*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.
Paxil, with the active ingredient paroxetine, is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) drug class. Paxil is FDA-approved to treat several disorders, including major depression and generalized anxiety disorder. Common side effects may include nausea, diarrhea, and an upset stomach. While many side effects are mild and may disappear on their own, some may persist or become serious and need medical treatment.
If you’re considering Paxil, online psychiatry platforms such as Talkiatry and Brightside Health can connect you with a provider quickly. They offer assessments and can provide a prescription if they determine Paxil or another medication may help your symptoms.
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
Paxil is a prescription antidepressant medication used to treat depression, anxiety, and other mental health conditions in adults.
Paxil, with the active ingredient paroxetine, is a selective serotonin reuptake inhibitor (SSRI).
If you are considering Paxil, 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
What Is Paxil (Paroxetine)?
Paxil (paroxetine) is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) drug class. This medication is used to treat depression and certain anxiety disorders, among other conditions.1 Paxil is available as the generic medication paroxetine with the same treatment risks and benefits as the branded form.
How Does Paxil Work?
Paxil is thought to work by increasing serotonin levels in the brain. This change helps improve mood and emotional wellbeing for some who take it. Serotonin is a body chemical involved in mood regulation.1
What Is Paxil Used to Treat?
Paxil is used to treat several mental health conditions, but only for adults. It is not approved for use in children and adolescents.
Paxil is an FDA-approved treatment for the following conditions:1
- Major depressive disorder
- Generalized anxiety disorder
- Obsessive-compulsive disorder (OCD)
- Panic disorder
- Social anxiety disorder
- Post-traumatic stress disorder (PTSD)
Off-Label (Non-FDA-Approved) Uses of Paxil
In some cases, a provider may consider prescribing Paxil for off-label use. Off-label means that a medication is not FDA-approved for a specific use, but a provider can prescribe it as a treatment because they believe it may offer a benefit to someone.
Common off-label uses of Paxil may include:2
- Premature ejaculation
- Social anxiety
- Postpartum depression
How Effective Is Paxil?
Paxil has been shown to be an effective treatment for depression, OCD, and many types of anxiety and panic disorders. Supportive studies included hundreds of patients and lasted from 8 to 24 weeks. They showed Paxil to be effective to reduce symptoms of depression, OCD, and anxiety and panic disorders.1 These studies showed that taking 10 mg or 20 mg of Paxil is the appropriate dose for most people. It is important to note that not every patient in the clinical trials who took Paxil had a reduction in their symptoms.1
When compared to other commonly used SSRI medications, Paxil is often found to be less ideal. This is because Paxil can have more side effects compared to other medications. A study compared treatment of depression with Paxil, sertraline (Zoloft) and escitalopram (Lexapro) and found that Paxil had more side effects. As a result, a higher percentage of those taking Paxil stopped their treatment than those taking the other medications.3 Also, Paxil is broken down in the liver via a method that makes it likely to interact with other medications.1
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.
How Long Do I Need to Keep Taking Paxil?
The length of treatment with Paxil varies for each patient and is based on many factors. The condition being treated, degree of improvement, and symptoms will all play a role in determining how long someone needs to take Paxil. Studies show that symptoms significantly improve after 4 to 8 weeks of treatment.
A number of studies have continued treatment for up to 24 weeks. Also, many patients take Paxil for several months to years. If Paxil causes side effects, or does not work as effectively as hoped, your prescriber may decide to switch or stop your treatment. Do not change your dosage unless directed by your prescriber.
Common Paxil Side Effects
Individuals taking Paxil may experience common side effects. 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
- Constipation
- Dizziness
- Male and female sexual problems
- Fatigue or drowsiness
- Dry mouth
- Sweating
- Tremor
- Anxiety/nervousness
*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 Paxil side effects to be serious 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, 4
- Suicidal thoughts or actions
- Toxicity to fetuses or newborn babies
- Bruising or unusual bleeding
- Symptoms of mania or hypomania
- Seizures or convulsions
- Angle-closure glaucoma (serious eye condition)
- 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.
What Are The Long-term Effects of Taking Paxil?
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.1
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
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.
Who Should Not Take Paxil?
Some patients may experience side effects from Paxil more than others. While it’s unclear who may not respond well to Paxil, specific patient populations should be cautious with the medication. Those taking other SSRIs, SNRIs, or medications that increase serotonin in the brain should avoid Paxil due to the risk of serotonin syndrome. Discuss all health conditions with your provider so they can select the medication most suitable for you.
Populations who are at an increased risk for experiencing side effects include those who are or have:1
- Have glaucoma (high pressure in the eye)
- Have heart problems
- Have or had bleeding problems
- have low sodium levels in your blood
- Have bone problems
- Have kidney or liver problems
- Bipolar disorder
- Prior allergic reactions to paroxetine
- Prior vision issues such as glaucoma
- A history of seizures
- Pregnant or who plan to become pregnant
- Breastfeeding or who plan to breastfeed
Drug Interactions With Paxil
Taking certain medications, herbs, or supplements alongside Paxil can change how it works in your body or increase the risk for serious side effects. Always talk with your prescriber about what to avoid while using Paxil.
Substances you should avoid using while taking Paxil include:1
- Additional SSRI or SNRI medications
- Monoamine oxidase inhibitors (MAOIs)
- Tricyclic antidepressants (TCAs)
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Buspirone
- Blood thinners
- Orap (pimozide)
- Mellaril (thioridazine)
- Migraine medications
- Alcohol
This is not a comprehensive list of the possible interactions with Paxil. You should talk with your provider and your pharmacist about all prescription and over-the-counter medications, herbs, and supplements you take before starting Paxil.
Paxil Withdrawal
For some people taking Paxil, abruptly stopping the medication can lead to antidepressant discontinuation syndrome, also known as antidepressant withdrawal.
If your provider determines that stopping your medication is necessary, they will provide a plan for stopping your medication gradually. Doing so can minimize your risk of developing withdrawal symptoms. 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.
Paxil Dosages for FDA-Approved Treatment
Your specific Paxil dose will vary depending on the condition being treated and your age, but the standard is 20 mg daily. If you don’t get enough relief from taking Paxil, your prescriber may adjust your dosage or suggest an alternative.
How Should I Take Paxil?
Always take your Paxil dosage as prescribed by your provider. Paxil is typically taken once a day in the morning with or without food. Paxil comes in the form of tablets, suspension (liquid), and extended-release (long-acting) tablets.1 Swallow the tablet whole with water, typically with or without food, depending on your tolerance. Do not crush or break the tablet because doing so can disrupt its controlled-release properties.1
What Happens If I Miss a Dose of Paxil?
If you miss a dose of Paxil, take it as soon as possible. However, if it is closer to your next dose, skip the missed dose and return to your medication routine. It is important to stick to your Paxil schedule, as this helps prevent the risk of experiencing withdrawal symptoms.
Can You Overdose on Paxil?
Yes, it is possible to overdose on Paxil, and doing so can lead to serious complications. Overdosing on Paxil may occur when taking more than prescribed or when taken alongside other antidepressants or substances.
Signs of an overdose on Paxil include:2
- Excessive drowsiness
- Nausea and vomiting
- Rapid or irregular heartbeat
- Dizziness and fainting
- Seizure
- Muscle weakness or tremors
What Should You Do If You Take Too Much Paxil?
If you suspect you have overdosed on Paxil, seek immediate medical assistance.2 Do not wait to see if symptoms develop. Keep the medication packaging or any relevant information about the dosage with you to the emergency room. This information can assist healthcare providers assess your situation accurately.
How to Get a Prescription for Paxil
To get a prescription for Paxil 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 for Paxil should be included in your treatment plan.
Can I Get Paxil Prescribed Online?
To get an online prescription for Paxil, 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.
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 treatment may be 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 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?
- Is it safe to take Paxil with my other medications?
- Will my insurance cover Paxil?
- Does my medical history increase the risk for side effects?
- What should I do if I want to stop taking Paxil?
- Can I consume alcohol while taking Paxil?
- What should I do if Paxil does not work for me?
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.
- Do not 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.
Frequently Asked Questions
Can Paxil Be Used During Pregnancy?
No, Paxil is linked to fetal heart defects and is not prescribed during pregnancy.5
Can Paxil Be Used While Breastfeeding?
It may depend. Like many other drugs, Paxil is secreted in human milk, and caution should be exercised when using it while breastfeeding. The benefits and risks should be weighed with your healthcare provider to decide if it is safe to take.
Is it Safe to Drive While Taking Paxil?
Drowsiness is a potential side effect of Paxil. Do not drive or do other potentially dangerous activities until you know how Paxil may affect you.1
Is It OK to Drink Alcohol While Taking Paxil?
No. People taking Paxil should not drink alcohol due to an increased risk of harmful side effects.
What Are Common Side Effects of Paxil?
Common side effects include nausea, diarrhea, upset stomach, loss of appetite, constipation, dizziness, and sexual function problems.
How Long Will Paxil Side Effects Last?
Side effects are one of the most common reasons people choose to stop taking medication. While some Paxil side effects can be managed and may fade away, some may persist unless a person stops taking the medication. Side effects can occur even when taking the medication correctly.
Does Paxil Affect Sex Drive?
Increased serotonin levels impact hormones such as testosterone and dopamine. While this process is not completely understood, these hormonal effects may inhibit sex drive for some who take Paxil.6
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.
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 tablet, film coated. (September 10, 2024). Retrieved from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm
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Shrestha P, Fariba KA, Abdijadid S. Paroxetine. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Retreived from https://www.ncbi.nlm.nih.gov/books/NBK526022/
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Sanchez, C., Reines, E. H., & Montgomery, S. A. (2014). A comparative review of escitalopram, paroxetine, and sertraline: Are they all alike?. International clinical psychopharmacology, 29(4), 185–196. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC4047306/
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Scotton, W. J., Hill, L. J., Williams, A. C., & Barnes, N. M. (2019). Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions. International journal of tryptophan research : IJTR, 12, 1178646919873925. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734608/
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Udechuku, A., Nguyen, T., Hill, R., & Szego, K. (2010). Antidepressants in pregnancy: A systematic review. The Australian and New Zealand Journal of Psychiatry, 44(11), 978–996. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21034181/
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Jing, E., & Straw-Wilson, K. (2016). Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review. The Mental Health Clinician, 6(4), 191–196. Retrieved from https://doi.org/10.9740/mhc.2016.07.191
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 and reorganized. Revised and retitled content in “What is Paxil (Paroxetine)?”, to include “How Does Paxil Work?” “What Is Paxil Used to Treat?” Revised “How Is Paxil Administered” and retitled to “How Should I Take Paxil?” Added sections titled “Paxil Dosages for FDA-Approved Treatment”, “How Effective Is Paxil?”, “How Long Does it Take Paxil to Work?” “How Long Do I Need to Keep Taking Paxil?”, “What Are the Long-term Effects of Paxil?”. Consolidated “Paxil Warnings & Associated Risks” into new “Risks” feature. Added “Who Should Not Take Paxil?”, “Paxil Withdrawal”, “How to Get a Prescription for Paxil”. Retitled “Questions to Ask Your Health Team About Paxil” to “Questions to Ask Your Provider”. Removed “For Further Reading” section, added FAQs. Replaced “Final Thoughts” with “Prescriber’s Tips” feature.
Author: Diana Rangaves, PharmD, RPh
Medical Reviewer: Heidi Moawad, MD
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