Paroxetine Side Effects Sexually: What Can Happen and How to Cope

Paroxetine, sold under the brand name Paxil^®, is an antidepressant. And, as with most medications, it comes with possible side effects. But what are paroxetine side effects, sexually speaking?

Side effects generally aren’t something you want. However, if you’re experiencing premature ejaculation (PE), one paroxetine sexual side effect can actually be useful: delayed ejaculation.

Beyond this, common paroxetine side effects include:

• Drowsiness

• Sweating

• Sleep disturbance

• Dry mouth

• Loss of appetite

• Other sexual side effects, including sexual dysfunction

We’ll go over all the side effects of the drug, including long-term and sexual side effects, in more detail. For those considering taking paroxetine for its delayed ejaculation benefits, we’ll cover other ways to treat premature ejaculation.

Paroxetine belongs to a class of medication known as selective serotonin reuptake inhibitors (SSRIs) — along with citalopram, fluoxetine, and sertraline, among others.

It’s technically an antidepressant, but depression isn’t the only thing paroxetine is used for.

What Is Paroxetine (Paxil) Used For?

Paroxetine is approved by the U.S. Food and Drug Administration (FDA) to treat:

• Major depressive disorder (MDD)

• Generalized anxiety disorder (GAD)

• Social anxiety disorder in adults

• Obsessive-compulsive disorder (OCD) in adults

• Post-traumatic stress disorder (PTSD)

• Panic disorder

• Premenstrual dysphoric disorder (PMDD)

• Hot flashes caused by menopause

Off-label use is when a drug is prescribed by a medical professional to treat something it’s not officially FDA-approved for — a totally legal and common practice. Paroxetine can also be prescribed off-label for:

• Postpartum depression (PPD)

• Separation anxiety

• OCD in kids and teens

• Social anxiety disorder in kids and teens

• Body dysmorphic disorder

• Dysthymia (persistent depressive disorder)

• Malignancy-related pruritus (itching caused by cancer) that’s unresponsive to standard treatment

• Premature ejaculation

Did that last one spark your interest? Learn more in our guide to premature ejaculation pills.

Paroxetine can help a range of medical issues, but (of course) there’s a catch. The medication comes with side effects.

Many paroxetine side effects are dose-dependent, meaning you may experience more side effects — or more severe side effects — with higher doses. Paroxetine 20mg side effects may be completely different, for example, to those you’d get from a smaller dose.

Paroxetine Side Effects vs. Other Antidepressants

Still, as far as side effects from antidepressants go, SSRIs like paroxetine might be the best.

SSRIs have fewer side effects than other types of antidepressants like:

• Tricyclic antidepressants (TCAs). TCAs include nortriptyline, amitriptyline, doxepin, and imipramine.

• Monoamine oxidase inhibitors (MAOIs). This includes linezolid, isocarboxazid, methylene blue injection, and tranylcypromine.

• Serotonin and norepinephrine reuptake inhibitors (SNRIs). Venlafaxine and duloxetine are examples of SNRI antidepressants.

• Atypical tetracyclic antidepressants (TeCAs). Mirtazapine, bupropion, and trazodone are atypical antidepressants.

Why do SSRIs like paroxetine have fewer side effects? These medications have little or no effect on neurotransmitters (brain chemicals) like dopamine and norepinephrine. As the name suggests, selective serotonin reuptake inhibitors mainly impact serotonin (the “feel-good” chemical).

Now for the juicy stuff — what are the side effects of paroxetine?

Common Side Effects of Paroxetine

The most common side effects of paroxetine include:

• Drowsiness

• Sweating

• Sleep disturbance

• Dry mouth

• Loss of appetite

• Sexual side effects (hang tight — we’ll cover these in more detail soon)

Side effects may start within the first week of taking paroxetine and gradually disappear within two to three weeks. Phew.

These side effects may be common, but that doesn’t mean they’re guaranteed to affect you. According to the FDA, the most common side effects affect five percent or more of people taking paroxetine.

For instance, in placebo-controlled clinical trials for major depressive disorder, 23 percent of participants taking paroxetine experienced drowsiness, compared to nine percent who took a placebo. And 11 percent of people on paroxetine experienced sweating, compared to just two percent in the placebo group.

Other Paroxetine Side Effects 

Beyond the common adverse effects, there are a few others to keep an eye out for.

Here’s a rundown of the other rare but possible Paxil side effects in males:

• Gastrointestinal problems. Never fun. We’re talking nausea, constipation, and diarrhea.

• Skin issues. Think itchiness, eczema, alopecia (hair loss), and photosensitivity (a reaction to sunlight).

• Metabolic effects. These include weight gain and hyponatremia (abnormally low sodium levels in your blood).

• Nervous system effects. There have been rare reports of headaches, dizziness, tremor, and extrapyramidal symptoms, like restlessness and involuntary movements.

• Cardiovascular effects. These may include palpitations, fast heart rate, swelling, chest pain (angina), and vasodilation (widening blood vessels).

• Psychiatric effects. In rare cases, taking SSRIs might have an adverse effect of causing loss of interest, emotional flattening, or mania.

In terms of mental health considerations, kids and teens may also experience an increased risk of suicide. Short-term studies have found that antidepressants like paroxetine increase the risk of suicidal thoughts and behavior in children, adolescents, and young adults. If you’re looking after a young person on paroxetine, pay attention to any unusual changes in behavior or worsening suicidality. If they do express a desire to harm themselves, seek professional support right away.

The list of possible adverse events could go on and on, with everything from eye pain to blurred vision and even glaucoma cropping up. And, as with many meds, there’s also a risk of allergic reaction.

But paroxetine side effects may get better with time as your body gets used to the medication.

Long-Term Side Effects of Paroxetine

It’s unclear if there are any long-term side effects of paroxetine.

That said, there’s a risk of discontinuation syndrome (also called withdrawal syndrome) if you suddenly decrease your dose or stop using paroxetine.

Compared to other SSRIs, discontinuation syndrome is more common and severe with paroxetine.

Abruptly stopping the medication could result in any of these withdrawal symptoms:

• Headache

• Tiredness

• Nausea or vomiting

• Crying, irritability, or anxiety

• Dizziness

• Fever or chills

• Vivid dreams

• Electric shock-like sensations

• Dyskinesia (involuntary movements)

• Depersonalization (feeling disconnected from your body and mind)

Discontinuation syndrome might kick in within a week of discontinuing an SSRI like paroxetine, and the symptoms may clear up within about three weeks.

Seek medical advice if you want to stop taking paroxetine. A healthcare professional can provide a plan to slowly reduce your dose over the course of at least two weeks to lower the chances of withdrawal symptoms.

Paroxetine Side Effects Sexually 

If you’re suffering from anxiety or depression, your love life may have already taken a hit. So, it’s a cruel twist of fate that paroxetine can come with sexual side effects.

Unfortunately, sexual side effects from antidepressants aren’t uncommon.

In placebo-controlled trials with more than 3,200 participants, paroxetine side effects sexually appeared among both men and women.

Paroxetine sexual side effects include:

• Decreased libido (sex drive) in both men and women

• Ejaculatory disturbance

• Erectile dysfunction (ED)

• Orgasmic disturbance in women

Paxil’s sexual side effects are usually reversible, although in rare cases, they may last months or even years after you stop taking the drug. Yikes.

Paroxetine may also affect male fertility by causing abnormal sperm DNA fragmentation (damage in sperm’s genetic material, making conception less likely and miscarriage more likely).

Speak to a healthcare provider if you’re experiencing paroxetine side effects sexually.  They may recommend medications, like sildenafil, to help.

Your provider might also reduce your dose, recommend cognitive behavioral therapy (CBT), or suggest a different medication altogether.

There’s a silver lining to all these paroxetine side effects sexually, though.

Paroxetine can cause delayed ejaculation. This might be annoying for guys who don’t have any penis problems, but if you find yourself finishing too fast, paroxetine can help treat premature ejaculation.

A 2019 systematic review and meta-analysis looked at 19 randomized controlled trials of paroxetine. It found that paroxetine was more effective than a placebo, fluoxetine, and escitalopram at increasing intra-vaginal ejaculatory latency time (IELT). In non-science speak, that’s how long you last while having penetrative sex.

However, paroxetine may work even better in a team. The research found that paroxetine and tadalafil or behavior therapy were more effective at treating PE than paroxetine alone.

One caveat is that other side effects were more likely when paroxetine was used with another treatment.

These side effects were mild and tolerable, though.

When paroxetine was combined with another medication, the most common side effects included: 

• Nausea 

• Muscle soreness

• Heart palpitation 

• Flushing 

A 2014 review found that a daily paroxetine treatment of 10mg to 40mg was usually effective at delaying ejaculation.

Paroxetine for Premature Ejaculation vs. Other SSRIs

Other SSRIs can help you last longer in bed too. But paroxetine seems to cause the most significant delay in ejaculation, increasing IELT about 8.8-fold over baseline measures — in other words, helping guys last nearly nine times as long as they normally do.

This can happen quickly too. You might see improvements in the bedroom within five to 10 days of starting treatment — but give paroxetine two to three weeks to fully kick in before deciding whether it does or doesn’t work for you.

Learn more in our guide to antidepressant sexual side effects.

Paroxetine doesn’t mix well with some other drugs.

Be sure to let your healthcare provider know about any medication or supplements you take before starting paroxetine to avoid harmful drug interactions.

You can’t take paroxetine with:

• Thioridazine

• Pimozide

• MAOIs

• Triptans

• TCAs

• Fentanyl

• Lithium

• Tramadol

• Tryptophan

• Buspirone

• St. John’s wort

Mixing paroxetine with thioridazine or pimozide can cause cardiac arrhythmias (abnormal heart rhythm).

If you mix peroxide and an MAOI, TCA, or many of these other substances, there’s a risk of serotonin syndrome, which can be life-threatening.

Look out for symptoms like muscle rigidity, agitation, racing heartbeat, and high or low blood pressure. Get medical attention right away if you experience any of these.

Paroxetine can also increase the risk of abnormal bleeding. Taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, and other anticoagulants with it may elevate the risk further.

One final thing: You shouldn’t take other medications that contain paroxetine — like Paxil CR, Pexeva^®, and Brisdelle^® — with paroxetine itself.

The list of possible paroxetine side effects is lengthy — and there’s no guarantee that any medication is the best option for everyone.

While it can take some trial and error, it’s important to be aware of potential side effects and have coping mechanisms in place while you’re figuring things out. You can:

• Talk to your provider about whether adjusting to a lower dose is appropriate to still be effective for PE or depression symptoms.

• Try having sex right before you take your daily paroxetine pill so the amount of medication in your system is at its lowest, possibly leading to fewer sexual side effects.

• Ask your provider if taking a “medication holiday” makes sense. That’s when you take periodic short breaks from your prescription to see if side effects are more manageable without interrupting treatment effectiveness.

If these things don’t work for you, it may be best to seek alternative medications.

Good news! Paroxetine isn’t the only way to treat PE. 

Yes, one paroxetine side effect is delayed ejaculation. But for some people, the others can be pretty gnarly, and the medication isn’t right for everyone. 

Here are other premature ejaculation treatments to consider. 

Topical PE Treatments

Topical PE treatments don’t involve popping a pill or getting a prescription. You can buy these products over the counter from your local drugstore and online. 

They usually come in the form of a wipe, cream, or spray that you apply to your penis to reduce sensitivity.

Topical PE treatments typically contain:

• Benzocaine (like our Clockstopper benzocaine wipes)

• Prilocaine

• Lidocaine

The downside is that you may need to use a topical treatment every time you have sex, and they can get a little messy.

Topical treatments also come with side effects — though you might decide they’re much more tolerable than paroxetine side effects.

Specifically, they can cause irritation and numbness on your penis. And if you’re having vaginal sex, they can cause numbness in your partner too. (Tip: Wear a condom to stop this from happening.)

PE Medications

Paroxetine isn’t the only medication that can give you a helping hand in the bedroom.

A healthcare provider can prescribe other SSRIs off-label to help with PE. These include:

• Escitalopram

• Fluoxetine

• Fluvoxamine

• Zoloft^® (sertraline)

Anafranil^® (clomipramine) is another antidepressant in the TCA category that can also help improve PE.

Phosphodiesterase 5 inhibitors (PDE5 inhibitors) are a class of medication usually used to treat erectile dysfunction. But in some cases, they can help PE too.

These include:

• Viagra^® (sildenafil)

• Levitra^® (vardenafil)

• Cialis^® (tadalafil)

Quick heads-up: Tramadol can improve PE, but it’s not a common treatment. The medication can be addictive, and it comes with side effects like drowsiness, nausea, vomiting, dry mouth, itchiness, and dizziness.

A healthcare provider can help determine which medication is best suited to support your sexual function issues.

Therapy for PE

We could probably all benefit from seeking therapy for one thing or another, including if you’re struggling with PE. There are plenty of approaches to getting the mental health support you need.

You can try:

• Online therapy

• Couples therapy

• Sex therapy

Therapy can address any psychological factors contributing to PE and help with the distress and mental health problems PE can cause.

Alternative therapies like meditation and hypnosis for PE might also be useful.

Physical Techniques for PE

There are a few things you can try at home to help you avoid finishing too fast. This includes:

• The squeeze technique. When you’re close to climax, stop sex for a moment and squeeze the tip of your penis with your index finger and thumb. This should decrease arousal and help you keep things going for longer.

• The start-stop technique. Just before you’re about to climax, hit pause until the urge to ejaculate passes. Then, get back to it. With a few practice runs, you should be able to better recognize what it feels like just before you climax and stop in time.

• Distraction. Increase your sexual stamina by thinking about something else while getting it on. Just don’t think of anything too off-putting, as you may lose your erection altogether.

• Using a condom. The humble condom could help you control ejaculation. It makes your penis less sensitive, which might buy you more time.

• Masturbating before sex. When you know you’re likely going to have sex later, try masturbating a few hours beforehand. This may help you last longer with your partner.

• Pelvic floor exercises. Known as Kegels, this technique involves squeezing of a different sort. You can squeeze and train your pelvic floor muscles to gain more ejaculatory control. Research shows that pelvic floor exercises can help men increase how long they last in bed from 30 seconds to two minutes on average.

• Talk to your partner. Premature ejaculation might not be your idea of pillow talk. But discussing PE with your partner can reduce the pressure around performing in the bedroom, and you can brainstorm solutions together. Reading this article for a partner with PE? We’ve covered how to make a guy last longer.

Your first step in treating PE is to reach out to a medical professional.

They can determine what’s causing your PE and recommend the best treatment options for you, whether that’s paroxetine or something else entirely.

We know it’s not the most fun topic of conversation, but don’t be embarrassed about PE. It’s more common than you may think, affecting about 20 to 30 percent of men in the sexually active age group.

We’ve covered how to last longer in bed and how to prevent premature ejaculation in more detail on our blog.

Paroxetine, just like most meds, comes with side effects. If you’re battling premature ejaculation, you’ll be happy to hear delayed ejaculation is one such side effect.

Here’s the low-down on the rest: 

• The most common paroxetine side effects are usually mild. These include drowsiness, sweating, and dry mouth. They may crop up within the first week of treatment, but try to ride that wave — side effects should go away within two to three weeks.

• There’s a risk of serious side effects. Other side effects include paroxetine erectile dysfunction, trouble sleeping, and mania. Mixing paroxetine with certain other drugs can also cause troubling side effects. 

• Alternative PE treatments exist. Don’t like the sound of these side effects? Try other PE treatments like topical wipes, other SSRIs, therapy, or the squeeze technique.

If worrying side effects pop up, speak to a healthcare provider. If you’re experiencing premature ejaculation and considering paroxetine, speak to a healthcare provider. If you want a different treatment, well…you get the idea. 

A medical professional can give you the best advice for reclaiming your sex life, no matter your situation or the specific sexual problems you’re facing.

In the meantime, check out our guide to lifelong premature ejaculation.

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