aka Aropax, Paroxat, Deroxat, Rexetin, Sereupin, Seroxat, Xetanor
Paxil and Effexor have long led the list of antidepressants notorious for difficult withdrawal, the others being Zoloft and Luvox. (But this may be because Paxil and Effexor have been very widely prescribed for a long time; Lexapro and Cymbalta are certainly also very difficult to taper.)
From the July 2011 Medication Guide from GlaxoSmithKline here (PDF) http://us.gsk.com/pr...ts/us_paxil.pdf
Discontinuation of Treatment With Paxil
Recent clinical trials supporting the various approved indications for Paxil employed a taper-phase regimen, rather than an abrupt discontinuation of treatment. The taper-phase regimen used in GAD and PTSD clinical trials involved an incremental decrease in the daily dose by 10 mg/day at weekly intervals. When a daily dose of 20 mg/day was reached, patients were continued on this dose for 1 week before treatment was stopped.
With this regimen in those studies, the following adverse events were reported at an incidence of 2% or greater for Paxil and were at least twice that reported for placebo: Abnormal dreams, paresthesia, and dizziness. In the majority of patients, these events were mild to moderate and were self-limiting and did not require medical intervention.
During marketing of Paxil and other SSRIs and SNRIs, there have been spontaneous reports of adverse events occurring upon the discontinuation of these drugs (particularly when abrupt), including the following: Dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations and tinnitus), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms.
Patients should be monitored for these symptoms when discontinuing treatment with Paxil. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate....
Discontinuation of Treatment With Paxil
Symptoms associated with discontinuation of Paxil have been reported (see PRECAUTIONS: Discontinuation of Treatment With Paxil). Patients should be monitored for these symptoms when discontinuing treatment, regardless of the indication for which Paxil is being prescribed. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.
From FDA prescribing information at http://www.drugs.com/pro/paxil.html
- Regular Paxil comes in 10, 20, 30, and 40 mg tablets (also true of generic paroxetine).
- Paxil CR comes in 12.5, 25, and 37.5 mg tablets.
- Paxil Oral Suspension (liquid) comes in a concentration of 10 mg/5ml
Reduce by 10% per month to start
The 10% rule holds for Paxil, like other psychiatric drugs: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)
See Why taper by 10% of my dosage?
Cutting up tablets
To reduce your dosage, cut regular Paxil tablets up with a pill cutter, available at any drug store.
If you get your prescription filled with the 10mg tablets, you may be able to cut them in half or quarters to reduce by 5mg or 2.5mg at a time.
Paxil CR tablets are enteric-coated and not designed to be split. Switch to regular Paxil if you wish to cut up the tablets.
Precisely weighing tablet pieces or crushed tablets with an electronic digital scale
You may wish to precisely measure your dosage with an electronic scale that measures milligrams. These are available for under $30 US. See Using a digital scale to measure doses
Use Paxil liquid to taper
This is the easiest and most accurate way to taper Paxil.
See FDA prescribing information at http://www.drugs.com/pro/paxil.html
Paxil Oral Suspension (liquid) comes in a concentration of 10 mg/5ml.
The ordering code for brand-name Paxil orange-colored, orange-flavored, 10mg/5 ml, in 250 ml white bottles is NDC 0029-3215-48 (http://www.hipaaspac...es/0029-3215-48 )
Some people are sensitive to changes in the form of the drug. If you are taking tablets, you may wish to take part of your daily dosage in tablet form and part in liquid for a few days to ease the transition from tablets to liquid.
Use oral syringes to taper with the liquid, see http://survivinganti...ing-techniques/
Make your own liquid
You can make your own liquid with water. See How to make a liquid from tablets or capsules
Using a combination of tablets or capsules and liquid
Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.
If your doctor prescribes liquid and tablets or capsules at the same time, most likely, he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance.
Have a compounding pharmacy make up capsules of smaller dosages
With a prescription, a compounding pharmacy will accurately weigh small doses and put them into capsules for you. This is usually somewhat expensive. See http://survivinganti..._3001#entry3001
Edited by Altostrata, 28 August 2015 - 03:05 PM.