*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Common Paxil side effects include nausea, headache, changes in sleep and appetite, and sexual dysfunction. Serious side effects require medical attention such as a risk of suicidal thoughts, symptoms of mania, and allergic reactions.
One of the most common reasons people want to stop taking a medication is the occurrence of side effects. If Paxil side effects persist beyond the first few weeks, a prescriber can help you determine next steps, which may include a change in dosage, timing of dosage, or to a different medication.
If you are considering Paxil or want to discuss your current medication treatment with a provider, online psychiatry platforms, such as Talkiatry and Brightside Health are a good place to start. Their providers offer assessments and prescription consultation, and can answer any questions you have about Paxil’s side effects.
Boxed Warning: Paroxetine (Paxil) – Risk of suicidal thoughts and behaviors in certain people
Paroxetine, the active ingredient in Paxil, has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA). Paroxetine can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Regardless of your age, you should talk with your doctor about serious risks with paroxetine and any other medications before starting treatment.
Key Takeaways
Common Paxil side effects can impact your digestive system, sleep patterns, appetite, and sexual functioning. There is also a risk of serious side effects that require medical attention.
If Paxil side effects persist longer than a few weeks, your provider can help you determine next steps, which may include a change in dosage, timing of dosage, or medication.
There are several ways to cope with Paxil side effects, including self care practices, medication adjustments, and therapy.
If you are considering Paxil or an alternative, a good place to start is with an evaluation from a medical provider. Many online psychiatry platforms offer online assessments and medication management, such as Talkiatry, or Circle Medical.
Online Psychiatry and Medication Management Covered by Insurance
Talkiatry can match you with a real psychiatrist who takes your insurance and is seeing new patients. They’re in-network with major insurers and offer medication management. Get started with a short online assessment
Common Paxil Side Effects
Individuals taking Paxil may experience common side effects that impact their digestive system, sleep, appetite, and sexual functioning. Some may require medical attention but many often resolve on their own.
Common side effects of Paxil may include:*1
- Nausea
- Diarrhea
- Upset stomach
- Loss of appetite
- Headache
- Increased sweating
- Dizziness
- Erectile and ejaculation difficulties
- Difficulty achieving orgasm
- Reduced sex drive
- Fatigue or drowsiness
- Insomnia
- Tremor
- Anxiety
*All medications, including Paxil, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.
Serious Paxil Side Effects
There is a risk for side effects to be severe or persistent. If these side effects appear, it is important to seek immediate medical attention.
Serious side effects of Paxil that require immediate medical attention include:*1,2
- Suicidal thoughts or actions
- Bruising or unusual bleeding
- Symptoms of mania or hypomania
- Seizures or convulsions
- Allergic reactions
- Muscle rigidity, fever, tremors, and/or seizures (Could be a sign of serotonin syndrome)
*All medications, including Paxil, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.
Long-term Effects
Taking Paxil may lead to long-term and harmful complications. These are mainly influenced by pre-existing medical conditions or the interaction of Paxil with another substance such as alcohol. This can impact organs or result in memory problems. For example, taking Paxil while on blood thinners increases the risk of excessive bleeding.
What Are the Risks & Warnings for Paxil?
Suicidal Ideation & Behavior
Paroxetine, the active ingredient in Paxil, has a black box warning. The risk is higher for individuals 24 years of age or younger, during the first few weeks of treatment or when the dose is changed. If you or someone else shows signs of suicidal thoughts or behaviors, seek medical help right away.
Triggering Manic Episodes
For some people with bipolar disorder, taking Paxil may increase the risk of a manic episode. Prior to starting treatment with an antidepressant like Paxil, patients with depressive symptoms should be screened to determine if they are at risk for bipolar disorder.
Serotonin Syndrome
Taking Paxil may lead to serotonin syndrome, a potentially life-threatening condition resulting from a build-up of serotonin in the body. Symptoms include fever, sweating, confusion, fast or irregular heartbeat, severe muscle stiffness or twitching, agitation, hallucinations, loss of coordination, nausea, vomiting, or diarrhea.
While the risk may be higher when taking multiple medications that can elevate serotonin levels, it can also occur when taking Paxil alone.
Abnormal Bleeding
Medications that affect serotonin activity, such as Paxil, can increase the risk of abnormal bleeding. Signs of abnormal bleeding can include bruising under the skin, a cut that does not stop bleeding, discolored stool, nose bleedings, or vomiting blood.
Seizures
For some people with a history of seizures, taking Paxil may increase the risk of seizures occurring.
Hyponatramia
A rare but serious side effect, hyponatremia (low sodium levels), has been associated with the use of antidepressants such as Paxil. Low sodium levels in your blood may be serious and may cause death. Elderly people may be at greater risk for this.
Angle-closure Glaucoma (Serious Eye Condition)
For some people, taking Paxil may increase the risk of angle-closure glaucoma, a rare but serious eye condition that requires immediate medical care. If you have eye problems or a family history of glaucoma, your doctor may recommend an eye exam before taking Paxil.
Heart-related Problems
For some people, taking Paxil may increase the risk of heart-related problems and increased blood pressure. Any fast, slow, skipping, or irregular heartbeat should be addressed as soon as possible.
Antidepressant Discontinuation Syndrome
People discontinuing Paxil abruptly may have symptoms of Paxil withdrawal, also called antidepressant discontinuation syndrome. Because of this, it is always recommended to taper the dose of medication as instructed by your provider. Do not stop taking Paxil or adjust your dosage on your own.
Common symptoms of Paxil withdrawal include dizziness, nausea, fatigue, shaking, sweating, and agitation.
Pregnancy Risks
It is not known what risks Paxil poses to pregnant individuals or their unborn babies. Speak to your prescriber about the risks and potential benefits of taking Paxil as soon as possible during pregnancy.
Breastfeeding Risks
It is not known what risks Paxil poses to breastfeeding. Speak to your prescriber about the risks and potential benefits of taking Paxil as soon as possible during breastfeeding.
Allergic Reactions
While not common, allergic reactions to Paxil are possible. If you have had an allergic reaction to Paxil, you should not take medicines with the same active ingredient, paroxetine. You should always report to your nearest emergency room if you have any problems breathing or notice swelling when taking Paxil.
Severe allergic to Paxil can include breathing problems (stridor), swelling, and a rash or hives.
Drug Interactions
Taking certain medications, herbs, or supplements alongside Paxil can change how it works in your body or increase the risk for serious side effects. This article does not consider all the possible interactions.
Substances you should avoid using while taking Paxil include:
- Additional SSRI or SNRI medications
- Monoamine oxidase inhibitors (MAOIs)
- Tricyclic antidepressants (TCAs)
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Buspirone
- Alcohol
Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
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*This is not a comprehensive list of all warnings and precautions for Paxil. You should talk with your doctor about any questions you have and to understand the potential warning and precautions of any medication.
Important Things to Know About Taking Paxil
Before starting Paxil, it’s important to understand what to expect during your first weeks of treatment. Your prescriber will discuss your dosage, how to take your medication, precautions for the medication, potential side effects you may experience, and what to do if side effects become a problem.
How Long Does It Take for Paxil to Work?
After taking Paxil for the first week or two, some individuals may start to feel better. It can take about 4-8 weeks for Paxil to become fully effective . Each person may have a different response time based on how their body absorbs and processes the medication.
Can Paxil Worsen Symptoms at First?
Yes, some people starting Paxil may experience uncomfortable side effects such as insomnia, anxiety, increased sweating, and fatigue.1 Paxil can also increase the risk of suicidal thoughts and behaviors in some people. If you experience worsened symptoms or side effects of any kind, contact your provider immediately.
What Happens If I Miss a Dose?
If you forget to take your Paxil dose, take it as soon as you remember. If your next dose is due soon, skip the missed one and take your next scheduled dose. Never take two doses at once, and continue taking your medication as prescribed unless your prescriber directs you to do otherwise.1
Who Experiences Side Effects More?
Some patients may experience side effects from Paxil more than others. While predicting who will respond poorly is difficult, specific patient populations should be cautious with Paxil. Patients taking other SSRIs, SNRIs, or medications that increase serotonin in the brain should avoid Paxil due to the risk of serotonin syndrome.
Adolescent patients and their parents should be aware of the risk of increased suicidal ideation when starting Paxil. It is essential to discuss your health conditions with your physician to select the medication that is the most suitable for you.
Populations who are at an increased risk for experiencing side effects include those who are or have:3
- Susceptible to nausea and vomiting
- Suicidal ideations
- A history of serotonin syndrome
- Bipolar disorder
- Prior allergic reactions to paroxetine
- Prior vision issues such as glaucoma
- A history of seizures
How to Cope With Common Paxil Side Effects
There are ways to cope with the most common Paxil side effects*. Many may go away on their own during the first few weeks. Contact your provider if side effects persist or worsen.
Digestive Symptoms
Taking Paxil can cause digestive side effects such as nausea, stomach upset, diarrhea, and loss of appetite. To reduce these, follow meal timing recommendations for Paxil. Also, drink plenty of water, eat smaller, more frequent meals, and avoid spicy foods. You may also try ginger or peppermint teas, but talk with your healthcare provider before taking any prescription or over-the-counter medicine or using supplements such as tea.
Increased Sweating
Many medications, including Paxil, can cause increased sweating. Wearing loose clothing and using a topical antiperspirant can help. Your provider may also make an adjustment or change of medication if the sweating interferes with your daily life. Be aware that excessive sweating is also a symptom of serotonin syndrome. This is a rare but potentially life-threatening complication with antidepressants that requires immediate medical care.1
Sleep Changes
Sleep changes such as drowsiness and insomnia may occur when taking Paxil. Stick to a regular sleep schedule, keep a sleep diary to track patterns, and get daily light exposure. Getting 30 minutes of exercise during the day can help your sleep quality, but avoid intense activity before bed. Your provider may also recommend taking your medication at a certain time of the day or using sleep aids.
Tremors
Taking Paxil may cause tremors for some people. Your provider may adjust or change your medication depending on the severity of your tremor. If the tremor is mild and does not interfere with your daily activity, you may not need any treatment or medication changes. Speak to your provider so they can determine the best course for you.4
Anxiety
Some taking Paxil may feel anxiety when starting Paxil. The exact cause of this side effect is not clear and may fade on their own as your body adjusts to the medication. If your anxiety persists or worsens, contact your provider as agitation is also a symptom of serotonin syndrome, a serious condition that requires immediate medical care.1
Sexual Side Effects
Men taking Paxil may experience erectile dysfunction, decreased sex drive, and delayed ejaculation. Women may have problems with orgasms and decreased sex drive.1 These effects may go away after the first few weeks. Scheduling sexual activity before taking a dose may also reduce the risk or impact of sexual side effects. If these effects are bothersome or persistent, your provider may consider a change of dosage or medication.
*All medications, including Paxil, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.
Online Psychiatry and Medication Management Covered by Insurance
Talkiatry can match you with a real psychiatrist who takes your insurance and is seeing new patients. They’re in-network with major insurers and offer medication management. Get started with a short online assessment
More Ways to Manage Paxil Side Effects
Here are more ways to cope with and reduce the impact of Paxil side effects.
Practice Good Sleep Hygiene
Following good sleep hygiene practices can help you get better sleep while your body adjusts to the medication. Try to wake up and go to bed about the same time each day, and make sure your sleeping environment is relaxing and comfortable to you. If you experience drowsiness, avoid doing activities that require alertness, such as driving or operating machinery.
Healthy Lifestyle Activities
Eating well, sleeping enough, and getting adequate exercise are all parts of a healthy lifestyle. These activities are important for all aspects of your physical and mental health and can help you endure the impact of side effects.
Follow a Daily Routine
Following your normal routine is important whether or not the medication is working yet. Doing your regular daily activities can keep life more predictable and reduce stress as you adjust to the medication. Also, be sure you are taking your medication as prescribed and at a consistent time each day.
Consider Therapy
Psychotherapy can support you by addressing the impact of side effects and helping you develop strategies to manage them. For in-person treatment, your primary care provider or insurance company can provide a referral, or you may get one from family or friends.
To find an online therapist, an online therapist directory is a great starting point. Many online psychiatry platforms, such as Talkiatry and Brightside Health, also offer therapy services.
Should I Stop Taking Paxil If I Start Feeling Side Effects?
Do not stop taking Paxil unless you have been advised to do so by your provider. Doing so can cause uncomfortable symptoms, including dizziness, fatigue, irritability, and nausea. For some people who have been taking antidepressants over a long course of time, abruptly stopping Paxil can lead to antidepressant discontinuation syndrome, also known as antidepressant withdrawal.
If you are experiencing side effects from your medication, tell your provider. They will help you determine the best course for continued treatment, which may include changing your dosage, the time for your dosage, or your medication. If your doctor determines discontinuing your medication is the best option, they will provide a plan for stopping your medication gradually, which can minimize your risk of developing withdrawal symptoms.
When Should I Call My Doctor About Paxil Side Effects?
Side effects are one of the most common reasons people choose to stop taking medication. While some effects can be managed and may fade away, some do not go away unless a person stops taking the medication. Side effects can occur even if you are taking your medication correctly.
Contact your provider as soon as possible if side effects persist or become hard to tolerate so you can consider other treatment options. While not common, some people taking Paxil may experience serious side effects. These effects often require immediate medical care and some may be life-threatening. If you notice any of the serious side effects listed above, seek medical care immediately.
When Should I Seek an Alternative to Paxil Due to Side Effects?
Paxil’s initial side effects typically subside after a few weeks. If after some time you are looking to change your medication due to continued side effects, work with a doctor to find an alternative. There are many Paxil alternatives available. All classes of antidepressants can help reduce depression symptoms, though potential risks and benefits can vary.
Other SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs) are usually the first antidepressants considered as Paxil alternatives because of their safety and effectiveness.
Atypical antidepressants work differently to improve symptoms and don’t fit into a formal category. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are older medications with more side effects. However, they may be helpful for those who need to avoid or can’t tolerate other types of antidepressants.
How to Get a Prescription for Paxil or Alternative Medications
To get a prescription for Paxil or an alternative in person, start with an evaluation for your symptoms. Your primary care provider, who may be a physician, nurse practitioner, or physician assistant, can help you get the process started. They may make a referral to a psychiatrist or specialist to determine if a prescription Paxil alternatives should be included in your treatment plan.
To get an online prescription for a Paxil alternative, you will also start by getting evaluated by an online psychiatric provider. We have thoroughly reviewed platforms like Talkiatry or Circle Medical that prescribe non-controlled substances such as antidepressants and some anti-anxiety medications.
Benzodiazepines are controlled substances that may be used to treat anxiety symptoms. To get prescribed benzodiazepines, you must do your evaluation with an online psychiatry provider that can and will prescribe controlled substances.
We have thoroughly evaluated online providers like Talkiatry that can and will prescribe benzodiazepines and found them each to be a good place to get started with an evaluation. If your provider feels a benzodiazepine is a good fit for your anxiety symptoms, they may offer you a benzodiazepine prescription online.
Online Psychiatry and Medication Management Covered by Insurance
Talkiatry can match you with a real psychiatrist who takes your insurance and is seeing new patients. They’re in-network with major insurers and offer medication management. Get started with a short online assessment
Questions to Ask Your Provider
It is important to discuss the potential side effects of Paxil with your doctor, psychiatrist, or therapist you may experience immediately after starting the treatment. Ask them whether these side effects will go away on their own or if any intervention is needed.
Also, many online psychiatry services are available with convenient access to mental health care for depression and anxiety problems. Individuals may even change prescribers and get a mental health evaluation, diagnosis, and personalized treatment plan.
Questions to ask your care team about Paxil side effects may include:
- How long will it take for me to adjust to taking Paxil?
- How quickly can Paxil cause side effects?
- What are the first days of Paxil side effects like?
- What is the best dosage to ensure fewer side effects, especially in the first week?
- When should I reach out to you if I am experiencing side effects?
- If I’m not able to tolerate the side effects, are there Paxil alternatives to consider?
- How should I cope with side effects?
- What to do if the side effects do not disappear after the first few weeks?
- Can I skip or lower a dose to avoid the side effects?
- Can I switch the drug if the side effects last longer or get worse?
- What to do if I have serious side effects?
Prescriber’s Tips
Your prescriber will share important information about your Paxil prescription. They will explain how to take and store your medication, what to avoid when taking it, and what to do about side effects. Follow these tips for safe and effective use of Paxil.
- Take your medication as prescribed, do not change your dose or stop taking it unless your prescriber tells you to. Keeping a consistent dosing schedule reduces the chance of unwanted side effects. When taking antidepressants, this approach can prevent withdrawal symptoms such as dizziness, brain zaps, and flu-like symptoms.1
- Take your medication at the same time each day. Doing so can help you remember to take it, making it as effective as possible. Your healthcare provider can help determine the optimal timing based on your sleep patterns and initial medication response.
- Tell your prescriber right away if you or your child have any worsening mental health symptoms. Antidepressants have a boxed warning for increased risk of suicidal thoughts and behaviors in children under age 18 and young adults.
- Ask your doctor whether it is safe to drink alcohol while taking Paxil.
- Tell your prescriber about all medications and supplements you take, including over-the-counter treatments. Many over-the-counter medications and supplements can interact with prescription medications. This is because they are processed by the same gut enzymes, cytochrome P450 (CYPs). These interactions can lead to unwanted side effects or reduce the effectiveness of your prescription medication.5
Frequently Asked Questions
What Is Paxil (Paroxetine) & What Is It Used to Treat?
Paxil (paroxetine) is an antidepressant in the selective serotonin reuptake inhibitors (SSRI) drug class.1 It is FDA-approved to treat major depression, OCD, panic disorder, social anxiety disorder, generalized anxiety disorder, and PTSD in adults only. Paxil is not approved for use in children and adolescents.
What Does Paxil Do?
Paxil is a selective serotonin reuptake inhibitor that works by increasing serotonin levels in the brain. Serotonin is a body chemical involved in mood regulation.1
How Does Paxil Make You Feel During the First Week?
During the first week of taking Paxil, the medication is building up in your body. This may trigger side effects for some people. It takes several weeks for Paxil to start working and you may not notice any difference in your symptoms yet.
Which Antidepressants Cause the Fewest Side Effects?
SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs) are antidepressants that cause the fewest side effects. These are newer classes of antidepressants and are often preferred for their milder side effects.
Which Antidepressants Cause the Most Side Effects?
Monamine oxidase inhibitors (MAOIs), tetracyclic, and tricyclic antidepressants (TCAs) cause the most side effects. These are older classes of medication and are not first-line treatments for depression because they have more side effects than newer antidepressants.
Should I Stop Taking Paxil If I Experience Side Effects?
Do not stop taking Paxil unless you have been advised to do so by your provider. Doing so can lead to antidepressant discontinuation syndrome, also known as antidepressant withdrawal. This can cause uncomfortable symptoms, including dizziness, fatigue, irritability, and nausea.
What’s the Number One Side Effect of Paxil?
In the clinical trials for Paxil, the most commonly reported side effect was nausea.1
ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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Paxil- paroxetine hydrochloride capsule. (September 10, 2024). DailyMed.nlm.nih.gov. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm
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Scotton WJ, Hill LJ, Williams AC, Barnes NM. (2019, Sep 9). Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions. International Journal of Tryptophan Research. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734608/
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Santarsieri, D., & Schwartz, T. (2015). Antidepressant efficacy and side-effect burden: a quick guide for clinicians. Drugs in Context, 4, 1–12.Retrieved from https://doi.org/10.7573/dic.212290
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Drug-induced tremors. (2024). MedlinePlus.gov. Retrieved from https://medlineplus.gov/ency/article/000765.htm
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Marken, P. A., & Munro, J. S. (2000). Selecting a Selective Serotonin Reuptake Inhibitor: Clinically Important Distinguishing Features. Primary Care Companion to the Journal of Clinical Psychiatry. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181142/
We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.
Author: No Change
Reviewer: No Change
Primary updates: Added “Key Takeaways” feature. Edited for clarity. Condensed “What is Paxil?” and moved to FAQs. Combined “Paxil Side Effects” with intro paragraph. Removed “Rare Side Effects”. Added new “Warnings & Risks” feature and “Important Things to Know About Taking Paxil” section. Revised “Who Experiences Side Effects More?”. Revised “Paxil Withdrawal Symptoms” and moved it to “Warnings & Risks” feature. Added new sections/features “How to Cope With Common Paxil Side Effects”, “More Ways to Manage Paxil Side Effects”, “Should I Stop Taking Paxil If I Start Feeling Side Effects?”, “When Should I Seek an Alternative to Paxil Due to Side Effects?”, “How to Get a Prescription for Paxil or Alternative Medications” and all included subsections. Retitled “Questions to Ask Your Health Team” to “Questions to Ask Your Provider”. Replaced “Final Thoughts” with “Prescriber’s Tips” feature. Removed “For Further Reading”, Added FAQs.
Author: Diana Rangaves, PharmD, RPh
Medical Reviewer: Dena Westphalen, PharmD
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