What Is Paroxetine?
Paroxetine is a prescription medication that belongs to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs) [1]. It is the most potent SSRIs, meaning it can have a beneficial effect even at lower doses. Paroxetin is marketed under the brand names Paxil and Seroxat and can be prescribed to treat depression, obsessive-compulsive disorder, panic disorder, social anxiety disorder, generalised anxiety disorder, post-traumatic stress disorder, as well as some symptoms of menopause [1].
Paroxetine has a half-life of approximately 24 hours and no active metabolites; thus, it is eliminated from the body quickly, reducing the risks of side effects [2, 3]. The safety profile of paroxetine makes it a popular antidepressant for elderly patients, and has even been used off-label in adolescents [4, 5].
Like all medications, paroxetine can also have side effects. Side effects of taking paroxetine include sleep disturbance, dizziness and nausea, but these effects are rarely severe enough for patients to discontinue their medication [6, 7]. Overdosing with paroxetine is also more difficult than with other classes of antidepressants [8].
What Are The Side Effects of Paroxetine?
Mild Side Effects of Paroxetine
- Gastrointestinal Upset - Gastrointestinal symptoms are the most common side effects of paroxetine. This can include nausea, indigestion, constipation or diarrhoea. These are usually tolerable and rarely lead to drug discontinuation [7, 8].
- Headache - Individuals taking paroxetine are 5.4% more likely to experience headaches[9].
- Decreased Libido - Decreased libido is 2.6% more common in individuals taking paroxetine compared to people not taking paroxetine [9].
- Nervousness - Nervousness, or anxiety, can result in the early stages of taking paroxetine due to the neurochemical changes the drug induces. These are 2.0% more likely to occur while taking paroxetine [9].
- Paresthesia - Paresthesia refers to abnormal skin sensations like tingling or prickling, which is a rare mild side effect of taking paroxetine [9].
- Increased sweating - Increased sweating is another mild side effect of paroxetine, although it is comparable to other SSRIs [10].
Moderate To Severe Side Effects of Paroxetine
- Reduced blood clotting. Increases in serotonin reduce the release of blood clotting factors, increasing bleeding tendency. This may be a more significant problem during concurrent use of blood thinning medication, such as aspirin [11].
- Cardiac arrhythmias. In severe cases, SSRIs can increase the intervals between stages of the heartbeat, increasing the risk of heart arrhythmias [12].
- Serotonin syndrome. As paroxetine increases the availability of serotonin in the brain, there is a minor increase in the risk of serotonin syndrome, which is when there is too much serotonin in the brain. It is important to note that this is extremely rare, and even doses 10x higher than the therapeutic dose of paroxetine rarely lead to serotonin syndrome [12].
Withdrawal Symptoms After Taking Paroxetine
Symptoms of withdrawal or discontinuation may occur upon stopping paroxetine, although these effects are significantly lower compared to older tricyclic antidepressants. A three or four-week tapered withdrawal can be beneficial to avoid these [13].
Can I drink alcohol while taking paroxetine?
Alcohol is a psychoactive substance that increases the amount of the inhibitory neurotransmitter GABA in the brain, causing sedation and behavioural disinhibition (removal of inhibition). Therefore, alcohol interacts with the psychoactive effects of paroxetine, which increases serotonin availability. Drinking alcohol while taking paroxetine increases drowsiness, sedation and mental health symptoms [14]. Other than this, it is safe to drink alcohol as long as you don't drive, operate heavy machinery or engage in activities that would increase the risk of injury in a sedated state [14].
Patients with underlying liver disease ought to be highly cautious when drinking alcohol and taking paroxetine, as both paroxetine and alcohol are broken down in the liver. Overloading the liver can increase the chance of further liver damage [15].
To summarise, drinking alcohol while taking paroxetine is generally safe but should not be done regularly due to the detrimental impact of alcohol on paroxetine's antidepressant properties.
What should I do when I drink alcohol while taking paroxetine?
When drinking alcohol and taking paroxetine, you may experience increased sedation, fatigue and mood impairments. It is essential to monitor your symptoms and get a friend or relative to look out for you. You should contact a healthcare professional if you experience unusual symptoms or effects impairing your cognitive and motor ability or general well-being.
As alcohol can disrupt the therapeutic effect of paroxetine, it is vital to communicate your symptom relief with your healthcare provider. To avoid a dose increase and associated side effects, it may be best not to drink alcohol to maintain the optimal therapeutic efficacy of paroxetine.
Interactions of Paroxetine
Paroxetine is a neuroactive substance that travels through the bloodstream and can interact with several other substances. These interactions can alter the way the drug works, potentially leading to harmful effects or preventing the drug from working well.
- Non-steroidal anti-inflammatory drugs (e.g. aspirin and ibuprofen)
- Monoamine oxidase inhibitors [16]
- Other SSRIs (e.g. fluoxetine)
- Medication metabolised by Cytochrome P450 enzymes
- Antipsychotic drugs (e.g. olanzapine)
In summary, drinking alcohol while taking paroxetine is safe when drinking in moderation. Nonetheless, alcohol can reduce the antidepressant properties of paroxetine so drinking alcohol while taking paroxetine is not recommended.