Precautions and Warnings With Paroxetine (Cont.)

• Antidepressants (including paroxetine) may increase the risk of suicidal thinking or behavior in children, teenagers, and adults (see Depression and Suicide for more information). Therefore, if you notice any changes in symptoms or new symptoms, talk to your healthcare provider immediately. Some of these symptoms may include anxiety, hostility, agitation, panic, restlessness, hallucinations, extreme hyperactivity, and suicidal thinking or behavior (see Paxil and Suicide for more information).
   
• Before prescribing paroxetine for depression, your healthcare provider should make sure that you do not have bipolar disorder (instead of depression). Sometimes, the symptoms of bipolar disorder and depression are very similar, and paroxetine can cause problems in people with bipolar disorder.
   
• Taking paroxetine with thioridazine (Mellaril^®) can increase your risk of a dangerous irregular heart rhythm called QT prolongation. Therefore, healthcare providers do not generally recommend taking these two medications together.

(Click Drug Interactions With Paroxetine for more information about other possible drug interactions with paroxetine.)

• Taking paroxetine with other medications that affect serotonin can increase your risk of a dangerous group of symptoms called serotonin syndrome. These other medications include other antidepressants, triptans (migraine medications), and several other medications (see Drug Interactions With Paroxetine for more information). Contact your healthcare provider immediately if you have any possible symptoms of serotonin syndrome, including:

o Confusion

o Seeing or hearing things that are not really there (hallucinations)

o Fast heartbeat (tachycardia)

o Feeling faint

o Fever

o Sweating

o Muscle spasms

o Difficulty walking

o Diarrhea.

• If you have a seizure disorder, there is a possibility that taking paroxetine may cause seizures. Talk to your healthcare professional before taking paroxetine if you have seizures.
   
• Paroxetine can cause akathisia, an internal feeling of jitteriness or restlessness. Akathisia can be very disturbing, so make sure to tell your healthcare provider if you are experiencing this side effect.
   
• If you are stopping paroxetine, you should be monitored by a healthcare professional for paroxetine withdrawal symptoms. If you do develop any symptoms of paroxetine withdrawal (such as irritability, anxiety, confusion, headache, lethargy, or insomnia), your healthcare provider may slow down the rate at which the paroxetine is stopped (see Paroxetine Withdrawal).
   
• Paroxetine may cause bleeding in the stomach or intestines. This risk is increased in those taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Symptoms of gastrointestinal bleeding may include:

o Bright red blood coating the stool

o Dark blood mixed with the stool

o Black or tarry stool

o Bright red blood in vomit

o Vomit that has the appearance of coffee grounds.

If you experience any of these symptoms, call your healthcare provider.

• If you are elderly or taking a diuretic, paroxetine could cause low salt levels in the blood (hyponatremia). These generally return to "normal" when paroxetine is stopped.
   
• If you have liver problems or kidney problems, you may need a lower paroxetine dose, since the liver helps to remove paroxetine from the blood.
   
• Paroxetine can make glaucoma (a condition of the eye) worse. Talk to your healthcare provider before taking paroxetine if you have glaucoma.
   
• Paroxetine may affect your ability to perform complex tasks requiring mental and motor skills. Therefore, you should become accustomed to its effect on you before engaging in activities requiring mental or motor concentration (such as driving a car or operating machinery). Taking paroxetine with alcohol or other medications that cause drowsiness can increase this effect.
   
• Paroxetine is considered a pregnancy Category D medication. This means that the drug may cause harm to an unborn baby if it is used during pregnancy. In particular, there is evidence that paroxetine taken during early pregnancy can increase the risk of heart problems in babies. In general, paroxetine is not recommended for use during pregnancy. Talk to your healthcare provider about the risks and benefits of using paroxetine during pregnancy (see Paxil and Pregnancy for more information).
   
• Paroxetine passes through breast milk. Therefore, if you are breastfeeding or plan to start, be sure to talk with your healthcare provider about using paroxetine (see Paxil and Breastfeeding).