TaperCommunityparoxetine
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial treatment.
Paroxetine is an SSRI with notable anticholinergic activity, approved for major depressive disorder, OCD, panic disorder, social anxiety disorder, GAD, and PTSD. It is widely recognized as one of the more difficult SSRIs to discontinue.
10mg, 20mg, 30mg, 40mg
Tablets: 10mg, 20mg, 30mg, 40mg; Oral suspension: 10mg/5mL; Controlled-release (CR) tablets: 12.5mg, 25mg, 37.5mg
Category D (positive evidence of risk — cardiac malformations)
Potent and selective inhibitor of serotonin reuptake (SERT). Also has significant anticholinergic (muscarinic) activity and weak norepinephrine reuptake inhibition, which contribute to its withdrawal profile.
Short half-life for an SSRI. Liquid formulation available. Often considered one of the harder SSRIs to taper.
Particularly difficult to stop due to short half-life and anticholinergic withdrawal. Very slow final taper essential.
Evidence-based phased reduction schedule. Always taper under medical supervision.
| Phase | Duration | Notes |
|---|---|---|
| Initial reductions | 4-6 weeks | Use available tablet strengths. Anticholinergic rebound may begin in this phase. |
| Middle reductions | 6-8 weeks | Ask your prescriber about liquid suspension or CR tablets for smoother transitions. |
| Lower dose reductions | 6-8 weeks | Paroxetine's non-linear kinetics mean even small changes can have an outsized effect. Go slow. |
| Final reductions | 8-16 weeks | Liquid formulation is often necessary for precise adjustments. Work closely with your prescriber. |
12-24 hours after missed dose (shortest onset of all SSRIs)
2-5 days
2-6 weeks for most symptoms
Electric shock sensations, emotional lability, and derealization can persist 2-6 months. Paxil has the highest rate of protracted withdrawal among SSRIs.
Practical insights shared by members tapering Paxil. Not medical advice — always consult your prescriber.
Toxicity
Serotonin syndrome risk. Anticholinergic toxicity at high doses. Associated with higher rates of discontinuation syndrome than other SSRIs.
Pharmacokinetics
Completely absorbed after oral dosing but extensive first-pass metabolism reduces bioavailability to ~50%. Tmax ~5 hours. Food does not significantly affect absorption.
~8.7 L/kg
Extensively metabolized hepatically via CYP2D6 (primary) with CYP3A4 contribution. Paroxetine inhibits its own metabolism (CYP2D6 saturation), leading to non-linear pharmacokinetics.
Renal (~64% as metabolites, ~2% unchanged) and fecal (~36%).
~93–95%
Non-linear; clearance decreases at higher doses due to CYP2D6 saturation.
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