Paxil CR Warnings and Precautions
Some warnings and precautions for Paxil CR include:
- Antidepressants (including Paxil CR) may increase the risk of suicidal thinking or behavior in children, teenagers, and adults (see Antidepressants and Suicide for more information). Therefore, if you notice any changes in symptoms or new symptoms while taking Paxil CR, talk with your healthcare provider immediately. Some of these symptoms include anxiety, hostility, agitation, panic, restlessness, hallucinations, extreme hyperactivity, and suicidal thinking or behavior (see Paxil CR and Suicide for more information).
- Before prescribing Paxil CR 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 Paxil CR can cause problems in people with bipolar disorder.
- Paxil CR can interact with certain other medications (see Paxil CR Drug Interactions).
- Taking Paxil CR with thioridazine (Mellaril®) can increase your risk of a dangerous irregular heart rhythm called QT prolongation. Therefore, it is not recommended that you take these two medications together (see Paxil CR Drug Interactions for more information).
- Antidepressants can cause a group of dangerous symptoms known as serotonin syndrome. Taking Paxil CR with other medications that affect serotonin can increase your risk of serotonin syndrome. These other medications can include other antidepressants, triptans (migraine medications), and several other medications (see Paxil CR Drug Interactions for more information). Contact your healthcare provider immediately if you have any possible symptoms of serotonin syndrome, including:
- Seeing or hearing things that are not really there (hallucinations)
- A fast heartbeat (tachycardia)
- Feeling faint
- A fever
- Muscle spasms
- Difficulty walking
- If you have a seizure disorder, there is a possibility that taking Paxil CR may cause seizures. Talk with your healthcare professional before taking Paxil CR if you have seizures.
- Paxil CR 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 Paxil CR side effect.
- If you are stopping Paxil CR, you should be monitored by a healthcare professional for Paxil CR withdrawal symptoms. If you do develop any symptoms of withdrawal -- such as irritability, anxiety, confusion, headache, lethargy, or insomnia -- your healthcare provider may slow down the rate at which the Paxil CR is stopped (see Paxil CR Withdrawal).
- Paxil CR 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:
- Bright red blood coating the stool
- Dark blood mixed with the stool
- Black or tarry stool
- Bright red blood in vomit
- 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, Paxil CR could cause low salt levels in the blood (hyponatremia). This generally returns to "normal" when Paxil CR is stopped.
- If you have liver or kidney problems, you may need a lower Paxil CR dose, since the liver helps to remove Paxil CR from the blood.
- Paxil CR can make glaucoma (a condition of the eye) worse. Talk with your healthcare provider before taking Paxil CR if you have glaucoma.
- Paxil CR may affect your ability to perform complex tasks requiring mental and motor skills. Therefore, it is recommended that you become accustomed to its effect on you before becoming involved in activities requiring mental or motor concentration (such as driving a car or operating machinery). Taking Paxil CR with alcohol or other medications that cause drowsiness can increase this effect.
- Paxil CR is considered a pregnancy Category D medication. This means that Paxil CR may cause harm to an unborn baby if it is used during pregnancy. In particular, there is evidence that Paxil CR taken during early pregnancy can increase the risk of heart problems in babies. In general, Paxil CR is not recommended for use during pregnancy. Talk with your healthcare provider about the risks and benefits of using Paxil CR during pregnancy (see Paxil CR and Pregnancy for more information).
- Paxil CR passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about this (see Paxil CR and Breastfeeding).