Paroxetine
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Paroxetine
Paroxetine may be used to delay ejaculation. This medication, often branded as Paxil, is most commonly used to treat depression, anxiety, and obsessive compulsive disorder (OCD). Delay of ejaculation was noted to be a side effect in men taking this medication, and has since been studied specifically with regard to premature ejaculation. It has been shown to delay the intra-vaginal ejaculatory latency time (IELT).
How Paroxetine works
Paroxetine is a selective serotonin reuptake inhibitor (SSRI). It works by raising the levels of serotonin, an important chemical in your brain that’s involved with regulating your mood. It also results in an increase in the amount of 5-hydroxytryptamine (5-HT) in postsynaptic membrane receptors which is the mechanism by which it delays ejaculation.
Typical dosing for Paroxetine
- On demand dose of 20 mg taken 3-4 hours before sexual activity
- Daily 10-20 mg; 10 mg is the most common daily dose for PE
- On average it takes 4-6 weeks of daily medication to have effect
mensRxplus Recommendations:
- May take with or without food. If paroxetine causes nausea for you then take it with food.
- If taking a daily dose more than 10 mg you should not suddenly stop taking the medication, but should instead wean off to avoid withdrawal symptoms. A typical weaning protocol involves lowering the dose by 5-10 mg per week. It typically takes 4-6 weeks to wean off the 40 mg daily dose. mensRxplus typically prescribes 10 mg daily dose so this is less of a concern.
- Paroxetine can make you sleepy and dizzy. Don’t drive or do anything requiring concentration until you know how this medication affects you.
- Tell your primary medical provider that you are taking this medication because it can interact with many other medications.
- Interactions with other medications are less likely if taking paroxetine occasionally on-demand, compared to if taking daily.
Side Effects:
Common Side Effects
Based on patients taking this medication for depression, obsessive compulsive disorder (OCD), and/or anxiety:
- Abnormal ejaculation (up to 28%)
- Nausea (up to 25%)
- Weakness (up to 22%)
- Sleepiness or trouble sleeping (up to 24%)
- Dry mouth (up to 18%)
- Constipation (up to 16%)
- Sweating (up to 14%)
- Dizziness (up to 14%)
- Diarrhea (up to 12%)
- Low libido (up to 12%)
- Shakiness (up to 11%)
Other less commonly reported side effects could include: blurry vision, nervousness, low appetite, anxiety, yawning, numbness or tingling.
Serious Side Effects
- Suicidal thoughts or behaviors
- Serotonin syndrome: fast heart rate, dizziness, sweating, flushing, tremor (shakiness), muscle stiffness, muscle twitching or spasms, uncoordinated movement, distress, seizures, distress, hallucinations, coma
- Seizures
- Abnormal heart rhythm (QT prolongation): chest pounding, short of breath, chest pain, feeling faint or lightheaded
- Severe bleeding: bruising that doesn’t improve, black-colored stools, pink or red-colored urine, coughing up or vomiting blood, or unusual bleeding from the nose or gums
- Low blood sodium levels: nausea, fatigue, headache, confusion, disoriented, hallucinations (seeing things that aren’t real), seizures, unconsciousness
Drug Interactions
Let your healthcare provider know if you take any of the below medications because Paroxetine (Paxil) will not be safe for you to take.
- Currently take or have taken an MAOI, linezolid (Zyvox), or methylene blue (ProvayBlue) in the last 14 days
- Taking thioridazine (Mellaril)
- Taking pimozide (Orap)
- Other antidepressants (both SSRI and non-SSRI). Taken together this could raise the amount of serotonin and result in something called serotonin syndrome. This can also occur with triptan migraine medications, like sumatriptan (Imitrex) and some opioids, like tramadol (Ultram)
There is an extensive list of drugs that paroxetine may interact with. You should avoid paroxetine when taking the following medications:
- Bepridil
- Bromopride
- Cisapride
- Clorgyline
- Dronedarone
- Eliglustat
- Furazolidone
- Iproniazid
- Isocarboxazid
- Linezolid
- Mesoridazine
- Methylene Blue
- Moclobemide
- Nialamide
- Pargyline
- Phenelzine
- Pimozide
- Piperaquine
- Procarbazine
- Rasagiline
- Saquinavir
- Selegiline
- Sparfloxacin
- Terfenadine
- Thioridazine
- Toloxatone
- Tranylcypromine
- Ziprasidone
Paroxetine can affect the metabolism of the following medications so dose adjustments may be required. Discuss with your medical provider.
- Abciximab
- Aceclofenac
- Acemetacin
- Acenocoumarol
- Alfentanil
- Almotriptan
- Amineptine
- Amiodarone
- Amisulpride
- Amitriptyline
- Amitriptylinoxide
- Amoxapine
- Amphetamine
- Amtolmetin Guacil
- Anagrelide
- Apixaban
- Apomorphine
- Ardeparin
- Argatroban
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Aspirin
- Atomoxetine
- Bemiparin
- Benzhydrocodone
- Benzphetamine
- Betrixaban
- Bivalirudin
- Brexpiprazole
- Bromfenac
- Bufexamac
- Buprenorphine
- Bupropion
- Buserelin
- Buspirone
- Butorphanol
- Cangrelor
- Carvedilol
- Celecoxib
- Ceritinib
- Certoparin
- Chloroquine
- Choline Salicylate
- Cilostazol
- Citalopram
- Clarithromycin
- Clomipramine
- Clonixin
- Clopidogrel
- Clozapine
- Codeine
- Crizotinib
- Cyclobenzaprine
- Dabigatran Etexilate
- Dabrafenib
- Dalteparin
- Danaparoid
- Dasatinib
- Degarelix
- Delamanid
- Delavirdine
- Desipramine
- Desirudin
- Deslorelin
- Desmopressin
- Desvenlafaxine
- Deutetrabenazine
- Dexibuprofen
- Dexketoprofen
- Dextroamphetamine
- Dextromethorphan
- Dibenzepin
- Diclofenac
- Diflunisal
- Dihydrocodeine
- Dipyridamole
- Dipyrone
- Dolasetron
- Domperidone
- Donepezil
- Doxepin
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Droperidol
- Droxicam
- Duloxetine
- Edoxaban
- Efavirenz
- Eletriptan
- Encorafenib
- Enoxaparin
- Entrectinib
- Epoprostenol
- Eptifibatide
- Escitalopram
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenfluramine
- Fenoprofen
- Fentanyl
- Fepradinol
- Feprazone
- Fingolimod
- Floctafenine
- Fluconazole
- Flufenamic Acid
- Fluoxetine
- Flurbiprofen
- Fluvoxamine
- Fondaparinux
- Formoterol
- Foscarnet
- Fostemsavir
- Frovatriptan
- Glasdegib
- Glucagon
- Glycopyrrolate
- Glycopyrronium Tosylate
- Gonadorelin
- Goserelin
- Granisetron
- Haloperidol
- Heparin
- Histrelin
- Hydrocodone
- Hydromorphone
- Hydroxychloroquine
- Hydroxytryptophan
- Hydroxyzine
- Ibuprofen
- Iloprost
- Imipramine
- Indomethacin
- Inotuzumab Ozogamicin
- Iobenguane I 123
- Iobenguane I 131
- Ivabradine
- Ivosidenib
- Ketoconazole
- Ketoprofen
- Ketorolac
- Lasmiditan
- Lefamulin
- Lenvatinib
- Lepirudin
- Levofloxacin
- Levomilnacipran
- Levorphanol
- Lisdexamfetamine
- Lithium
- Lofepramine
- Lofexidine
- Lorcaserin
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Macimorelin
- Meclofenamate
- Mefenamic Acid
- Melitracen
- Meloxicam
- Meperidine
- Metaxalone
- Methacholine
- Methadone
- Methamphetamine
- Metoclopramide
- Metronidazole
- Mexiletine
- Milnacipran
- Mirtazapine
- Morniflumate
- Morphine
- Morphine Sulfate Liposome
- Moxifloxacin
- Nabumetone
- Nadroparin
- Nafarelin
- Nalbuphine
- Naproxen
- Naratriptan
- Nebivolol
- Nefazodone
- Nepafenac
- Niflumic Acid
- Nilotinib
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Nortriptyline
- Ondansetron
- Opipramol
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxaprozin
- Oxycodone
- Oxymorphone
- Oxyphenbutazone
- Ozanimod
- Palonosetron
- Panobinostat
- Parecoxib
- Parnaparin
- Pasireotide
- Pazopanib
- Pentazocine
- Perphenazine
- Phenindione
- Phenprocoumon
- Phenylbutazone
- Piketoprofen
- Pimavanserin
- Piroxicam
- Pitolisant
- Ponesimod
- Posaconazole
- Pranoprofen
- Prasugrel
- Proglumetacin
- Propafenone
- Propyphenazone
- Proquazone
- Protein C
- Protriptyline
- Quetiapine
- Remifentanil
- Revefenacin
- Reviparin
- Ribociclib
- Risperidone
- Rivaroxaban
- Rizatriptan
- Rofecoxib
- Safinamide
- Salicylic Acid
- Salsalate
- Scopolamine
- Secretin Human
- Selexipag
- Selpercatinib
- Sertraline
- Sevoflurane
- Sibutramine
- Siponimod
- Sodium Salicylate
- Solifenacin
- Sotalol
- St John’s Wort
- Sufentanil
- Sulfinpyrazone
- Sulindac
- Sulodexide
- Sulpiride
- Sumatriptan
- Sunitinib
- Tacrolimus
- Tamoxifen
- Tamsulosin
- Tapentadol
- Tenoxicam
- Tianeptine
- Tiaprofenic Acid
- Ticagrelor
- Ticlopidine
- Timolol
- Tinzaparin
- Tiotropium
- Tirofiban
- Tolfenamic Acid
- Tolmetin
- Tolterodine
- Tramadol
- Trazodone
- Treprostinil
- Triclabendazole
- Trimipramine
- Triptorelin
- Tryptophan
- Valbenazine
- Valdecoxib
- Vandetanib
- Vemurafenib
- Venlafaxine
- Vilazodone
- Vinflunine
- Voclosporin
- Vorapaxar
- Vortioxetine
- Warfarin
- Zolmitriptan
- Zuclopenthixol
Frequently Asked Questions
If taken as an on-demand medication for PE, paroxetine should be taken 3-4 hours before sexual activity.
There is not currently an FDA approved medication that is available in the US to treat premature ejaculation. Dapoxetine is an SSRI medication (similar to paroxetine) that has been approved and used in Europe for a number of years for premature ejaculation. It has not been brought to market in the US. Paroxetine and other SSRI medications have been studied in randomized controlled trials and found to be safe and efficacious for treatment of PE. Paroxetine has been prescribed for years in the US for PE despite being “off label.” Paroxetine is supported in the American Urologic Association (AUA) guideline for PE.
There have been several studies over the past 25 years supporting the safety of use. Also, paroxetine is widely used as an anti-depressants so its side effects are generally well known. It is FDA approved for other indications, which means the FDA has determined it is safe for humans to take. Paroxetine is supported in the American Urologic Association (AUA) guideline for PE. This is the governing body for US Urologists / Andrologists who study and treat men with PE.
Yes, paroxetine may be combined with topical treatments for PE, along with behavioral therapy. In combination this may have an increased benefit for men with PE.
Warnings
Suicidal Thoughts
Taking paroxetine can make your depression worse and cause suicidal thoughts, or thoughts of self harm. The risk is highest if you’re 24 years of age or younger, during the first few weeks of taking the medication, and when your dose changes. If you or anyone around you notice that you have suicidal thoughts or unusual behavior (e.g., anxiety, panic attacks, difficulty sleeping, feeling angry or irritated, restlessness) while taking paroxetine (Paxil), get medical help right away.
Withdrawal Symptoms
Stopping daily paroxetine suddenly, or rapidly reducing your dose, can cause withdrawal symptoms such as nausea, anxiety, agitation ,flu-like symptoms, trouble sleeping, and dizziness. To reduce the risk of withdrawal symptoms, those taking a daily dose over 10mg should reduce the dose by 5-10 mg per week.
Serotonin Syndrome
Serotonin Syndrome happens when there’s too much serotonin in the brain. Your risk for serotonin syndrome is higher if you use paroxetine with other medications that can raise your serotonin levels, such as certain antidepressants, mental health medications, pain medications, and migraine medications. Let your provider know about all the medications you take before starting paroxetine. Symptoms of serotonin syndrome include fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion. Seek medical help right away if you have any of these symptoms.
Low Blood Sodium Levels
Paroxetine can lower blood sodium levels. This is more of a risk if you take diuretic medications that also lower your sodium. Symptoms of low sodium (hyponatremia) are weakness, confusion, difficulty concentrating, headache, or memory problems. Seek medical help right away if you have any of these symptoms.
Risk of Bleeding
Paroxetine can raise your risk of bleeding or bruising in those who are taking antiplatelets (e.g., aspirin, clopidogrel (Plavix)) or anticoagulants (e.g., warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto)). Get medical help if you get bruising that doesn’t improve, black-colored stools, pink or red-colored urine, coughing up or vomiting blood, or unusual bleeding from the nose or gums.
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