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Paxil CR Fact Sheet

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Medication Name (brand): 
Paxil CR
Medication Name (clinical): 
paroxetine CR
Manufacturer: 

GlaxoSmithKline

Indications: 
  • Major depression

  • Panic Disorder
  • Social Anxiety Disorder
  • Premenstrual Dysphoric Disorder
  • Off-label use for generalized anxiety disorder, obsessive compulsive disorder, and posttraumatic stress disorder.

Mechanism: 

Selective Serotonin Reuptake Inhibitor (SSRI). Different from Paxil IR because of an enteric-coated “geomatrix,” which delays release of the drug by 4 to 5 hours.

Dosing: 
  • Supplied in 12.5 mg yellow, 25 mg pink, and 37.5 mg blue tablets (not breakable).

  • Many patients tolerate a starting dose of 25 mg QD.
  • Start at 12.5 mg QD for the elderly or those most susceptible to side effects. Can be taken QAM or QPM (may be either sedating or activating).
  • Effective dose 12.5 mg to 62.5 mg QD.

Side Effects: 
  • Most common are nausea, fatigue, insomnia, and sexual dysfunction; its cousin, Paxil IR, is considered by most practitioners to cause more weight gain, sexual dysfunction, and fatigue than all of the other SSRIs

  • Causes less initial nausea and possibly less weight gain than Paxil IR
  • Black Box Warning: In clinical trials, SSRIs and SNRIs increased the risk of suicidality in children (from 2% to 4%). No actual suicides occurred in these trials, and none of the trials included MAOIs, but all antidepressants are required to carry this warning anyway.
  • Pregnancy Category D (risk of congenital heart defects, neonatal distress)

Drug-drug Interactions: 
  • Inhibits 2D6; will increase effective serum levels of tricyclics, phenothiazines, type 1C antiarrythmics; contraindicated with mellaril

  • Highly protein-bound, so monitor dilantin, coumadin, and digoxin levels may be increased

Pearls: 

Significant withdrawal syndrome if not gradually tapered; warn patients of dizziness, insomnia, electrical shock sensations.

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