Does Paxil cause gynecomastia? (+2 evidences)
By
Dr Maryam Shabbir (PhD)
| Reviewed by
Ivan Kahwa
The contents of this article are fact-based except otherwise stated within the article.
Author bio
Dr Maryam Shabbir PhD is a pharmacist with expertise in drugs delivery, pharmacology, dosage form design, transdermal drug delivery system, microneedles, and solubility enhancement. She writes and reviews content on these topics.
Dr Maryam Shabbir’s Highlights:
Assistant Professor at The University of Lahore, Lahore, Pakistan.
PhD in Pharmaceutics with a focus on solubility enhancement of BCS class II and III drugs and their delivery through transdermal route using microneedles.
Doctor of Pharmacy at the University of Lahore with a two-year scholarship.
Professional Experience:
Dr Maryam Shabbir joined Faculty of Pharmacy, The University of Lahore as soon as she completed her Pharm-D in 2010. In 2017, she got promoted as an assistant professor.
Dr Maryam Shabbir has supervised twenty two M.Phil. students in pharmaceutics in areas such as transdermal drug delivery system, nanoparticles, microparticle, solid dispersion, and transdermal patches.
Dr Maryam Shabbir has also contributed to several business consultancies and research projects, including the development of lyophilized wafer of Acyclovir with Medisearch Pharmacal Pvt. Ltd., a major pharmaceutical industry in Pakistan.She has also worked as a team member in one of the Contract Research Organizations of Pakistan.
Dr Maryam Shabbir has organized two International conferences and three national conferences as conference secretary for the University of Lahore in collaboration with Punjab Higher Education Commission of Pakistan.
Dr Maryam Shabbir has submitted two patents to the Intellectual Property Organization of Pakistan (IPO), and three patents are in pipeline. She has also presented her work in different exhibitions organized by the Higher Education Commission of Pakistan. She works in close liaison with the Innovation Hub, University of Lahore, Pakistan.
Dr Maryam Shabbir participated as a member of the examination board for several Master’s exams and as an external examiner for Pharm-D in reputable universities of Pakistan. She is also a member of Punjab Pharmacy Council and Pakistan Pharmacist Association.
Education:
2010 Pharm D at the University of Lahore, Lahore, Pakistan
2013 Master of Philosophy (Pharmaceutics) at the University of Lahore, Lahore, Pakistan
2022 PhD (Pharmaceutics) at the University of Lahore, Lahore, Pakistan
The main publications of Dr. Maryam Shabbir are:
Saeed S, Barkat K, Ashraf MU, Shabbir M, Anjum I, Badshah SF, et al. Flexible Topical Hydrogel Patch Loaded with Antimicrobial Drug for Accelerated Wound Healing. Gels. 2023;9(7):567.
Arshad J, Barkat K, Ashraf MU, Badshah SF, Ahmad Z, Anjum I, Shabbir M, et al. Preparation and characterization of polymeric cross-linked hydrogel patch for topical delivery of gentamicin. e-Polymers. 2023;23(1):20230045.
Arshad J, Barkat K, Ashraf MU, Badshah SF, Ahmad Z, Anjum I, Shabbir M, Mehmood Y, Khalid I, Malik NS, Bin Jardan YAl. Fabrication of pH responsive hydrogel blends of chondroitin sulfate/pluronic F-127 for the controlled release of ketorolac: its characterization and acute oral toxicity study. Drug Development and Industrial Pharmacy. 2022;48(11):611-22.
Maher S, Shabbir M, Anam I, Khan N, Iqbal S, Saleem F. Anti-inflammatory and anti-oxidant activities of methanolic extract of medicinal plants from Balochistan. Int J Biol Biotechnol. 2020;15:691-7.
Shabbir M, Sajid A, Hamid I, Sharif A, Akhtar MF, Raza M, et al. Influence of different formulation variables on the performance of transdermal drug delivery system containing tizanidine hydrochloride: in vitro and ex vivo evaluations. Brazilian Journal of Pharmaceutical Sciences. 2019;54:e00130.
Nagra U, Adnan S, Shafqat S, Shabbir M, Ali S, Zafar A, et al. Effect of Sustained Release Polymers on Drug Release Profile of Aceclofenac Tablets Physicochemical Properties, Analysis of Kinetics and Fit Factor. Indian J Pharm Educ Res. 2019;53:58-65.
Fatima S, Akhtar MF, Ashraf KM, Sharif A, Saleem A, Akhtar B, Peerzada S, Shabbir M, Ali S, Ashraf W, Antioxidant and alpha amylase inhibitory activities of Fumaria officinalis and its antidiabetic potential against alloxan induced diabetes. Cellular and molecular biology (Noisy-le-Grand, France). 2019;65(2):50-7.
Saeed S, Raza M, Shabbir M, Akhtar MF, Sharif A, Zaman M, et al. Study of Multi-Drug Resistance Associated with Anti-Tuberculosis Treatment by DOT Implementation Strategy in Pakistan. Journal of Basic & Applied Sciences. 2018;14:107-12.
Arshad I, Ali S, Amin U, Shabbir M, Raza M, Sharif A, et al. Effect of hydrophilic and hydrophobic polymer on the release of ketoprofen and allopurinol from bilayer matrix transdermal patch. Advances in Polymer Technology. 2018;37(8):3076-83.
Sohail K, Javaid Z, Hamid I, Sharif A, Akhtar MF, Raza M, Ali S, Shabbir M, Peerzada S, Ahmad S. Formulation and evaluation of ranitidine floating tablets using different polymer combinations. Journal of Toxicological &Pharmaceutical Sciences. 2017;1(1):18-25.
Sharif A, Akhtar MF, Akhtar B, Saleem A, Manan M, Shabbir M, et al. Genotoxic and cytotoxic potential of whole plant extracts of Kalanchoe laciniata by Ames and MTT assay. EXCLI journal. 2017;16:593.
Shahid N, Adnan S, Farooq M, Ali S, Shabbir M, Masood Z, et al. Development of compressed coated polypill with mucoadhesive core comprising of atorvastatin/clopidogrel/aspirin using compression coating technique. Acta Poloniae Pharmaceutica. 2017;74(2):477-87.
Shabbir M, Fazli AR, Ali S, Raza M, Sharif A, Akhtar MF, et al. Effect of hydrophilic and hydrophobic polymer on in vitro dissolution and permeation of bisoprolol fumarate through transdermal patch. Acta Pol Pharm. 2017;74:187-97.
Saba Mazhar NS, Raza M, Akhtar B, Zahra A, Akhtar MF, Saleem A, Chishti SA, Shabbir M, Sharif A. A descriptive study of Measles outbreak in Lahore, Pakistan in 2013. J Toxicol Pharmaceut Sci. 2017;1(1):26-30.
Manzoor I, Raza M, Shabbir M, Ali S, Akhtar MF, Peerzada S, et al. Formulation and characterization of curcumin nanoparticles prepared from eudragit L-100 and poly vinyl alcohol as polymer. J Toxicol Pharmaceut Sci. 2017;1(1):7-12.
Akhtar MF, Sharif A, Saleem M, Saleem A, Akhtar B, Raza M, Ijaz H, Shabbir M, Ali S, Nasim MB, Peerzada S. Genotoxic and cytotoxic potential of Alternanthera Bettzickiana, an important ethno-medicinal plant. Cellular and Molecular Biology. 2017;63(8):109-14.
Ahmed S, Saeed-Ul-Hassan S, Islam M, Qureshi F, Waheed I, Munawar I, Ishtiaq S, Rasool S, Akhtar MF, Chishti SA, Shabbir M. Anti-oxidant activity of Pistachia khinjuk supported by phytochemical investigation. Acta Pol Pharm. 2017;74(1):173-8.
Shahid N, Ali S, Shabbir M, Waqar K. Compressed coated polypill with mucoadhesive core for cardiovascular disease-A review. The Pharma Innovation. 2016;4(3, Part B).
Shabbir M, Ali S, Farooq M, Adnan S, Yousaf M, Idrees A, et al. Formulation factors affecting in vitro and ex vivo permeation of bisoprolol fumarate from a matrix transdermal patch. Advances in Polymer Technology. 2016;35(3):237-47.
Mehmood A, Hamid I, Sharif A, Akhtar MF, Akhtar B, Saleem A, Shabbir M, et al. Evaluation of anti-inflammatory, analgesic and antipyretic activities of aqueous and ethanolic extracts of seeds of Buchanania lanzan Spreng. In animal models. Acta poloniae pharmaceutica. 2016;73(6):1601-8.
Ali S, Shabbir M, Shahid N, Amin U, Hamid I, Raza M. Effect of Polysorbate 80 Through Rabbit’s Skin Using Transdermal Patch Loaded with Bisoprolol Fumarate as Model Drug. Pakistan J Zool. 2016;48(1):227-34.
Akhtar MF, Saleem A, Sharif A, Akhtar B, Nasim MB, Peerzada S, Raza M, Ijaz H, Ahmed S, Shabbir M, Ali S. Genotoxic and cytotoxic action potential of Terminalia citrina, a medicinal plant of ethnopharmacological significance. EXCLI journal. 2016;15:589.
Ali S, Shabbir M, Shahid N. The Structure of Skin and Transdermal Drug Delivery System-A Review. Research Journal of Pharmacy and Technology. 2015;8(2):103-9.
Shabbir M, Ali S, Shahid N, Rehman K, Amin U, Raza M. Formulation considerations and factors affecting transdermal drug delivery system-A review. International Journal of Pharmacy and Integrated Life Sciences. 2014;2(9):20-35.
Ali S, Shabbir M, Farooq M, Adnan S, Shahid N. The enhancement effect of permeation enhancers on Bisoprolol fumarate across animal membrane using Franz diffusion cell. Research Journal of Pharmacy and Technology. 2014;7(12):1391-5.
Conference papers
Shabbir M (2022), Sustainable Development Goals (SDGs): A Policy Gap between Health and Pharmaceutical Industry. In International Social Science Conference 2022 (School of International Social Sciences, University of Lahore).
Shabbir M (2022), Controlling Permeation of Ketoprofen and Allopurinol through Bilayer Transdermal Patch using Multiple Pharmaceutical Ingredients. In Current Advancement in Pharmacy Practice (CAPP)- Theory to Practice (University of Lahore, Lahore)
Shabbir M (2018), Nanocarriers Mediated Photodynamic Therapy for the Treatment of Different Cancers. In the 4th Annual International Pharmacy Scientific Symposium and Poster Exhibition-2018 (University of Central Punjab, Lahore).
Shabbir M (2018), Lipid Enveloped Polymeric Nanoparticles for Targeted Photodynamic Chemotherapy. In the 3rd International Health Trigon Summit-2018 (University of Lahore).
You can view some of Dr Maryam’s work below and links to her professional profile.
Publon Profile: publons.com/researcher/1495244/maryam-shabbir
ORCID: 0000-0002-9308-5175
Researchgate: https://www.researchgate.net/profile/Maryam-Shabbir-4
Google Scholar: Maryam Shabbir – Google Scholar
Linkedin Profile: https://www.linkedin.com/in/maryam-shabbir-b409a270
Reviewer bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss if Paxil can cause gynecomastia in men. We will also discuss the research study and the interventions to reverse gynecomastia.
Does Paxil cause gynecomastia?
Yes, Paxil may cause gynecomastia. However, there are very rare chances of developing gynecomastia with the use of Paxil. While some teenagers experience gynecomastia as a normal event, it is crucial to examine Paxil-induced breast growth in adults.
The mechanism by which Paxil causes gynecomastia is still not fully known. The treatment of Paxil-induced gynecomastia includes stopping the drug. Surgical and medical interventions are only used in very rare cases.
Gynecomastia is usually asymptomatic and goes unnoticed by the patient. The occurrence of gynecomastia in men rises with age and is often thought to be caused by an increasing estradiol/testosterone ratio. This makes interpreting Paxil-related gynecomastia more difficult
How may Paxil cause gynecomastia?
Because of adaptive alteration in dopaminergic neurons, Paxil causes changes in dopaminergic neurotransmission and hyperlactatemia. Two pathways have been hypothesised for Paxil causing gynecomastia:
- Presynaptic suppression of dopamine release due to serotonin release by serotonergic neurons, and
- Prolactin release due to stimulation of postsynaptic serotonergic receptors present in the hypothalamus (1, 2).
What does the research suggest?
In a case report, a 30-year-old man reported an enlarged left breast during the use of Paxil for panic disorder. The breast examination confirmed that there was no malignancy and the level of prolactin was 14 ng/ml. The discontinuation of Paxil and surgical interventions were done to fix gynecomastia (3).
The Netherland Pharmacovigilance Center Lareb database obtained 12 cases of gynecomastia-related reports due to the use of Paxil. Other side effects might also include increased hyperlactatemia, breast tenderness and increased tiredness.
Does Paxil-induced gynecomastia affect breastfeeding?
Gynecomastia in females can happen due to the increased level of estrogen and drugs. Paxil-induced gynecomastia can affect one or both of the breasts. It may begin as a painful lump or fatty tissue beneath the nipple. Breats often grow unevenly in such cases.
The symptoms can include pain, swelling, tenderness and nipple discharge. This can be more problematic for women who are breastfeeding. It will cause more pain to the mother while feeding. Additionally, the nipple discharge can cause more discomfort.
Increased levels of prolactin can cause galactorrhea. It is a pale yellow milky discharge that is not related to pregnancy or breastfeeding. This can cause an increase in the baby’s breast tissues. If the discharge is persistent, the mother and child should be evaluated by the healthcare professional.
Is Paxil-induced gynecomastia reversible?
Gynecomastia often resolves on its own over time. However, if gynecomastia is the result of a medical condition then it might require therapy. If Paxil is causing gynecomastia then the patient should always refer to the doctor for better options.
Clinical and non-clinical interventions can be adapted to reduce the occurrence of gynecomastia. In case of severity, the doctor might instruct the patient to discontinue the medication or to try a new antidepressant.
What are the non-surgical interventions to reduce Paxil-induced gynecomastia?
The following lifestyle modification can be adopted by men facing the challenge of Paxil-induced gynecomastia:
- Loss weight,
- Exercise,
- Dieting to avoid excessive weight gain,
- Avoiding the use of steroids or drug abuse,
- Reducing alcohol consumption,
- Hormonal replacement therapy.
What are the surgical interventions to reduce Paxil-induced gynecomastia?
If the appearance or personal issues upset the patient, surgery could be an option. There are two gynecomastia surgery options:
- Liposuction: this procedure removes breast fat but not breast gland tissues.
- Mastectomy: the breast gland tissue is removed during this procedure.
What are the pharmacological interventions to reduce Paxil-induced gynecomastia?
Some pharmacological therapy may be tried if the gynecomastia is severe, does not resolve on its own, and does not have a curable underlying cause. Medical treatment falls into three categories (4):
- Androgen therapy with testosterone or danazol,
- Anti-estrogens like tamoxifen, and
- Aromatase inhibitors like letrozole.
Which other conditions can cause similar symptoms?
It is important to understand that other disease conditions can mimic the symptoms of gynecomastia. These conditions might include:
- Fatty breast tissue: it is also known as pseudo gynecomastia. It occurs occasionally in obese patients.
- Breast cancer: it is less common in men but the presence of a firm lump increases the possibility of male breast cancer.
- Lipoma: this fatty, slow-growing mass is not gynecomastia.
- Mastitis: inflammatory breast tissue that may or may not be infected.
Conclusion
In this article, we discussed the possibility of getting gynecomastia with Paxil use. We also discussed the non-surgical, surgical, and pharmacological interventions that can be used to reduce Paxil-induced gynecomastia. I recommend that you always consult your doctor if you feel breast tenderness or enlargement during Paxil use without feeling shy.
Was this helpful?
References
1.-
Bowman JD, Kim H, Bustamante JJ. Drug‐induced gynecomastia. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2012 Dec;32(12):1123-40. https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1002/phar.1138?casa_token=Up42P0oQBzEAAAAA:HxR68ai0SnFVA4mAJy5hVWERrBvbU8J8N8li5K27CF2SI1LMFCD5vgsAIEUqMzjoUiL5m6n526ASgA
2.-
Kaufman KR, Podolsky D, Greenman D, Madraswala R. Antidepressant-selective gynecomastia. Annals of Pharmacotherapy. 2013 Jan;47(1):e6-. https://journals.sagepub.com/doi/abs/10.1345/aph.1r491
3.-
Damsa C, Schulz P. Case of gynecomastia during paroxetine therapy. The Journal of clinical psychiatry. 2003 Aug 15;64(8):2332. https://www.psychiatrist.com/jcp/case-gynecomastia-during-paroxetine-therapy/
4.-
Swerdloff RS, Ng JC. Gynecomastia: etiology, diagnosis, and treatment. Endotext [Internet]. 2023 Jan 6. https://www.ncbi.nlm.nih.gov/books/NBK279105
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