5 mg/day (SAD).
Hepatic Severe impairment: start 12.5 mg/day; max 50 mg/day (MDD, PD) or 37.5 mg/day (SAD).
Instructions
- Administer as a single morning dose, with or without food.
- Swallow tablets whole; do not chew or crush.
- Reduce dose gradually when discontinuing.
Available strengths
- ER tab 12.5, 25, 37.5 mg
- cap 7.5 mg
- tab 10, 20, 30, 40 mg
- susp 10 mg/5 mL
Contraindications
- Taking, or within 14 days of stopping, MAOIs (including the MAOIs linezolid and intravenous methylene blue) because of an increased risk of serotonin syndrome
- Taking thioridazine because of risk of QT prolongation
- Taking pimozide because of risk of QT prolongation
Cautions
- Serotonin syndrome
- Embryofetal toxicity (cardiovascular malformations with first-trimester exposure)
- Increased risk of bleeding
- Activation of mania/hypomania
- Seizures
- Angle-closure glaucoma
- Hyponatremia
- Sexual dysfunction
- Discontinuation syndrome
Adverse reactions
- Abnormal ejaculation
- Nausea
- Somnolence
- Dry mouth
- Constipation
- Dizziness
- Insomnia
- Decreased libido
- Sweating
- Tremor
- Asthenia
- Abnormal vision
Pregnancy Associated with a less than 2-fold increase in cardiovascular malformations with first-trimester exposure; late exposure linked to postpartum hemorrhage and neonatal complications.
Lactation Undefined
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 12.5 mg | ER tab | 30 qd | $15.60 | offered |
| 25 mg | ER tab | 30 qd | $11.57 | offered |
| 37.5 mg | ER tab | 30 qd | $11.92 | offered |
Other forms: Paroxetine (PAXIL)
⚠ BOXED WARNING
- Suicidal thoughts and behaviors in patients under 25
Classes and tags
Clinical profile
Serotonin and MAOI
Provisional washout figures
Elevating mechanismSRI
Exposure dependenceTherapeutic exposure; severe toxicity requires meaningful MAO-A inhibition
Evidence confidenceHigh
InterpretationPotent clinically significant SRI; severe serotonin toxicity is expected with meaningful MAO-A inhibition. A second SRI generally represents therapeutic duplication/additive adverse effects, not the classic life-threatening interaction.
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