Is it safe to increase Paxil from 20mg to 40mg? (+3 factors)

In this article, we will discuss the safety profile of increasing the Paxil dose from 20mg to 40mg. We will look at some factors that may affect this dosage increase of Paxil. We will delve into the possible expectations from this dosage change.

Is it safe to increase Paxil from 20mg to 40mg?

Yes, it is considered safe to increase Paxil from 20mg to 40mg. The dosage of Paxil can be increased to yield an optimal and efficient treatment.

Paxil belongs to Selective serotonin reuptake inhibitor (SSRI) antidepressants and is used to treat anxiety, depression, obsessive-compulsive disorder, and related conditions. It is also considered a more potent and selective drug than other SSRIs (1). 

As Paxil is a prescription medication, it is advised to not increase or reduce the dosage of this medication without consulting your doctor. Paxil is always initially started at a low dose which is slightly increased depending upon its effectiveness and side effects.

Increasing the dosage of Paxil may cause certain side effects. However, these side effects usually subside with time as the body gets used to the higher medication dose. 

When is it not safe to increase Paxil dose?

It is not safe to increase the dose of Paxil from 20mg to 40mg in renally impaired patients. Patients with kidney impairment may find it difficult to process an increase in Paxil dose from 20mg to 40mg. 

Certain patients with liver impairment may also affect the medication’s effect on the body. As Paxil is processed by CYP450 liver enzymes, therefore, impairment in the liver may cause difficulty in processing higher doses of Paxil in such patients. 

If patients are already experiencing severe adverse effects while taking Paxil at 20mg. Then, it is not safe to increase their doses to 40mg as it would increase the onset of side effects due to increased dosage. 

What does research suggest?

The research studies suggest that the average starting dosage of Paxil as an antidepressant should be 20mg per day. This is the minimal effective dose of Paxil to start the treatment regimen (2).

It has been reported that 20 mg per day is usually the optimal dosage for most of the patients. However, if the patients fail to show an adequate therapeutic response at this dosage, then their healthcare provider might increase their medication dosage (2). 

If the patient does not show improvement within 1 to 3 days of initiating Paxil treatment, then your doctor must give a 10 mg increment in your Paxil dosage which should be monitored for efficacy and can further be increased at weekly intervals (2). 

Paxil is preferred to be given as a single dosage usually given in the morning but if your prescriber suggests then you can take it at night time as well (2). However, selecting the best time to take Paxil should always be discussed with your doctor beforehand. 

The maximum effective therapeutic dose of Paxil should not increase by 50mg per day in children and adults. Whereas the dosage for the elderly should be between 20mg to 40mg per day (2). 

What are the factors to consider before increasing the Paxil dose?

The following are some factors that should be considered before increasing the Paxil dosage (3,4): 

  • Efficacy of the current dosage- The most important factor to consider before decreasing the Paxil dosage from 20 mg to 40mg is its efficacy. If the medication is not showing efficient therapeutic and clinical results at the lower dose, then your doctor may consider increasing it. 


  • Improved medical condition- Improved health condition is an important factor to consider before increasing the drug dosage. By increasing the dosage, there will be an improvement in mental health conditions as more drug molecules are available to react and exhibit their effects in the brain.


  • Possible side effects of increasing the dosage- By increasing the dosage of Paxil there is a fairly possible chance of increased side effects. Although, the side effects appear temporarily and may subside with time. However, if the side effects are intolerable, then you need to seek medical attention. 

Paxil is generally a safe drug and is considered safer even with overdose. It has been observed that paxil exhibits very little anticholinergic activity. An increased dosage of Paxil may cause the following side effects (3,4):

  • Nausea
  • Drowsiness
  • Coma
  • Seizures
  • Fever
  • Sweating
  • Confusion
  • Aggressive behaviour


  • Medication interactions by increasing dosage- By increasing the Paxil dosage, there is a chance of increased medication or drug interaction with concomitant drugs. The increased amount of Paxil in the body interferes with the mechanism of actions of other drugs taken concomitantly. 

What to do if an increased Paxil dose causes side effects?

If you suspect that you are facing excessive side effects after increasing the Paxil dosage, immediately contact your doctor and seek medical help. 

However, increasing the Paxil dosage is generally not very troublesome because it is a common practice to increase the antidepressant dosage e.g. Fluoxetine, after your body has adapted to a lower dosage. 

In case, you experience severe side effects or your body has not accepted the increased dosage of Paxil, then your doctor might suggest an alternate antidepressant that might not cause specific side effects.

Your healthcare provider must evaluate and assess your health condition and increase the dosage based on your body’s acceptance of medication and tolerability of side effects.


In conclusion, I would suggest that it is comparatively safe to increase the dosage of Paxil from 20mg to 40mg. However, this increment should be based on various factors as discussed above. 

The medication dosage increment should always be discussed and implemented under your prescriber’s guidance. However, I would suggest always consulting your doctor before increasing the medication dosage on your own as it is highly discouraged and may result in harmful consequences.  

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Boyer WF, Feighner JP. An overview of paroxetine. J Clin Psychiatry. 1992 Feb;53 Suppl:3-6. PMID: 1531819.


Dunner DL, Dunbar GC. Optimal dose regimen for paroxetine. J Clin Psychiatry. 1992 Feb;53 Suppl:21-6. PMID: 1531817.


Boyer WF, Blumhardt CL. The safety profile of paroxetine. J Clin Psychiatry. 1992 Feb;53 Suppl:61-6. PMID: 1531828.


AHFS Patient Medication Information [Internet]. Bethesda (MD): American Society of Health-System Pharmacists, Inc.; c2019. Paroxetine; [updated 2020 Jun 24; reviewed 2018 Jul 5; cited 2020 Jul 1]; [about 5 p.]. Available from:

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