Paxil Cr

Paxil CR contains paroxetine in a tablet designed to release the medicine gradually over the day rather than all at once. Paroxetine is a selective serotonin reuptake inhibitor (SSRI): it increases the amount of serotonin available between nerve cells, which over several weeks can lift mood and reduce anxiety. In the UK SmPC for paroxetine, the licensed uses are major depressive episodes, obsessive-compulsive disorder, panic disorder with or without agoraphobia, social anxiety disorder, generalised anxiety disorder and post-traumatic stress disorder.

Three controlled-release strengths are offered: 12.5mg and 25mg in packs of 30, 60, 90, 120 or 180 tablets, and 37.5mg in packs of 30, 60, 90 or 120. The tablets are swallowed whole and must not be crushed or chewed, as that would undo the slow-release design.

Paroxetine is licensed in the UK as a prescription-only medicine (POM), but only in immediate-release forms: 10mg, 20mg, 30mg and 40mg tablets, sold as Seroxat and as generic paroxetine. Paxil CR is an imported brand with no UK marketing authorisation, and the photograph shows the manufacturer’s pack. Controlled-release milligram strengths do not convert one-for-one into immediate-release doses, so switching between the two needs a prescriber’s input.

For immediate-release paroxetine, the SmPC recommends 20mg once daily for depression, social anxiety, generalised anxiety and PTSD, with a maximum of 50mg a day. For OCD and panic disorder the target is 40mg daily, built up gradually (panic disorder starts at 10mg), with a maximum of 60mg. Older adults should not exceed 40mg daily. Benefit usually builds up over several weeks, with the dose reviewed within two to four weeks of starting, and depression is treated for at least six months after symptoms settle. Paroxetine is generally taken in the morning with food. Any equivalent controlled-release regimen is set by the prescriber.

Paroxetine must not be combined with MAOIs; it can be started two weeks after an irreversible MAOI or 24 hours after a reversible one such as moclobemide, linezolid or methylthioninium chloride. Thioridazine and pimozide are also contraindicated. It is not used under the age of 18. Care is needed with epilepsy, glaucoma, bleeding disorders, bipolar illness and in pregnancy.

Other serotonergic medicines, including triptans, tramadol, lithium, St John’s wort and other antidepressants, raise the risk of serotonin syndrome. NSAIDs, aspirin and anticoagulants increase the chance of bleeding. Paroxetine also inhibits the liver enzyme CYP2D6 and can affect tamoxifen, metoprolol and some antipsychotics. Common effects are nausea, sexual difficulties, drowsiness or insomnia, sweating, dizziness, yawning and weight changes. Suicidal thoughts can increase early in treatment, especially in younger adults; seek help immediately via your GP, 999 or A&E.

Paroxetine is known for withdrawal symptoms such as dizziness, sensory disturbances, anxiety and vivid dreams if stopped abruptly, so the dose is tapered over weeks. Whether Paxil CR or a UK-licensed paroxetine product suits you is for your doctor or prescriber to decide.