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Altostrata

Tips for tapering off Paxil (paroxetine)

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Altostrata

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/products/assets/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.hipaaspace.com/Medical_Billing/Coding/National.Drug.Codes/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://survivingantidepressants.org/index.php?/topic/235-tapering-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://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__p__3001#entry3001

Edited by Altostrata
updated

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KatyM

I was on 12.5 for 3 years...After my son went in the Army and my boss was awful to me.....I quit my job and started a new one...Then my son went to Iraq...Wow they bumped me up to 25....Now Im doing ok my son is coming home and I love my job...Also I have Colitis for about 10 years....Big flare up when they bumped me up to 25...I am 56 years old and gaining weight like crazy....Want off of Paroxitine now...Doctor sais take the 25 for 2 more weeks....Then go down to the 12.5 for 2 weeks than every other day....Like i said yoyo...I was told I cant cut these pills cause they are time released....I dont think there is a smaller dose than what i am taking? Help!!!!

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Brandy

Your doctor is giving you a common taper schedule that DOES NOT WORK for most people! This is something doctors just don't know about yet. Withdrawal schedules that work for some other kinds of medications are disasters with medications like paroxetine and so many others. Most people who follow taper schedules like that one end up with big problems - not always immediately, but fairly soon.

 

Then doctors think their "original condition" is worse and tell them they have to go back on medication - often switching them to a newer, allegedly "better" med which compounds the problems because they often don't help the withdrawal but create a new addiction and its own set of side effects and sooner or later (often sooner!) another withdrawal on top of the first one. Aaaaargh! But fortunately you realized there were problems sooner than many of us did, so you can avoid this medication merry-go-round.

 

Please be sure and read the entire thread about tapering that I linked to in my response to your other post. (That thread explains a lot of things far better than I could!) Don't let it overwhelm you! Just get familiar with the concepts and options, and then you'll get lots of personal responses to help you find what's suitable for you, and help and support as you do a slow, safe taper where you won't be a human yo-yo! (And will have a lot less problems in the future!)

 

It never hurts to go slower, and it gives your body much better circumstances for healing from the changes the med makes while taking it. That's the key issue to recovering well and having quality of life while you do! Your doctor is right that you can't cut the "CR" extended release ones, but that's not a problem! In order to do a slow taper that will avoid the problems you're having (and many more!), you need to switch to regular paroxetine. It's the same medication, and the "extended release" of the CR seems to be deceptive. I've never used that form, but from what I've read, it's simply coated to delay it's absorbing into your system.

 

People don't have problems switching from cr (extended release) to regular; it's switching to other meds, even in the same drug family, that so often causes new problems. I'd suggest you switch to the liquid (suspension) form of paroxetine. You don't need to do that right away, but pretty soon that will be the best way to accurately measure out the small doses to do 10% (or whatever percentage works for you; some people need to drop by even less) drops after stabilizing on each new dose after taking each dose for 3-6 weeks or more to stabilize on it and be ready to drop further.

 

Your doctor will need to prescribe the form of paroxetine you'll need. See if he'll prescribe it in the liquid suspension form for you. 20 mg. will be the equivalent of 25 mg cr's as far as I know. Once you get that (let us know if your doctor refuses, but he or she should accept that you feel more comfortable tapering very slowly, and if they don't, remind them that it can't hurt to go slow!), take 20 mg. every single day (no alternating days!!!!) and then we'll help you learn how to taper safely from there. By the way, I'm not surprised your colitis got worse on the higher dose.

 

Digestive problems often are exacerbated by these meds. But don't rush your taper! Tapering too fast would make it far worse than the med itself does. That's because the lining of the intestine needs to heal, and too-fast tapering interferes with that healing. It's very common to gain weight on this med. You most likely will lose the weight you gained in a while, but that can't be rushed by faster tapering. And it can take a while after tapering, but it will happen!

Edited by KarenB
added paragraph spacing

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Shanti

My doctor wasn't cooperating with me to get Liquid Paxil so I talked to my Pharmacist and he said he doesn't need a new prescription from my Doctor. So he is ordering it for me. I just thought others should know this in case their Doctors aren't cooperating.

 

Does anyone know how much it costs? I'm only concerned now that I'll have to pay out of pocket for it and it'll be too expensive.

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Altostrata

Google and you shall find. When you do, please post here.

 

Shanti, you can combine a half-tablet with liquid to make up your dosage, if your insurance will cover the tablet but not the liquid. That will make the liquid go farther.

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Shanti

 

I Googled. And it looks like around $200. I hope it's covered! Or maybe there's a generic of it and cheaper. I'll post how much it is when I get it.

 

Unfortunately, I believe that price is for the generic liquid. The brand is even pricier! That's why a lot of people who can't afford it (like me) wait until they are at a lower dose so the liquid lasts longer. They usually come in 250ml bottles and 2.5ml=5mg. At your current dose a bottle will last you 27 days. If you were at 10mg a bottle would last you 50 days.

 

Wow. If my insurance doesn't cover it then I'm just gonna have to get digital scales and use the tablets. That's just crazy!

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Altostrata

You can combine tablets and liquid, use the liquid for the odd bits of dosage.

 

For example, you can cut a 30mg tablet in half and take the 15mg tablet piece with 3.5mg liquid to make 18.5mg.

 

If you can get a full prescription for 30mg tablets, the tablets will last you 2 months.

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Shanti

Well, my insurance doesn't cover the liquid and it's $600! Wow. So I'm going to get a digital jewelers scale at eBay or somewhere.

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Shanti

I was able to get a jeweler's scale and a pill crusher all under $25. Much better than $600! Anyone that is shopping for one, make sure it measures to mg. I saw a lot that only measured grams.

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arcticmonkey

Is making a liquid solution from paxil a good idea ?

Anyone had any success with this ?

In what paxil/water ratio should the solution be ?

 

I'm currently down to 5 mg paxil,and I need a way to make very small reductions in dosage,which is not possible by cutting the pill.So I need someone to elaborate the method of making a liquid solution from paxil.

 

Also has anyone here gotten visual snow because of antidepressant withdrawal ?

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primrose

Is making a liquid solution from paxil a good idea ?

Anyone had any success with this ?

In what paxil/water ratio should the solution be ?

 

I'm currently down to 5 mg paxil,and I need a way to make very small reductions in dosage,which is not possible by cutting the pill.So I need someone to elaborate the method of making a liquid solution from paxil.

 

Also has anyone here gotten visual snow because of antidepressant withdrawal ?

Hi

 

I get visual snow if I haven't slept well.

 

As for making a liquid out of paxil in order to make tiny reductions, I can only share my experience of doing the same thing but with seroquel, the drug I am currently tapering from.

 

Im not saying my way is right, but it's working for me.

 

My starting dose was 25mg four times a day.

My cut is 2mg a day.

I got four small jars, and using a big marked syringe, I squirted 50ml in each jar.

So 50ml = 25mgs and one ml = 0.5mgs.

To achieve my 2mg a day cut, I cut one more ml of liquid each day from each of the 4 dose jars.

That's half a mg from each 6hrly dose jar, times that by four to give 2mg for each day.

I use smaller syringes to measure out my doses.

I am sure to shake each jar, get the lid off and plunge my syringe in there as fast as I can to draw my daily dose, because when the drug is in suspension, the particles can settle on the bottom, so keeping them suspended and moving makes for as accurate a dose as possible.

 

I will admit, I've forgotten a few doses and therefore havnen't stuck to every 6 hrs strictly, but, so far, its been cool, no withdrawal symptoms, but like I said, I am on the constant  lookout for the telltale sneezes and runny nose, which are the withdrawal symptoms I have got, before tapering, about a day after not taking my dose, for whatever reason.

 

This way is experimental for me, I am my own guinea pig.

Nothing ventured, nothing gained.

 

My thinking behind it was to keep as even a level of seroquel in my blood as possible, by taking every 6hrs. The half life is 6 ish hours, hence me dosing every 6hrs.

 

The daily cut means that the taper is a smooth descent.

 

I previously tapered from 200mg to 100mg in weekly 10mg steps.

If you were to plot my previous stepped taper, and this current smoother daily taper on a graph, the stepped one would look just that, a jagged, stepped line down.

The daily taper would look like a smooth curve.

 

So far, it's working for me.

I know what to do if symptoms appear.

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Altostrata

arcticmonkey, please see the first post in this topic and the other discussion in this topic.

 

primrose, making a liquid from Paxil and tapering is much more simple than the method you're using to go off Seroquel.

 

Also, reducing 2mg a day from 40mg Seroquel after being on it for years and recently going off benzos -- that's probably way too fast. I hope it doesn't catch up with you in a bad way.

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primrose

arcticmonkey, please see the first post in this topic and the other discussion in this topic.

 

primrose, making a liquid from Paxil and tapering is much more simple than the method you're using to go off Seroquel.

 

Also, reducing 2mg a day from 40mg Seroquel after being on it for years and recently going off benzos -- that's probably way too fast. I hope it doesn't catch up with you in a bad way.

Hi Alto

 

Thanks for  your concern. :)

 

I have tapered down from 100mg not 40mg. (sorry, you looked at my sig, I'll change that to 28mg.

 

I'll be sure to reduce my cut if those sneezes and that runny nose comes back.

As I said above, these two things are an early warning sign of seroqeul withdrawals.

 

So far so good though, thankfully. :D

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SetMeFree

Im down to 7 MG of Paxil.. Dropping 10 % reductions every 6 weeks.. I notice the more I cut the pills and expose the raw side of the pill.The more and more it irritates my Gi tract.Feels like my insides get beat up. Does anyone have these issues???

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Altostrata

You might put it in a gelatin capsule and see if that helps.

 

Please update your Introductions topic.

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MapleleafGirl

i used compounded pills from the pharmacy...my doctor gave me the prescriptions and i took them to a compounding pharmacy and they would make me up the exact doses..worked really well..

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Cheeky

My pharmacy is going to make me a liquid Paxil, I will be eventually tappering from 40mg of paxil, what ml should I ask ? I can half and quater the tablets and will add the liquid paxil to it.

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ladybug

My pharmacy is going to make me a liquid Paxil, I will be eventually tappering from 40mg of paxil, what ml should I ask ? I can half and quater the tablets and will add the liquid paxil to it.

 

With the ready-made liquid Paxil 2.5ml=5mg. Most people are able to make small drops with this ratio if they use a 1ml syringe. Hope this helps!

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Altostrata

If your pharmacy is going to make it, you can get it any concentration you wish. Probably 1mg per milliliter is the easiest to calculate: If you are reducing by 4mg, you would take 4mL using an oral syringe that holds 5mL.

 

Discuss this with your pharmacist.

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JessicaEva85

How low should you go when doing a 10% taper every 28 days with Paxil?

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Altostrata

Jessica, you need to see how dosage reductions affect you. Most people need to reduce to under 1mg before discontinuing completely.

 

Please start a topic for yourself in the Introductions forum to track your progress and questions.

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DLB

Exactly Alto, I have been under 1mg. since the beginning of December and I initially thought I would have been off by Christmas but here it is 3 months later and now at about .14 mg and doing ok. This is a real tricky part of the tapering process.

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Altostrata

I agree, DLB. Thank you for adding your experience here.

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Toulouse

OK - I'm biting the bullet and just doing the liquid suspension to try to get off these last couple of mg.s safely. (i'm down to 2.5 and have shaved off a bit with a razor so I'm not sure exactly where I'm at these last 2 days - 1.75??)  Being that it's hard for me to figure out correctly the dosage I'm at, I ordered, and am getting the Paxil oral suspension - and will try it tomorrow for the first time.

My question is that being on the generic for so long, and switching to the name brand PAXIL - will this effect me negatively? 

 

Also, what kind of syringe should I ask the pharmacist for?

Thanks for your time, and I will post updates on how my final tapering is coming along for any future taperists.

 

 

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Toulouse

Thank you Altostrata - but I also need help figuring out my taper numbers.  10mg = 5ml of the suspension.  Am I just dividing the mg in half to make the ml?

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Altostrata

10mg = 5ml means there is 1mg in 0.5mL of the liquid. If you want to take 2.5mg, for example, you would take 1.25mL of the liquid.

 

You can always ask a pharmacist to help you with the calculations.

Edited by Altostrata
corrected math error

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Toulouse

10mg = 5ml means there is 1mg in 0.5mL of the liquid. If you want to take 2.5mg, for example, you would take 5mL of the liquid.

 

You can always ask a pharmacist to help you with the calculations.

Thank you Alto. My dr helped me figure it out. Basically divide the ml by 2 to get the mg. So 5mg is equal to 2.5ml. 2.5 mg is equal to 1.25ml and so on.

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Altostrata

That's correct. I fixed my error.

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Rachelina

Maybe this belongs in an existing topic but I'm not sure which. 

 

I'm not sure how to store my liquid Paxil. I searched online and found the manufacturer's info sheet which says to store below 77 degrees F. But several other sources, such as drugs.com, said to store at room temperature. I also have an ancient (2008) bottle of liquid Paxil that says store between 65 and 77 degrees. 

 

I don't have air conditioning and it's starting to get hot, so the only option to keep it below 77 degrees is the fridge. But with all the conflicting information I'm not sure if this is OK.  I did stick it in the fridge yesterday when I saw the thermostat had reached 77. But when I researched further and saw several sources saying room temperature, I pulled it out (since by that time the temperature had gone down). Now I'm afraid I wrecked it somehow by putting it in the fridge. 

 

Last summer I didn't even think about this and kept it in my room, where I'm sure the temperature got into the 90's frequently. Sometimes I wonder if this could have played a part in the crash I had starting in November. Probably not, because that would be quite a delayed reaction, and usually I feel it sooner if there is some big change. But to be on the safe side I want to pay attention to proper storage. Any advice welcome!

Edited by KarenB
merged similar topics

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SquirrellyGirl

Hmm, I don't have an obvious answer for you, other than to perhaps ask a pharmacist about the best approach...You get into the 90's in New Hampshire?  I had no idea!  I know that probably includes humidity in your neck of the woods!  We get triple digits here but usually dry.

 

SG

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Rachelina

Thanks Squirrelly Girl! Yes it gets into the 90's, not quite often enough to be worth buying an air conditioner, but still too often for me! And yes the humidity is awful too. I'll ask the pharmacist I guess, but I'm also curious how other people store their liquid. And how important it is not to go above 77 at all. At least I have it downstairs now which is cooler than my bedroom and cooler than outside, but it's still going to get into the 80's sometimes. 

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ChessieCat

Just did a search and found this:

 

https://www.apotex.com/us/en/products/downloads/pil/paxil_irtb_ins.pdf

 

How should I store PAXIL?
Store PAXIL Tablets at room temperature between 59º and 86ºF (15º and 30ºC).
Store PAXIL Oral Suspension at or below 77ºF (25ºC).
Keep PAXIL away from light.
Keep bottle of PAXIL closed tightly.

 

I imagine if it it was not to be stored in the refrigerator it would be stated, especially since the tablet temp is stated as "between".

 

But yes, you could check with the pharmacist or ring the number on the sheet:  For more information about PAXIL call 1-800-706-5575.

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snostorm

This medication should be illegal.  I would have NEVER went on this medication had I known what I was in store for.  I started this medication in 2002.  The makers of this drug should be made to pay for all the people they got hooked on this drug.  

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grandmaD

I only just noticed that my box of aropax is manufactured by "Aspen" Australia.  Previously it was from GSK.  I cannot tell you at what point it changed, probably in the last year.

 

Would it still be EXACTLY THE SAME ingredients/tablet???  Because Aropax from GSK says it is "paroxetine hydrochloride" whereas the one from Aspen says it is "paroxetine hydrochloride hemihydrate"

 

I wonder if this would explain why I experienced many symptoms being the worst ever in year 6 of taper and especially the last 4-5 months with unexplainable muscle spasms and severe back and hip aches????

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scallywag

Aspen is a generic manufacturer.  GSK is the brand name. A change from one to the other could explain increased symptoms.

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