What Pharmacists Say About When To Take Paroxetine (Plus 4 More Tips)

Paroxetine is an antidepressant medication. It’s part of a group of medications called selective serotonin reuptake inhibitors (SSRIs). It’s a first-choice option for multiple mental health conditions, including depression, anxiety, and premenstrual dysphoric disorder.

Paroxetine is available as many different products, including immediate-release (IR) and extended-release (ER) tablets. It’s also available as an oral solution. Other brand-name products called Pexeva and Brisdelle are also available. Each of these products is FDA-approved for different health conditions. 

If you’ve been prescribed paroxetine, you may be wondering if there’s a best time of day to take it and what side effects you might experience. Well, we have some tips to help you get the most out of your prescription.

What is paroxetine?

Paroxetine is the main ingredient in multiple medications. These medications are FDA-approved for various health conditions as shown in the table below.

All paroxetine products are available as brand-name and generic medications, except Pexeva which is available as a brand-name product only. In this article, we’ll focus specifically on paroxetine IR.

Paroxetine IR comes in a few tablet dosages:

• 10 mg

• 20 mg

• 30 mg

• 40 mg

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It’s also available as an oral liquid in a 10 mg/5 mL dosage. 

How is paroxetine dosed?

The starting dose of paroxetine IR depends on what you're using it for. For depression, OCD, and PTSD, the starting dose is 20 mg. In some people, a lower starting dose of 10 mg may be more appropriate. For panic disorder, the starting dose is 10 mg. 

The maximum dose is 50 mg to 60 mg, depending on what you’re treating.

5 tips for taking paroxetine

If you’ve been prescribed paroxetine IR, these tips will help you get the most benefit from your medication. 

1. When is the best time to take paroxetine?

Paroxetine IR is usually taken once daily in the morning. But side effects may affect when you choose to take paroxetine. In clinical studies of paroxetine for depression, over 20% of people experienced sleepiness, and insomnia occured in over 10%.

So, if paroxetine makes you sleepy, you can try taking it in the evening. On the other hand, if it causes you to have trouble falling asleep (insomnia), stick to taking it in the morning. 

2. Should I take paroxetine with food?

Paroxetine IR can be taken with or without food. Having food in your stomach doesn’t affect how well paroxetine works. 

But nausea is one of the most common side effects of paroxetine, having been reported by over 25% of people. Taking it with food may help prevent you from experiencing nausea.

3. Should I separate paroxetine from my other medications?

No, you don’t have to separate paroxetine from your other medications. 

But you should know about possible drug interactions. Drug interactions can make it more likely you’ll experience side effects. Examples of medications that interact with paroxetine include:

• Medications that raise serotonin levels. This includes other SSRIs, serotonin and norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs). High serotonin levels can lead to a dangerous side effect called serotonin syndrome. 

• Medications that are broken down by the same enzyme (protein) that breaks down paroxetine. These include dextromethorphan (Delsym, Robitussin), metoprolol (Lopressor), and venlafaxine (Effexor XR). Your healthcare provider may need to lower the dosage of these medications while you’re taking paroxetine.

• Medications that raise your risk of bleeding. Paroxetine can raise your risk of bleeding, especially if combined with other medications that can also cause bleeding. Examples include nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, and antiplatelet medications.

• Medications that bind to proteins in the blood. Paroxetine attaches (binds) tightly to proteins in the blood. This may cause interactions with other medications that bind to blood proteins. One example of another highly protein-bound medication is warfarin (Coumadin, Jantoven).

• Tamoxifen. This medication is used to treat and prevent breast cancer. Paroxetine may lower levels of tamoxifen.

Note that this is not a complete list of drug interactions that can occur with paroxetine. Always keep an updated list of your medications and share it with your healthcare provider and pharmacist. They can help you check for drug interactions with paroxetine.

4. What happens if I miss a dose of paroxetine?

If you’ve missed a dose of paroxetine IR, take it as soon as you remember. But if it’s closer to the time of your next dose, just wait for your regularly scheduled dose. Don’t double up on doses at one time. Taking two doses at once can increase your risk of side effects. 

Taking paroxetine daily is important. If paroxetine is stopped abruptly, or the dose is lowered too quickly, withdrawal symptoms can occur. This is called antidepressant discontinuation syndrome. Symptoms are usually mild, and may include nausea, headache, and flu-like symptoms. But rarely, symptoms are more severe and can result in extreme mental health changes.

5. What can I do if I have side effects from paroxetine?

Everyone responds differently to medications. Some people will have side effects with paroxetine, while others may not experience them at all. And luckily, many of these side effects improve within the first few weeks of therapy. 

Some of the most common side effects of paroxetine include:

• Stomach problems, like nausea, diarrhea, and constipation

• Changes in sleep patterns, like sleepiness or trouble sleeping

• Weakness

• Dizziness

• Feeling anxious

• Sexual problems

• Sweating

• Shakiness

• Lowered appetite

• Dry mouth

• Yawning

• Headache

If you experience bothersome side effects from paroxetine, talk to your healthcare provider. Some of these side effects are more likely with higher doses, so they may suggest lowering your dose or switching to another antidepressant. 

Paroxetine can also have more serious side effects, but they’re rare. Still, it's important to be aware of them. If you experience any of the severe side effects listed below, contact your healthcare provider right away. 

• Suicidal thoughts or behaviors, especially in people younger than 25 years old (and most often seen when starting treatment and after dosage changes) 

• Serotonin syndrome (symptoms of serotonin syndrome may include sweating, fast heart rate, and confusion)

• Withdrawal symptoms (discontinuation syndrome) when stopping paroxetine abruptly or lowering the dose too quickly

• Higher risk of bleeding

• Low sodium levels (symptoms include extreme tiredness, headaches, and confusion)

• Seizures

• Worsening glaucoma

• Mania or feelings of excitement in people with bipolar disorder

• Osteoporosis or bone fractures

If you’re pregnant, talk to your healthcare provider before starting paroxetine. It’s possible that paroxetine may harm your unborn baby. So, they may recommend a different SSRI if you’re pregnant. But if you become pregnant while taking paroxetine, don’t stop it without talking to your healthcare provider. It’s important to effectively manage mental health conditions like depression while pregnant.

How to save money with your paroxetine prescription

Paroxetine is covered by most insurance plans. This includes government insurance plans like Medicare and Medicaid. Ways to save on your paroxetine prescription include:

• Take a generic version. Like many medications, generic paroxetine is less expensive than the brand-name version, Paxil. Whenever possible, ask your healthcare provider to prescribe the generic version. 

• Try using a free GoodRx coupon. This can help you save money on your paroxetine prescription, lowering the cost of 30 tablets of paroxetine 20 mg to less than $4. 

• Fill a 90-day supply. Depending on your insurance, this may be the most cost-effective way to fill your paroxetine prescription.

• Use a mail-order pharmacy. Like 90-day supplies, your insurance may prefer you use a mail-order pharmacy and offer cost-savings as an incentive.

• Split your pills in half. For example, if you're prescribed paroxetine 20 mg once daily, a prescription for 40 mg tablets will leave you with two doses per tablet. This means that 30 tablets of the 40 mg strength would last 60 days. This is only true for the IR tablets. Cutting or splitting ER tablets can result in too high of a dose at one time. 

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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