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Pharmacology/crippling panic. want to restart paxil


QUESTION: I Apologize for the length of this email. I will try to keep it to the point but also want to list the important info. I am very scared and in need of some advice. I have been taking Paxil for 15 years for anxiety. I started with 20mg for 8 years, down to 15mg for 4 years and 7.5mg for the past 4 years.
Three months ago I discontinued use of the Paxil completely. I had no negative side effects except for the common "electrical shock" sensation. In fact I felt VERY good. feeling new emotions, enjoying life more than every.
One week ago (three months after stopping the paxil) while on vacation I had an intense panic attack which has continued for 5 days. I saw a doctor yesterday as soon as I arrived home and I was given oxazepam (Serax) to deal with the intense panic I feel, but it does very little to help unless I take a high amount (20 mg).
I want to start taking the paxil again but have read that there may be some negative interactions between paxil and Serax.
Is it safe to start my paxil again? How long will it take to help my panic attacks? I have read it can take up to 2 weeks.
I am considering checking myself into the hospital for sedation and monitoring until it takes effect. I cant take this any more.
Thank you.

ANSWER: There isnt any reason why you cannot restart paxil while on a benzodiazepine (any of them really). That is commonly used for payients with anxiety and depression (or depressed patients with muscle spasm in some cases). In any event there are always risks when taking medications - they are increased by taking multiple medications but there is nothing remarkably dangerous about this combination. Certainly there are drugs that i would not dispence together for fear of the safety of the patient. However, if someone presented to my pharmacy with these two i would be confident filling them.  Paxil can take time to work - it can take weeks in some cases and i have seen patients feel the difference from antidepressants in one or two doses. It is really about how you respond to the drug.

Be well.

Dr. Cappuccilli

---------- FOLLOW-UP ----------

QUESTION: Thank you so much for your fast response! Do you think that the Paxil will take effect more quickly based on the fact that I had been on it for so long in the past? I have taken it regularly for 15 years and have been off of it for only 3 months. I was taking 7.5mg at the time that I stopped. I have restarted at 15mg. I took one dose yesterday and one dose today. I am hoping to feel some relief soon. I am not asking how long it will take to "feel normal again". I am just hoping for SOME relief from the debilitating panic soon. Thank you!

I am on my ipad so this answer will be short and there is really no way to predict that.  I have seen people - including myself - find the right anti-depressant and feel  better in days.  Someone who hasnt taken them before usually takes up to 6 weeks to feel the effects.  Having been on it before may make that spin up time shorter - especially since you are going back at a higher dose than what you were on when you stopped.  I would imagine you are starting to feel better already - now 6 or 7 days in?


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Dr. Joshua Cappuccilli


I can answer most questions involving medication use, side effects, adverse effects, interactions and how drugs relate to specific disease states. No one can answer all questions; I will respond as such if I cannot provide an answer. I will provide resources / references for the information that I use to formulate the answer given.


I am a Doctor of Pharmacy currently practicing in Florida in a retail pharmacy.

California Phamacist Association American Pharmacy Assocaition

BA University of South Florida PharmD University of Florida APhA Medication Therapy Management certification

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