Buy Paroxetine No Prescription

Generic Name: Paroxetine HCl

Common Brand Name: Paxil, Paxil CR

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The following product information is not intended to replace the physician's or manufacturer's instructions.

Paroxetine common medical uses:
Paroxetine (Paxil) is in a class of drugs called selective serotonin reuptake inhibitors. It helps to improve a person's mood by treating depression. Paroxetine (Paxil) is approved by the United States Food and Drug Administration (FDA) for treatment of depression and for the following anxiety disorders: obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, post-traumatic stress disorder, and social anxiety disorder.

Paroxetine contraindications:

• Paroxetine should not be used in persons allergic to any ingredient in this medicine.
• This medication should not be used in persons in persons currently taking or have taken a monoamine oxidase (MAO) inhibitor within the last 14 days.
• It should not be used in combination with thioridazine because, as with other drugs which inhibit the hepatic enzyme CYP450 2D6, paroxetine can elevate plasma levels of thioridazine. Administration of thioridazine alone can lead to QTc interval prolongation with associated serious ventricular arrhythmia such as torsades de pointes, and sudden death.
• Paroxetine should not be used in combination with pimozide.

Paroxetine dosage:

• Generalized anxiety disorder, Post-traumatic stress disorder:
  Adults: IR formulation: 20 mg/day as a single dose with or without food, usually in the morning. May increase dose by 10 mg/day at intervals of 7 days. Usual range is 20 to 50 mg/day.
• Depression:
  Adults IR formulation: 20mg/day initially; may increase by 10mg/day at intervals of at least 7 days (max, 50 mg/day). Administer as single daily dose, usually in morning.
  Adults CR formulation: 25mg/day as a single dose, usually in the morning (usual dose range, 25 to 62.5mg/day). May increase dose in increments of 12.5 mg/day at intervals of at least 7 days (max, 62.5 mg/day).
• Obsessive-compulsive disorder:
  Adults IR formulation: 20 mg/day initially; recommended dose is 40 mg/day. May increase dose by 10 mg/day at intervals of at least 7 days (max, 60 mg/day). Administer as single daily dose, usually in morning.
• Panic Disorder:
  Adults IR formulation: 10mg/day initially; recommended dose is 40mg/day. May increase dose by 10 mg/day at intervals of at least 7 days (max, 60 mg/day). Administer as single daily dose, usually in morning.
  Adults CR formulation: 12.5mg/day as a single dose, usually in the morning. May increase dose in increments of 12.5mg/day at intervals of at least 7 days (max, 75mg/day).
• Premenstrual dysphoric disorder:
  Adults CR formulation: 12.5 mg/day initially, usually in the morning; change doses at intervals of at least 7 days; usual range is 12.5 to 25 mg/day. May be administered either daily throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle.
• Social Anxiety Disorder:
  Adults IR formulation: 20 mg/day as a single daily dose, usually in the morning. Usual range is 20 to 60mg/day.
  Adults CR formulation: 12.5 mg initially, usually in the morning. Usual range is 12.5 to 37.5 mg/day. May increase dose in increments of 12.5 mg/day at intervals of at least 7 days (max, 37.5 mg/day).

Dosage adjustment in elderly, severe renal or hepatic function impairment

• IR formulation: 10 mg/day initially; do not exceed 40 mg/day.
• CR formulation: 12.5 mg/day initially; do not exceed 50 mg/day.

• Take without regard to meals but with food if GI upset occurs.
• CR tablets should be swallowed whole. Do not crush, chew, divide, or break tablets.
• Shake suspension well before measuring dose.

Paroxetine (Paxil) side effects:
Every medicine can cause side effects, but many people have no, or minor, side effects. Tell your doctor or pharmacist if any of the following occurs:

• Body as a Whole:
  Frequent: Malaise, pain.
  Infrequent: Allergic reaction, chills, face edema, infection, moniliasis, neck pain, overdose.
  Rare: Abnormal laboratory value, abscess, adrenergic syndrome, cellulitis, chills and fever, cyst, hernia, intentional overdose, neck rigidity, pelvic pain, peritonitis, substernal chest pain, ulcer.
• Cardiovascular:
  Frequent: Vasodilation (4%); palpitation (3%); hypertension, tachycardia (at least 1%).
  Infrequent: Bradycardia, conduction abnormalities, ECG abnormal, hypotension, migraine, ventricular extrasystoles.
  Rare: Angina pectoris, arrhythmia, atrial arrhythmia, atrial fibrillation, bundle branch block, cerebral ischemia, cerebrovascular accident, congestive heart failure, extrasystoles, low cardiac output, myocardial infarct, myocardial ischemia, pallor, phlebitis, pulmonary embolus, supraventricular extrasystoles, thrombosis, varicose vein, vascular headache.
• Dermatological:
  Frequent: sweating (14%); rash (3%); pruritus (at least 1%).
  Infrequent: Acne, alopecia, dry skin, ecchymosis, eczema, furunculosis, herpes simplex, urticaria.
  Rare: Angioedema, contact dermatitis, erythema nodosum, herpes zoster, maculopapular rash, photosensitivity, skin discoloration, skin ulcer.
• Endocrine:
  Rare: Diabetes mellitus, hyperthyroidism, hypothyroidism, thyroiditis.
• GastroIntestinal:
  Frequent: nausea (36%); dry mouth (21%); diarrhea (19%); constipation (16%); decreased appetite (9%); dyspepsia (5%); flatulence, increased appetite, taste perversion (4%); vomiting (3%); oropharynx disorder (2%).
  Infrequent: Bruxism, buccal cavity disorders, dysphagia, eructation, gastroenteritis, gastrointestinal flu, glossitis, increased salivation, liver function tests abnormal, mouth ulceration, vomiting and diarrhea, rectal hemorrhage.
  Rare: Aphthous stomatitis, bloody diarrhea, bulimia, colitis, duodenitis, esophagitis, fecal impaction, fecal incontinence, gastritis, gingivitis, hematemesis, hepatitis, ileus, jaundice, melena, peptic ulcer, salivary gland enlargement, stomach ulcer, stomatitis, tongue edema, tooth caries.
• Hematologic and Lymphatic:
  Infrequent: Anemia, leukopenia, lymphadenopathy, purpura, WBC abnormality.
  Rare: Eosinophilia, iron deficiency anemia, leukocytosis, lymphedema, lymphocytosis, microcytic anemia, monocytosis, normocytic anemia.
• Metabolic and Nutritional:
  Frequent: Weight gain, weight loss.
  Infrequent: Edema, hyperglycemia, peripheral edema, thirst.
  Rare: Alkaline phosphatase increased, bilirubinemia, dehydration, gout, hypercholesteremia, hypocalcemia, hypoglycemia, hypokalemia, hyponatremia, obesity, AST (SGOT) increased, ALT (SGPT) increased.
• Musculoskeletal:
  Infrequent: Arthralgia, arthritis, traumatic fracture.
  Rare: Arthrosis, bursitis, cartilage disorder, myositis, osteoporosis, tetany.
• Central Nervous System:
  Frequent: insomnia, somnolence (24%); asthenia (22%); headache (18%); tremor (15%); dizziness (14%); decreased libido (12%); nervousness (9%); anxiety, paresthesia (6%); agitation (5%); abnormal dreams, impaired concentration (4%); depersonalization (3%); amnesia, drugged feeling (2%); confusion (1%); emotional lability, vertigo (at least 1%).
  Infrequent: Akinesia, alcohol abuse, amnesia, ataxia, convulsion, depersonalization, hallucinations, hyperkinesia, hypertonia, incoordination, lack of emotion, manic reaction, paranoid reaction, thinking abnormal.
  Rare: Abnormal EEG, abnormal gait, antisocial reaction, choreoathetosis, circumoral paresthesia, delirium, delusions, diplopia, drug dependence, dysarthria, dyskinesia, dystonia, euphoria, fasciculations, grand mal convulsion, hostility, hyperalgesia, hypokinesia, hysteria, libido increased, manic depressive reaction, meningitis, myelitis, neuralgia, neuropathy, nystagmus, psychosis, psychotic depression, reflexes increased, stupor, withdrawal syndrome.
• Respiratory:
  Frequent: Cough increased, rhinitis.
  Infrequent: Asthma, bronchitis, dyspnea, epistaxis, hyperventilation, pneumonia, respiratory flu, sinusitis.
  Rare: Hiccup, lung fibrosis, sputum increased, voice alteration.
• Special Senses:
  Infrequent: blurred vision (8%); abnormal vision, tinnitus (at least 1%).
  Rare: Amblyopia, cataract specified, conjunctival edema, corneal lesion, corneal ulcer, exophthalmos, eye hemorrhage, glaucoma, hyperacusis, otitis externa, photophobia, retinal hemorrhage, taste loss.
• Genitourinary:
  Frequent: abnormal ejaculation (28%); ejaculatory disturbance (13%); other male genital disorders (10%); female genital disorders including anorgasmia, impotence (9%); dysmenorrhea (5%); impaired urination, urinary disorder, urinary frequency or hesitancy (3%); UTI (2%).
  Rare: acute renal failure, eclampsia, priapism.

Paroxetine precautions:

• Children and adolescents under 18 years of age. Paroxetine should not be used in the treatment of children and adolescents under the age of 18 years. Suicide related behaviours (suicide attempts and suicidal thoughts) and hostility (predominantly aggression, oppositional behaviour and anger) were more frequently observed in clinical trials among children and adolescents treated with antidepressants compared to those treated with placebo.
• Akathisia/psychomotor restlessness. The use of paroxetine has been associated with the development of akathisia, which is characterized by an inner sense of restlessness and psychomotor agitation such as an inability to sit or stand still usually associated with subjective distress. This is most likely to occur within the first few weeks of treatment. In patients who develop these symptoms, increasing the dose may be detrimental.
• Mania. As with all antidepressants, paroxetine should be used with caution in patients with a history of mania. Paroxetine should be discontinued in any patient entering a manic phase.
• Renal/hepatic impairment. Caution is recommended in patients with severe renal impairment or in those with hepatic impairment.
• Diabetes. In patients with diabetes, treatment with an SSRI may alter glycaemic control. Insulin and/or oral hypoglycaemic dosage may need to be adjusted.
• Seizures. Overall the incidence of seizures is less than 0.1% in patients treated with paroxetine. The drug should be discontinued in any patient who develops seizures.
• Glaucoma. As with other SSRI's, paroxetine infrequently causes mydriasis and should be used with caution in patients with narrow angle glaucoma or history of glaucoma.
• Cardiac conditions. The usual precautions should be observed in patients with cardiac conditions.
• Hyponatraemia. Hyponatraemia has been reported rarely, predominantly in the elderly. Caution should also be exercised in those patients at risk of hyponatraemia e.g. from concomitant medications and cirrhosis. The hyponatraemia generally reverses on discontinuation of paroxetine.
• Haemorrhage. There have been reports of cutaneous bleeding abnormalities such as ecchymoses and purpura with SSRIs. Other haemorrhagic manifestations e.g. gastrointestinal haemorrhage have been reported. Elderly patients may be at an increased risk. Caution is advised in patients taking SSRI's concomitantly with oral anticoagulants, drugs known to affect platelet function or other drugs that may increase risk of bleeding (e.g. atypical antipsychotics such as clozapine, phenothiazines, most TCA's, acetylsalicylic acid, NSAID's, COX-2 inhibitors) as well as in patients with a history of bleeding disorders or conditions which may predispose to bleeding.

Drug Interactions:
Paroxetine is a potent inhibitor of cytochrome P450 2D6 (CYP2D6) , but a very weak inhibitor of CYP3A4. Caution should be exercised when paroxetine is coadministered with medications that are metabolized by CYP2D6, such as tricyclic antidepressants , phenothiazines (e.g., thioridazine) , or type IC antiarrhythmics (e.g., encainide, flecainide, or propafenone), or medications that inhibit CYP2D6, such as quinidine. Dosage reductions of paroxetine and/or the other medication may be necessary. Interactions with medications metabolized by the CYP3A4 isoenzyme are unlikely.

• Antidepressants, tricyclic (TCAs): paroxetine may inhibit TCA metabolism, leading to increased TCA plasma concentrations, and possibly causing adverse effects.
• Aspirin, Nonsteroidal anti-inflammatory drugs (NSAIDs), drugs that affect coagulation: caution should be used; risk of bleeding associated with concomitant use.
• Cimetidine: may increase paroxetine concentrations.
• Cyclosporine: concentrations of cyclosporine may be elevated, increasing the risk of toxicity.
• CYP2D6 substrates (flecainide, fluoxetine, phenothiazines, propafenone, qinidine): use with caution; concomitant use of paroxetine and other drugs metabolized by CYP2D6 may require lower doses of paroxetine or the other drug.
• Digoxin: mean digoxin area under the plasma concentration–time curve [AUC] decreased 15% in the presence of paroxetine; since there is little clinical experience with this combination, concurrent administration should be undertaken with caution.
• Lithium: use with caution due to limited clinical experience
• Metoprolol: concomitant use of paroxetine and metoprolol may result in severe hypotension
• Moclobemide: because of the potentially fatal effects of concomitant use of paroxetine and nonselective, irreversible monoamine oxidase [MAO] inhibitors, and the increased risk of development of the serotonin syndrome with concomitant use of paroxetine and the selective, reversible MAO-A inhibitor moclobemide, concurrent use is not recommended ; allowing 3 to 7 days to elapse between discontinuing moclobemide and initiating paroxetine therapy, and allowing 2 weeks to elapse between discontinuing paroxetine and initiating moclobemide therapy is advised
• Monoamine oxidase (MAO) inhibitors: concurrent use of MAO inhibitors with paroxetine may result in potentially fatal reactions, which may include confusion, agitation, restlessness, and gastrointestinal symptoms, or possibly hyperpyretic episodes, severe convulsions, hypertensive crises, or the serotonin syndrome; concurrent use is contraindicated , and at least 14 days should elapse between discontinuation of one medication and initiation of the other.
• Phenobarbital or Primidone: primidone is partially metabolized to phenobarbital, which induces many cytochrome P450 enzymes; administration of either of these agents concomitantly with paroxetine may reduce the systemic availability of paroxetine
• Phenytoin: concomitant administration with paroxetine may decrease the systemic availability of either agent.
• Procyclidine: concurrent use may increase the systemic availability of procyclidine.
• Serotonergics or other medications or substances with serotonergic activity: increased risk of developing the serotonin syndrome, a rare but potentially fatal hyperserotonergic state; symptoms typically occur shortly [hours to days] after the addition of a serotonergic agent, such as paroxetine, to a regimen that includes serotonin-enhancing drugs or an increase in dosage of a serotonergic agent.
• St. John's Wort: may increase undesirable effects.
• Theophylline: elevated theophylline concentrations have been reported during concurrent use.
• Thioridazine: may prolong the QTc interval, which is associated with serious ventricular arrythmias and sudden death; administration of paroxetine and thioridazine is not recommended.
• Tramadol: Combined use may cause serotonin syndrome.
• Tryptophan: Adverse experiences, consisting primarily of headache, nausea, sweating, and dizziness, have been reported when tryptophan was administered to patients taking Paxil.
• Warfarin: although paroxetine does not alter in vitro protein binding of warfarin , a pharmacodynamic interaction may exist that causes an increased bleeding diathesis despite unaltered prothrombin time.

Pregnancy and lactation
Some epidemiological studies suggest a small increased risk of cardiovascular malformation (e.g. ventricular (majority) and atrial septum defects) associated with the use of paroxetine during the first trimester. The mechanism is unknown. The data suggests that the risk of having an infant with a cardiovascular defect following maternal paroxetine exposure is less than 2/100 compared with an expected rate for such defects of approximately 1/100 in the general population. Available data do not suggest an increase of the overall rate of congenital malformation. Paroxetine should only be used during pregnancy when strictly indicated.

Based on available data, paroxetine is generally considered compatible (low risk to infant) while breast-feeding (human data).

Overdose:
If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include nausea, vomiting, drowsiness, severe dizziness, severe sweating, fast heartbeat, dilated pupils, change in the amount of urine, flushed face, fainting, seizures, or yellowing of the eyes or skin.

Missed dose:
If a dose is missed, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised by your doctor. If more than one dose is missed, contact your doctor or pharmacist.

How to buy:
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Storage:
Store at room temperature between 59 and 86 degrees F (15 to 30 degrees C) away from heat and light. Do not store in the bathroom.

References:

• 1. U.S. Food and Drug Administration. Paxil (Paroxetine) U.S. Prescribing Information. Available at (PDF format): Prescribing Information