How does it work?
Seroxat tablets and liquid contain the active ingredient paroxetine, which is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). This type of medicine acts on nerve cells in the brain. (NB. Paroxetine is also available without a brand name, ie as the generic medicine.)
In the brain there are numerous different chemical compounds called neurotransmitters. These act as chemical messengers between the nerve cells. Serotonin is one such neurotransmitter and has various functions that we know of.
When serotonin is released from nerve cells in the brain it acts to lighten mood. When it is reabsorbed into the nerve cells, it no longer has an effect on mood. It is thought that when depression occurs, there may be a decreased amount of serotonin released from nerve cells in the brain.
SSRIs work by preventing serotonin from being reabsorbed back into the nerve cells in the brain. This helps prolong the mood lightening effect of any released serotonin. In this way, paroxetine helps relieve depression, panic and fear.
Paroxetine may also be used in the treatment of anxiety disorders including obsessive-compulsive disorder, post-traumatic stress disorder and generalised anxiety disorder.
It may take between two to four weeks for the benefits of this medicine to appear, so it is very important that you keep taking it, even if it doesn't seem to make much difference at first. If you feel your depression or anxiety has got worse, or if you have any distressing thoughts or feelings in these first few weeks, then you should talk to your doctor.
It is recommended that you take your dose of this medicine in the morning, with or after food.
What is it used for?
Warning!
- Depression and other psychiatric illnesses are associated with an increased risk of suicidal thoughts, self-harm, and suicide. You should be aware that this medicine may not start to make you feel better for at least two to four weeks. However, it is important that you keep taking it in order for it to work properly and for you to feel better. If you feel your depression or anxiety has got worse, or if you have any distressing thoughts, or feelings about suicide or harming yourself in these first few weeks, or indeed at any point during treatment or after stopping treatment, then it is very important to talk to your doctor.
- This medicine may reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.
- It is recommended that you avoid drinking alcohol while taking this medicine.
- SSRI antidepressants have been associated with the development of unpleasant or distressing restlessness and the need to move, often accompanied by an inability to sit or stand still. This is most likely to occur within the first few weeks of treatment. If you experience these symptoms you should consult your doctor.
- Antidepressants may cause the amount of sodium in the blood to drop - a condition called hyponatraemia. This can cause symptoms such as drowsiness, confusion, muscle twitching or convulsions. Elderly people may be particularly susceptible to this effect. You should consult your doctor if you develop any of these symptoms while taking this medicine so that your blood sodium level can be checked if necessary.
- You should not suddenly stop taking this medicine, as this can cause withdrawal symptoms such as dizziness, pins and needles, anxiety, sleep disturbances (including intense dreams), agitation, tremor, nausea, diarrhoea, sweating, palpitations, irritability and confusion. Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They can usually be avoided by stopping the medicine gradually, usually over a period of weeks or months, depending on your individual situation. Follow the instructions given by your doctor when it is time to stop treatment with this medicine. On rare occasions some people have experienced withdrawal symptoms after accidentally missing a dose of this medicine.
- Following a review of new data from clinical trials of paroxetine in children under 18 years of age, the Committee on Safety of Medicines (CSM) has concluded that paroxetine is ineffective for treating depressive illness in this age group and actually increases the risk of harmful outcomes such as self-harm and potentially suicidal behaviour. If you are under 18 and taking paroxetine for depression you should consult your doctor for advice, but do not suddenly stop taking it as this can cause withdrawal symptoms. Paroxetine is not licensed and not recommended for any uses in children.
Use with caution in
Not to be used in
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- The safety of this medicine in pregnancy has not been established. It should be used with caution during pregnancy and only if the benefits to the mother outweigh any potential risks to the foetus. This is particularly important in the first and third trimesters where the medicine could have harmful effects on the baby. Symptoms that resemble side effects or withdrawal symptoms of paroxetine have been seen in new-born babies whose mothers took paroxetine in the third trimester. Seek medical advice from your doctor if you get pregnant or plan to have a baby while taking this medicine. If you get pregnant and decide to stop taking paroxetine you should not do so suddenly - see the warning above about withdrawal symptoms.
- Small amounts of paroxetine pass into breast milk, however the effect of this on the nursing infant is unknown. As a result, this medicine should only be used during breastfeeding if the expected benefits to the mother outweigh any risks to the nursing infant. Women who need to take this medicine could consider not breastfeeding. It is important to seek medical advice from your doctor.
Label warnings
- Take this medication with or after food.
Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
- Nausea
- Sexual problems
- Decreased appetite
- Sleepiness (somnolence)
- Difficulty in sleeping (insomnia)
- Dizziness
- Shaking, usually of the hands (tremor)
- Visual disturbances such as blurred vision
- Yawning
- Dry mouth
- Disturbances of the gut such as diarrhoea or constipation
- Sweating
- Weakness or loss of strength (asthenia)
- Weight gain
- Confusion
- Hallucinations
- Abnormal bleeding
- Seizures
- Skin reactions such as rash and itch
- Liver disorders
The side effects listed above may not include all of the side effects reported by the drug's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
Paroxetine should not be taken at the same time as monoamine oxidase inhibitor medicines (MAOIs). These include monoamine oxidase inhibitor antidepressants such as phenelzine and moclobemide, the antibiotic linezolid and the anti-Parkinson's medicine selegeline. Paroxetine should not be started until at least at least a day after stopping moclobemide or linezolid, and at least two weeks after stopping other monoamine oxidase inhibitors. Similarly, treatment with any MAOIs should not be started until at least one week after stopping treatment with paroxetine.
The amount of paroxetine in the blood may be decreased by antiepileptic medicines such as phenytoin, carbamazepine and phenobarbital. If you start taking any of these you should let your doctor know if you think your paroxetine has become less effective.
Paroxetine may increase the blood levels of the following medicines:
- antipsychotic medicines, such as aripiprazole, clozapine, perphenazine, risperidone, thioridazine, and pimozide (paroxetine must not be taken by people taking thioridazine or pimozide)
- some tricyclic antidepressants (clomipramine, imipramine, desipramine, trimipramine)
- atomoxetine
- procyclidine
- propafenone
- metoprolol.
There may be an increase in side effects if paroxetine is taken with the herbal remedy St John's wort (Hypericum perforatum). St John's wort should not be taken with paroxetine.
If paroxetine is taken with other medicines that enhance serotonin in the brain, there may be an increased risk of side effects such as agitation, restlessness and diarrhoea, known as the 'serotonin syndrome'. Other medicines that increase serotonin activity include the following:
- certain other antidepressants
- lithium
- rasagiline
- sibutramine
- the herbal St John's wort (Hypericum perforatum) - you should not take this in combination with paroxetine
- tramadol
- tryptophan
- triptans for migraine, such as sumatriptan.
There may be an increased risk of bleeding if paroxetine is taken by people who are taking any of the following medicines, which are known to affect the ability of the blood to clot:
- anticoagulants such as warfarin
- antiplatelet medicines such as aspirin, dipyridamole or ticlopidine
- non-steroidal anti-inflammatory drugs (NSAIDs) eg ibuprofen, diclofenac
- some antipsychotic medicines, eg clozapine, chlorpromazine
- some antisickness medicines, eg prochlorperazine
- tricyclic antidepressants.
People with diabetes may find that treatment with paroxetine alters control of their blood sugar. As a result, they may need an adjustment in their dose of insulin or antidiabetic tablets. Ask your doctor or pharmacist for more information and advice.
Other medicines containing the same active ingredient
Paroxetine tablets are available without a brand name, ie as the generic medicine.
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