Paroxetine (Page 8 of 9)

16 HOW SUPPLIED/STORAGE AND HANDLING

Paroxetine extended-release tablets USP, are supplied as a round, extended-release tablet as follows:

  • 12.5 mg yellow, film-coated, round, biconvex tablets debossed with “v11” on one side.
    Bottles of 30s with child-resistant closure, NDC 69367-335-30
  • 25 mg pink, film-coated, round, biconvex tablets debossed with “v12” on one side.
    Bottles of 30s with child-resistant closure, NDC 69367-336-30
  • 37.5 mg blue, film-coated, round, biconvex tablets debossed with “v13” on one side.
    Bottles of 30s with child-resistant closure, NDC 69367-337-30

Store at 25°C (77°F); excursions permitted from 15° to 30°C (59° to 86°F) [see USP Controlled Room Temperature].

17 PATIENT COUNSELING INFORMATION

Advise the patient to read the FDA-approved patient labeling (Medication Guide).

Suicidal Thoughts and Behaviors

Advise patients and caregivers to look for the emergence of suicidality, especially early during treatment and when the dosage is adjusted up or down, and instruct them to report such symptoms to the healthcare provider [see Boxed Warning and Warnings and Precautions (5.1)].

Important Administration Instructions

Instruct patients to swallow paroxetine extended-release tablets whole and to not chew or crush the tablets [see Dosage and Administration (2.1)].

Serotonin Syndrome

Caution patients about the risk of serotonin syndrome, particularly with the concomitant use of paroxetine extended-release tablets with other serotonergic drugs including triptans, tricyclic antidepressants, opioids, lithium, tryptophan, buspirone, amphetamines, St. John’s Wort, and with drugs that impair metabolism of serotonin (in particular, MAOIs, both those intended to treat psychiatric disorders and also others, such as linezolid). Instruct patients to contact their health care provider or report to the emergency room if they experience signs or symptoms of serotonin syndrome [see Warnings and Precautions (5.2), Drug Interactions (7.1)].

Concomitant Medications

Advise patients to inform their physician if they are taking, or plan to take, any prescription or over-the-counter drugs, since there is a potential for drugdrug interactions [see Warning and Precautions (5.3), Drug Interactions (7)].

Increased Risk of Bleeding

Inform patients about the concomitant use of paroxetine extended-release tablets with aspirin, NSAIDs, other antiplatelet drugs, warfarin, or other anticoagulants because the combined use has been associated with an increased risk of bleeding. Advise patients to inform their health care providers if they are taking or planning to take any prescription or over-the counter medications that increase the risk of bleeding [see Warnings and Precautions (5.5)].

Activation of Mania/Hypomania

Advise patients and their caregivers to observe for signs of activation of mania/hypomania and instruct them to report such symptoms to the healthcare provider [see Warnings and Precautions (5.6)].

Discontinuation Syndrome

Advise patients not to abruptly discontinue paroxetine extended-release tablets and to discuss any tapering regimen with their healthcare provider. Inform patients that adverse reactions can occur when paroxetine extended-release tablets are discontinued [See Warnings and Precautions (5.7)].

Sexual Dysfunction

Advise patients that use of paroxetine extended-release tablets may cause symptoms of sexual dysfunction in both male and female patients. Inform patients that they should discuss any changes in sexual function and potential management strategies with their healthcare provider [see Warnings and Precautions (5.13)].

Embryo-Fetal Toxicity

Advise women to notify their healthcare provider if they become pregnant or intend to become pregnant during treatment with paroxetine extended-release tablets. Advise women of risks associated with first trimester use of paroxetine extended-release tablets and that use later in pregnancy may lead to an increased risk for neonatal complications requiring prolonged hospitalization, respiratory support, tube feeding, and/or persistent pulmonary hypertension of the newborn (PPHN) [see Warnings and Precautions (5.4), Use in Specific Populations (8.1)]. Advise women that there is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to paroxetine extended-release tablets during pregnancy [see Warnings and Precautions (5.4), Use in Specific Populations (8.1)].

Lactation

Advise breastfeeding women using paroxetine extended-release tablets to monitor infants for agitation, irritability, poor feeding and poor weight gain and to seek medical care if they notice these signs [see Use in Specific Populations (8.2)].

Females and Males of Reproductive Potential

Advise men that paroxetine extended-release tablets may affect sperm quality, which may impair fertility; it is unknown if this effect is reversible [see Use in Specific Populations (8.3)].

Allergic Reactions

Advise patients to notify their healthcare provider if they develop an allergic reaction such as rash, hives, swelling, or difficulty breathing [see Adverse Reactions (6.1, 6.2)].

Manufactured by:
Visum Pharmaceutical Co., Ltd.
Haikou, Hainan, China, 570311

Distributed by:
Westminster Pharmaceuticals, LLC Nashville, TN 37217

Medication GuideParoxetine Extended-Release Tablets, USP(pa rox’ e teen)
This Medication Guide has been approved by the U.S. Food and Drug Administration. Revised: 9/2023
What is the most important information I should know about paroxetine extended-release tablets?Paroxetine extended-release tablets can cause serious side effects, including:
  • Increased risk of suicidal thoughts or actions. Antidepressant medicines may increase suicidal thoughts and actions in some children and young adults within the first few months of treatment or when the dose is changed. Paroxetine extended-release tablets are not for use in people younger than 18 years of age.
How can I watch for and try to prevent suicidal thoughts and actions?
  • Depression or other serious mental illnesses are the most important causes of suicidal thoughts and actions.
  • Pay close attention to any changes, especially sudden changes in mood, behavior, thoughts or feelings or if you develop suicidal thoughts or actions. This is very important when an antidepressant medicine is started or when the dose is changed.
  • Call your healthcare provider right away to report new or sudden changes in mood, behavior, thoughts or feelings or if you develop suicidal thoughts or actions.
  • Keep all follow-up visits with your healthcare provider as scheduled. Call your healthcare provider between visits as needed, especially if you have concerns about symptoms.
Call your healthcare provider or get emergency medical help right away if you have any of the following symptoms, especially if they are new, worse, or worry you:
  • attempts to commit suicide
  • acting aggressive or violent
  • new or worse depression
  • feeling agitated, restless, angry, or irritable
  • an increase in activity and talking more than what is normal for you
  • acting on dangerous impulses
  • thoughts about suicide or dying
  • new or worse anxiety or panic attacks
  • trouble sleeping
  • other unusual changes in behavior or mood
What are paroxetine extended-release tablets? Paroxetine extended-release tablets are a prescription medicine used in adults to treat:
  • A certain type of depression called Major Depressive Disorder (MDD)
  • Panic Disorder
  • Social Anxiety Disorder (SAD)
  • Premenstrual Dysphoric Disorder (PMDD)
Do not take paroxetine extended-release tablets if you:
  • take a monoamine oxidase inhibitor (MAOI)
  • have stopped taking an MAOI in the last 14 days
  • are being treated with the antibiotic linezolid or intravenous methylene blue
  • are taking thioridazine
  • are taking pimozide
  • are allergic to paroxetine or any of the ingredients in paroxetine extended-release tablets. See the end of this Medication Guide for a complete list of ingredients in paroxetine extended-release tablets.
Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI or one of these medicines, including intravenous methylene blue.Do not start taking an MAOI for at least 14 days after you stop treatment with paroxetine extended-release tablets.
Before taking paroxetine extended-release tablets, tell your healthcare provider about all your medical conditions, including if you:
  • have heart problems
  • have or had bleeding problems
  • have, or have a family history of bipolar disorder, mania or hypomania
  • have or had seizures or convulsions
  • have glaucoma (high pressure in the eye)
  • have low sodium levels in your blood
  • have bone problems
  • have kidney or liver problems
  • are pregnant or plan to become pregnant. Paroxetine may harm your unborn baby.
    • Taking paroxetine extended-release tablets during your first trimester of pregnancy may cause your baby to be at an increased risk of having a heart problem (cardiac malformations) at birth.
    • Taking paroxetine extended-release tablets during your third trimester of pregnancy may cause your baby to have breathing, temperature, and feeding problems, low muscle tone (floppy baby syndrome), and irritability after birth and may cause your baby to be at an increased risk of a serious lung problem at birth. Talk to your healthcare provider about the risk to your unborn baby if you take paroxetine extended-release tablets during pregnancy.
    • Tell your healthcare provider right away if you become pregnant or think you are pregnant during treatment with paroxetine extended-release tablets.
    • There is a pregnancy registry for females who are exposed to paroxetine extended-release tablets during pregnancy. The purpose of the registry is to collect information about the health of females exposed to paroxetine extended-release tablets and their baby. If you become pregnant during treatment with paroxetine extended-release tablets talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants at 1-866-961-2388 or visit online at https://womensmentalhealth.org/clinical-and-researchprograms/pregnancyregistry/antidepressants/.
  • are breastfeeding or plan to breastfeed. Paroxetine passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby during treatment with paroxetine extended-release tablets.
Tell your healthcare provider about all the medicines you take , including prescription and over-the-counter medicines, vitamins, and herbal supplements. Paroxetine extended-release tablets and some other medicines may affect each other causing possible serious side effects. Paroxetine extended-release tablets may affect the way other medicines work and other medicines may affect the way paroxetine extended-release tablets works.Especially tell your healthcare provider if you take:
  • medicines used to treat migraine headaches called triptans
  • tricyclic antidepressants
  • lithium
  • tramadol, fentanyl, meperidine, methadone, or other opioids
  • tryptophan
  • buspirone
  • amphetamines
  • St. John’s Wort
  • medicines that can affect blood clotting such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or warfarin
  • diuretics
  • tamoxifen
Ask your healthcare provider if you are not sure if you are taking any of these medicines. Your healthcare provider can tell you if it is safe to take paroxetine extended-release tablets with your other medicines.Do not start or stop any other medicines during treatment with paroxetine extended-release tablets without talking to your healthcare provider first. Stopping paroxetine extended-release tablets suddenly may cause you to have serious side effects. See, What are the possible side effects of paroxetine extended-release tablets?Know the medicines you take. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine.
How should I take paroxetine extended-release tablets?
  • Take paroxetine extended-release tablets exactly as your healthcare provider tell you to. Your healthcare provider may need to change the dose of paroxetine extended-release tablets until it is the right dose for you.
  • Take paroxetine extended-release tablets 1 time each day in the morning.
  • Take paroxetine extended-release tablets with or without food.
  • Swallow paroxetine extended-release tablets whole. Do not chew or crush paroxetine extended-release tablets.
  • If you take too much paroxetine extended-release tablets, call your poison control center at 1-800-222-1222 or got to the nearest hospital emergency room right away.
What are possible side effects of paroxetine extended-release tablets? Paroxetine extended-release tablets can cause serious side effects, including:
  • agitation
  • seeing or hearing things that are not real (hallucinations)
  • confusion
  • coma
  • fast heart beat
  • changes in blood pressure
  • dizziness
  • sweating
  • flushing
  • high body temperature (hyperthermia)
  • shaking (tremors), stiff muscles, or muscle twitching
  • loss of coordination
  • seizures
  • nausea, vomiting, diarrhea
  • Medicine interactions. Taking paroxetine extended-release tablets with certain other medicines including thioridazine and pimozide may increase the risk of developing a serious heart problem called QT prolongation.
  • Abnormal bleeding. Taking paroxetine extended-release tablets with aspirin, NSAIDs, or blood thinners may add to this risk. Tell your healthcare provider about any unusual bleeding or bruising.
  • Manic episodes. Manic episodes may happen in people with bipolar disorder who take paroxetine extended-release tablets. Symptoms may include:
  • greatly increased energy
  • racing thoughts
  • unusually grand ideas
  • talking more or faster than usual
  • severe problems sleeping
  • reckless behavior
  • excessive happiness or irritability
  • Discontinuation syndrome. Suddenly stopping paroxetine extended-release tablets may cause you to have serious side effects. Your healthcare provider may want to decrease your dose slowly. Symptoms may include:
  • nausea
  • sweating
  • changes in your mood
  • irritability and agitation
  • dizziness
  • electric shock feeling (paresthesia)
  • tremor
  • anxiety
  • confusion
  • headache
  • tiredness
  • problems sleeping
  • ringing in your ears (tinnitus)
  • seizures
  • Seizures (convulsions). Eye problems (angle-closure glaucoma). Paroxetine extended-release tablets may cause a type of eye problem called angle-closure glaucoma in people with certain other eye conditions. You may want to undergo an eye examination to see if you are at risk and receive preventative treatment if you are.
  • Low sodium levels in your blood (hyponatremia). Low sodium levels in your blood that may be serious and may cause death, can happen during treatment with paroxetine extended-release tablets. Elderly people and people who take certain medicines may be at a greater risk for developing low sodium levels in your blood. Signs and symptoms may include:
    • headache
    • difficulty concentrating
    • memory changes
    • confusion
    • weakness and unsteadiness on your feet which can lead to falls
    In more severe or more sudden cases, signs and symptoms include:
    • seeing or hearing things that are not real (hallucinations)
    • fainting
    • seizures
    • coma
    • stopping breathing (respiratory arrest)
  • Bone fractures.
  • Sexual problems (dysfunction). Taking selective serotonin reuptake inhibitors (SSRIs), including paroxetine extended-release tablets, may cause sexual problems.Symptoms in males may include:
    • Delayed ejaculation or inability to have an ejaculation
    • Decreased sex drive
    • Problems getting or keeping an erection
    Symptoms in females may include:
    • Decreased sex drive
    • Delayed orgasm or inability to have an orgasm
Talk to your healthcare provider if you develop any changes in your sexual function or if you have any questions or concerns about sexual problems during treatment with paroxetine extended-release tablets. There may be treatments your healthcare provider can suggest.The most common side effects paroxetine extended-release tablets include:
  • male and female sexual function problems
  • blurred vision
  • weakness (asthenia)
  • constipation
  • decreased appetite
  • diarrhea
  • dizziness
  • dry mouth
  • problems sleeping
  • nausea
  • sleepiness
  • sweating
  • tremor
These are not all the possible side effects of paroxetine extended-release tablets.Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
How should I store paroxetine extended-release tablets?
  • Store paroxetine extended-release tablets at 25°C (77°F); excursions permitted from 15° to 30°C (59° to 86°F) [see USP Controlled Room Temperature].
Keep paroxetine extended-release tablets and all medicines out of the reach of children.
General information about the safe and effective use of paroxetine extended-release tablets. Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not take paroxetine extended-release tablets for a condition for which it was not prescribed. Do not give paroxetine extended-release tablets to other people, even if they have the same symptoms that you have. It may harm them. You may ask your healthcare provider or pharmacist for information about paroxetine extended-release tablets that is written for healthcare professionals.
What are the ingredients in paroxetine extended-release tablets? Active ingredient: paroxetine hydrochlorideInactive ingredients: colloidal silicon dioxide, hypromellose, lactose monohydrate, magnesium stearate, ferric oxide yellow (12.5mg, 25 mg and 37.5 mg), glyceryl dibehenate, D&C Yellow No. 10 aluminum lake (12.5 mg), FD&C Blue No. 2 aluminum lake (12.5 mg and 37.5 mg), FD&C Red No. 40 aluminum lake (12.5 mg), FD&C Yellow No. 6 aluminum lake (12.5 mg), ferric oxide red (25 mg), ferrosoferric oxide (25 mg), methacrylic acid and ethyl acrylate copolymer dispersion, polyethylene glycol, polysorbate 80, sodium lauryl sulfate, talc, titanium dioxide and triethyl citrate.Manufactured by:Visum Pharmaceutical Co., Ltd. Haikou, Hainan, China, 570311Distributed by:Westminster Pharmaceuticals, LLC Nashville, TN 37217For more information about paroxetine extended-release tablets call 1-844-221-7294.

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