Paroxetine, sold under the brand name Paxil among others, is an antidepressant medication of the selective serotonin reuptake inhibitor (SSRI) class used to treat major depressive disorder, obsessive–compulsive disorder (OCD), panic disorder, social anxiety disorder, post-traumatic stress disorder (PTSD), generalized anxiety disorder, and premenstrual dysphoric disorder. It has also been used in the treatment of premature ejaculation, and hot flashes due to menopause. It is taken orally (by mouth). Common side effects include drowsiness, dry mouth, loss of appetite, sweating, trouble sleeping, and sexual dysfunction. In some patients, sexual dysfunction may persist even after the drug is discontinued, a condition known as post-SSRI sexual dysfunction; regulatory agencies including the European Medicines Agency and Health Canada have recommended that paroxetine's product labeling warn of this risk. Serious side effects may include suicidal thoughts in those under the age of 25, serotonin syndrome, and mania. Paroxetine was approved for medical use in the United States in 1992 and initially sold by GlaxoSmithKline. It is on the World Health Organization's List of Essential Medicines. It is available as a generic medication. In 2023, it was the 72nd most commonly prescribed medication in the United States, with more than 9 million prescriptions. In 2018, it was in the top 10 of most prescribed antidepressants in the United States.
Medical uses Paroxetine is primarily used to treat major depressive disorder, obsessive–compulsive disorder, post-traumatic stress disorder, social anxiety disorder, and panic disorder. It is also occasionally used for agoraphobia, generalized anxiety disorder, premenstrual dysphoric disorder, and menopausal hot flashes.
Depression A variety of meta-analyses have been conducted to evaluate the efficacy of paroxetine in depression. They have variously concluded that paroxetine is superior to placebo and that it is equivalent to other antidepressants. Despite this, there was no clear evidence that paroxetine was better or worse compared with other antidepressants at increasing response to treatment at any point in time.
Anxiety disorders Paroxetine was the first antidepressant approved in the United States for the treatment of panic disorder. Several studies have concluded that paroxetine is superior to placebo in the treatment of panic disorder. Paroxetine has demonstrated efficacy for the treatment of social anxiety disorder in adults and children. It is also beneficial for people with co-occurring social anxiety disorder and alcohol use disorder. It appears to be similar to a number of other SSRIs. Paroxetine is used in the treatment of obsessive-compulsive disorder. Comparative efficacy of paroxetine is equivalent to that of clomipramine and venlafaxine. Paroxetine is also effective for children with obsessive-compulsive disorder. Paroxetine is approved for the treatment of PTSD in the United States, Japan, and Europe. In the United States, it is approved for short-term use. Paroxetine is also FDA-approved for generalized anxiety disorder.
Menopausal hot flashes In 2013, low-dose paroxetine was approved in the US for the treatment of moderate-to-severe vasomotor symptoms such as hot flashes and night sweats associated with menopause. At the low dose used for menopausal hot flashes, side effects are similar to placebo and dose tapering is not required for discontinuation.
Fibromyalgia Studies have also shown paroxetine "appears to be well-tolerated and improve the overall symptomatology in patients with fibromyalgia", but is less robust in helping with the pain involved.
Premature ejaculation Off-label paroxetine prolongs intravaginal ejaculatory latency time by about 5.6 minutes versus placebo and shows a relatively lower risk of adverse events compared to other pharmacologic treatments for premature ejaculation.
Adverse effects
Common side effects include drowsiness, dry mouth, loss of appetite, sweating, insomnia, and sexual dysfunction. Serious side effects may include suicide in those under the age of 25, serotonin syndrome, and mania. While the rate of side effects appears similar compared to other SSRIs and SNRIs, antidepressant discontinuation syndromes may occur more often. Use in pregnancy is not recommended, while use during breastfeeding is relatively safe. The Federal Aviation Administration (FAA), the U.S. agency responsible for regulating civil aviation, considers paroxetine to be an antidepressant medication that is ineligible for an FAA Authorization of Special Issuance (SI) or Special Consideration (SC) of a medical certificate. Paroxetine shares many of the common adverse effects of SSRIs, including (with the corresponding rates seen in people treated with placebo in parentheses):
nausea 26% (9%) somnolence 23% (9%) dry mouth 18% (12%) headache 18% (17%) asthenia (weakness) 15% (6%) constipation 14% (9%) dizziness 13% (6%) insomnia 13% (6%) diarrhea 12% (8%) sweating 11% (2%) tremor 8% (2%) loss of appetite 6% (2%) nervousness 5% (3%) blurred vision 4% (1%) paraesthesia 4% (2%) hypomania 1% (0.3%) sexual dysfunction (≥10% incidence) Most of these adverse effects are transient and go away with continued treatment. Central and peripheral 5-HT3 receptor stimulation is believed to result in the gastrointestinal effects observed with SSRI treatment. Compared to other SSRIs, it has a lower incidence of diarrhea, but a higher incidence of anticholinergic effects (e.g., dry mouth, constipation, blurred vision, etc.), sedation/somnolence/drowsiness, sexual side effects, and weight gain. Due to reports of adverse withdrawal reactions upon terminating treatment, the Committee for Medicinal Products for Human Use at the European Medicines Agency recommends gradually reducing over several weeks or months if the decision to withdraw is made. See also Discontinuation syndrome (withdrawal). Mania or hypomania may occur in 1% of patients with depression and up to 12% of patients with bipolar disorder. This side effect can occur in individuals with no history of mania, but it may be more likely to occur in those with bipolar disorder or with a family history of mania. Paroxetine is described as a 'hepatoxic agent' and has been associated with hepatoxicity and jaundice.
… excerpt ends here. Continue reading the full article.



![Paroxetine: Mechanism of paroxetine inhibition of CYP2D6[92]](https://upload.wikimedia.org/wikipedia/commons/thumb/0/08/Paroxetine_CYP2D6.png/1280px-Paroxetine_CYP2D6.png?utm_source=en.wikipedia.org&utm_campaign=parser&utm_content=thumbnail)
![Paroxetine: Metabolism of paroxetine in humans[101]](https://upload.wikimedia.org/wikipedia/commons/thumb/f/f4/Paroxetine_metabolism.png/1280px-Paroxetine_metabolism.png?utm_source=en.wikipedia.org&utm_campaign=parser&utm_content=thumbnail)
