Can paroxetine be taken twice a day? (+5 effects)

In this article, we will discuss the dosing frequency of paroxetine. We will also discuss the side effects of taking more than the recommended dose of paroxetine. Paroxetine is a selective serotonin reuptake inhibitor (SSRI).

Can paroxetine be taken twice a day?

No, paroxetine can not be taken twice a day. The recommended time for taking paroxetine is in the daytime. However, it can also be taken at night. Different dosage forms of paroxetine are available in the market including:

• immediate-release tablets,
• controlled release tablets,
• capsules, and
• suspensions/ liquids.

The strength of these dosage forms varies, depending on the brand. The usual starting dose of paroxetine is 10-20 mg depending on the disease condition. You should always follow the dosage regimen prescribed by your doctor.

Can you take a half tablet of paroxetine twice a day?

It is not a problem to take a half dose of paroxetine in the morning and a half dose in the evening. However, paroxetine is a sedative drug, which is why it is preferred to be taken at night. Always consult the doctor before adopting such a practice.

How to take paroxetine?

• Take the dose as recommended by the doctor.
• Do not change the dose of the drug.
• Do not discontinue taking paroxetine abruptly.
• Paroxetine may be taken with or without food. Taking it with food reduces the chances of getting nausea or upset stomach.
• Avoid taking grapefruit or grapefruit juices. Do not consume alcohol.
• Paroxetine is preferably taken during the day. If the patient experiences increased sedation, then paroxetine should be administered at night.
• If paroxetine causes insomnia, then the patient should take the medication in the daytime.
• Do not chew or crush the tablet.
• Continue to take paroxetine even if the symptoms improve. The doctor will slowly taper off paroxetine. 

What is the dosing schedule for paroxetine?

How much paroxetine is safe?

The majority of the patients will begin their therapy with a dose of 10 mg or 20 mg. This may gradually increase until the doctor agrees on a dose that works for a patient with minimal side effects. The maximum recommended dose is 50-60 mg/day.

The dose of paroxetine might vary according to the disease condition. The maximum recommended dose for elderly patients (65 and above) is 40 mg/day. If the patient has a renal problem, the doctor might prescribe a lesser amount of paroxetine than usual.

What are the possible effects of taking paroxetine twice a day?

Increased suicidal thoughts: paroxetine can increase the occurrence of suicidal thoughts, especially in the first few months. These thoughts become more vivid when the dose of paroxetine is increased (1). 

Worsened depression: the patient might experience the following side effects if he takes more than the prescribed dose of paroxetine:

• panic attacks,
• aggressiveness,
• sleeplessness,
• extreme mood swings, and
• restlessness.

Why not take paroxetine twice a day?

Paroxetine is less dangerous in overdose than tricyclic antidepressants. It rarely causes death when taken alone. Patients have survived overdoses of up to 3600 mg of paroxetine. Death caused by paroxetine poisoning has often occurred as a result of the intake of multiple medicines, rather than paroxetine alone (2).

In the elderly, paroxetine has been linked to hyponatremia (low concentration of sodium in the body). In one of the case reports, an elderly patient experienced hyponatremia due to an overdose (360 mg) of paroxetine (3).

In another case report, a young girl showed signs of serotonin syndrome due to overdosing on paroxetine. The patient experienced tachycardia, altered mental state, hypertension, elevated body temperature, and hyperreflexia (4). 

Another young girl attempted suicide by overdosing on paroxetine. She had previously been diagnosed with suicide ideation and major depression. The symptoms of overdosing included incoherent speech, bradycardia, and restlessness (5).

What are the symptoms of an overdose of paroxetine?

The patient might also experience the following symptoms:

• Facial flushing,
• nausea and vomiting,
• sweating and dizziness,
• myoclonus hyperreflexia,
• seizures,
• incoherent speech,
• bradycardia,
• low blood pressure, and 
• severe serotonin syndrome.

What to do if the dose is missed?

If the patient forgets to take the dose at the prescribed time, then he should take it as soon as possible. However, if the next dose is due in some time, then the previous dose should be skipped. Never take double the dose to make up for the missed dose.

What to do in case of overdose?

There is no particular antidote for paroxetine. Treatment protocol should include the following standard procedures:

• assure proper airway and ventilation,
• monitor the heart rate and other vitals,
• gastric lavage,
• forced diuresis or dialysis.

Conclusion

In this article, we discussed that you should take paroxetine only once a day and follow the instructions of your doctor. I do not recommend splitting the dose of paroxetine in half as it might alter the content uniformity. If you take more than the prescribed dose, you might experience side effects, serotonin syndrome, or worsened depression. Never discontinue your dose abruptly, and always consult your doctor.

References