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Paxil, like the earlier antidepressant Prozac, apparently works by enhancing the action of a brain chemical called serotonin. This medication is prescribed to treat major depression, and has been shown to be effective for up to one year. Like Prozac, Paxil is less likely to cause typical side effects associated with older medications.

Tricyclic antidepressants like Elavil, Tofranil, Sinequan and Pamelor often produce dry mouth, dizziness, weight gain, and a sluggish or lethargic feeling. Paxil may not have these effects, and may have a slight stimulant action.

Side Effects and Interactions of Paxil

Side effects associated with this medication include exhaustion, sweating, nausea, decreased appetite, drowsiness, dry mouth, dizziness, insomnia, tremor, problems with ejaculation and anxiety. Less common adverse reactions include headache, palpitations, constipation, diarrhea, blurred vision and decreased libido. A wide range of other reactions have been reported but appear to be uncommon. Report any symptoms to your physician promptly.

It can also interact with a number of other medications. Anyone taking other antidepressants, especially drugs such as Nardil, Marplan or Parnate should stop such a medicine at least two weeks before starting on Paxil. If Paxil is taken first, two weeks should elapse before starting on one of these other medicines. If the amino acid tryptophan ever becomes available in the U.S. again, it should not be taken with Paxil, as it may increase the potential for adverse reactions.

Tricyclic antidepressants like Elavil, Pamelor or Tofranil could in theory have stronger actions and more pronounced toxicity when they are combined with Paxil. This may also occur with certain medications prescribed to regulate heart rhythm. Other compounds that could cause complications in combination with Paxil include Coumadin and possibly Lanoxin.

Tagamet may increase Paxil levels, while phenobarbital or Dilantin can lower them. Interactions between the herb St. John’s wort and Paxil are possible. Switching between antidepressants and herbal treatment calls for medical guidance (physicians can find a suggested protocol for gradual substitution of St. John’s wort in Hyla Cass’s book, St. John’s Wort: Nature’s Blues Buster).

Check with your pharmacist and physician before taking any other medicines or herbs in combination with Paxil.

Special Precautions

Some people may need very close monitoring if the doctor prescribes Paxil. For people who have had an episode of mania, there is a risk that manic symptoms could be triggered by this drug.

Patients who have had seizures also need to followed carefully, since Paxil, like most other antidepressants, may provoke seizures in susceptible individuals. Because it may cause drowsiness or dizziness, people taking this medicine should not drive or use dangerous machines unless an objective evaluation shows they are not impaired.

Older people and those with kidney disease or liver problems may need to start on a reduced dose, as they may eliminate Paxil less efficiently than otherwise healthy people.

Anyone with a history of suicide attempts must also be extremely vigilant. There have been reports that some people may develop a preoccupation with suicide or violence while taking Prozac. It is still not certain whether this is caused by the underlying mental condition or is in some way related to the drug. If Prozac were responsible for any of these incidents, there might also be a risk with Paxil. Family members must help monitor people on Paxil for suicidal thoughts or self-destructive behaviors. The doctor must be notified immediately in such cases.

Taking the Medicine

According to the manufacturer, Paxil should be taken once a day, preferably in the morning. It may be taken either with or without food.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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