Paxil Warnings and Precautions

• Antidepressants (including Paxil) 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 Paxil 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 can cause problems in people with bipolar disorder.
   
• Taking Paxil 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 (see Paxil Drug Interactions for more information about this and other drug interactions with Paxil).
   
• Antidepressants can cause a group of dangerous symptoms known as serotonin syndrome. Taking Paxil with other medications that affect serotonin can increase your risk of serotonin syndrome. These other medications include other antidepressants, triptans (migraine medications), and several other medications (see Paxil Drug Interactions for more information). Contact your healthcare provider immediately if you have any possible symptoms of serotonin syndrome, including:

• Confusion
• Seeing or hearing things that are not really there (hallucinations)
• Fast heartbeat (tachycardia)
• Feeling faint
• Fever
• Sweating
• Muscle spasms
• Difficulty walking
• Diarrhea.

• If you have a seizure disorder, there is a possibility that taking Paxil may cause seizures. Talk to your healthcare professional before taking Paxil if you have seizures.
   
• Paxil 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 Paxil, you should be monitored by a healthcare professional for Paxil withdrawal symptoms. If you do develop any symptoms of Paxil withdrawal, such as irritability, anxiety, confusion, headache, lethargy, or insomnia, your healthcare provider may slow down the rate at which the Paxil is stopped (see Paxil Withdrawal).
   
• Paxil 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 could cause low salt levels in the blood (hyponatremia). These generally return to "normal" when Paxil is stopped.
   
• If you have liver problems or kidney problems, you may need a lower Paxil dose, since the liver helps to remove Paxil from the blood.
   
• Paxil can make glaucoma (a condition of the eye) worse. Talk to your healthcare provider before taking Paxil if you have glaucoma.
   
• Paxil 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 Paxil with alcohol or other medications that cause drowsiness can increase this effect.
   
• Paxil 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 Paxil taken during early pregnancy can increase the risk of heart problems in babies. In general, Paxil is not recommended for use during pregnancy. Talk to your healthcare provider about the risks and benefits of using Paxil during pregnancy (see Paxil and Pregnancy for more information).
   
• Paxil passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about using Paxil (see Paxil and Breastfeeding).
   

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