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New: Paxil Linked to Birth Defects Paxil SSRI Side Effects Lawsuits: Suicide Claims If you or someone you know has been prescribed Paxil and have suffered serious side effects such as attempted suicide or birth defects, get the facts. Please review the information on our site and contact us for legal assistance. Paxil (paroxetine) is subject to FDA warnings, that state Paxil may cause suicide and violence in some children and teenagers. Other studies have shown that self harm and suicidal behavior may increase in some people taking this widely prescribed medication. New studies show that pregnant woman taking Paxil are at greater risk to having a child with rare birth defects. People who have been victims of these types of serious Paxil side effects may have possible claims against the drug maker. Our lawyers are interesting in speaking to people who may have been harmed by serious Paxil side effects. Contact us if you or a loved one has committed or attempted suicide, or if a child has birth defects you believe are related to Paxil use. Paxil Birth Defects Free Legal Consultation | Paxil Facts | Withdrawal Symptoms | Paxil Suicide Side Effects | Lawsuits If you need immediate attention for a Paxil Suicide or Birth Defects related matter please call 1-800-942-2056 This site is NOT authorized by Glaxo Smithkline Corporation: the manufacturers of Paxil and is not an Official Site of Paxil" All images are used for the purposes of dramatization. No Paxil claim is the same and results may vary. Call us for information about your legal rights Paxil Birth Defects, Paxil Side Effects and Infant Death On September 27, 2005, the FDA announced an alert to healthcare professionals and consumers as GlaxoSmithKline changed their warning label on Paxil (paroxetine) to include the risk of birth defects. The results of a recent study conducted by the two entities points to an increased risk of babies born with birth defects, specifically cardiovascular defects or congenital malformations, in instances where the mother was taking Paxil during the first trimester of pregnancy. Congenital malformations are physical defects present at birth and may involve the brain, heart, lungs, liver, bones, or intestinal tract. Congenital malformations are currently the leading cause of infant deaths in the U.S.; some examples include heart defects, cleft lip, cleft palate, Down syndrome, spina bifida, or limb defects. Paxil, an antidepressant drug, is used by millions of people worldwide and generates more than $1 billion USD in annual sales. Paxil has been in the news previously for complaints of severe withdrawal symptoms and risks of suicidal behavior and increased violence in children and adolescents. Paxil is known as a Selective Serotonin Reuptake Inhibitor (SSRI); other SSRI drugs include Prozac, Zoloft, Celexa and Lexapro. The FDA warns physicians to carefully weigh the potential risks and benefits of prescribing or renewing Paxil prescriptions to women during pregnancy or while breast-feeding. It is important that all patients are aware of the side effects, risks, and treatment alternatives. Paxil Category Warning too late for My Baby Paxil: A Mother's Warning GlaxoSmithKline Sued over Paxil Birth Defects Paxil Warning: Baby at Risk How Paxil can Ruin Lives Paxil and Birth Defects Paxil and Paxil Birth Defects in the News Jul-30-06: Parents of son born with severe heart defects sues Paxil makers GlaxoSmitKline. [NEWS RELEASE WIRE] Jul-20-06: Using Paxil or other SSRI's during pregnancy can cause pulmonary hypertension in newborns. [MEDACAPE] Jul-19-06: FDA healthcare professional alert on the increased risk of Neonatal Persistent Pulmonary Hypertension to mothers who took Paxil (Paroxetine). [FDA] Jul-19-06: Babies have risk of Persistent Pulmonary Hypertension (PPHN) if mothers take Paxil during pregnancy. [PHARMA LIVE] Jul-11-06: Authors, paid as consultants to drug makers, claim there is no danger to foetus when taking Paxil during pregnancy. [POST-GAZETTE] Apr-04-06: Study shows that use of SSRIs during pregnancy causes premature delivery, underweight babies, stillbirths and seizures in newborns. [CHRONICLE HERALD] Feb-23-06: Health Tip: Paxil and Pregnancy Don't Mix [FORBES] Feb-06-06: New study confirms baby’s risk when mother took Paxil, an SSRI antidepressant, while pregnant. Results show that the newborn may suffer from withdrawal symptoms such as seizures, tremors, gastrointestinal problems, and sleep disturbances immediately but the long term effects are still unknown. [FORBES] Dec-08-05: The Food and Drug Administration said that the warning label on GlaxoSmithKline's widely prescribed anxiety drug Paxil has again been revised to advise the drug may cause heart defects in babies. [MARKET WATCH] Sep-27-05: The FDA announces a Paxil label change and warning to physicians regarding the risk of major congenital malformations in infants born to women taking Paxil during the first trimester of pregnancy. [FDA] Sep-27-05: A joint study conducted by the FDA and the maker of Paxil reviewed medical records of 3,581 infants born to women who took Paxil or other antidepressants during the first trimester of pregnancy. A preliminary analysis found infants born to women who took Paxil were more likely to be born with an abnormality than babies born to women who took another antidepressant. [ABC NEWS] Register your Paxil / Paxil Birth Defect Complaint If you or a loved one has suffered from a newborn’s death or birth defect and the mother was prescribed Paxil during pregnancy, please fill in the form below for a free case evaluation by a Paxil lawyer, or call 1-866-886-5529 toll free. Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of PAXIL CR or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. PAXIL CR is not approved for use in pediatric patients. (See WARNINGS and PRECAUTIONS -- Pediatric Use.) Pooled analyses of short-term (4 to 16 weeks) placebo-controlled trials of 9 antidepressant drugs (SSRIs and others) in children and adolescents with major depressive disorder (MDD), obsessive compulsive disorder (OCD), or other psychiatric disorders (a total of 24 trials involving over 4,400 patients) have revealed a greater risk of adverse events representing suicidal thinking or behavior (suicidality) during the first few months of treatment in those receiving antidepressants. The average risk of such events in patients receiving antidepressants was 4%, twice the placebo risk of 2%. No suicides occurred in these trials. DESCRIPTION PAXIL CR (paroxetine hydrochloride) is an orally administered psychotropic drug with a chemical structure unrelated to other selective serotonin reuptake inhibitors or to tricyclic, tetracyclic, or other available antidepressant or antipanic agents. It is the hydrochloride salt of a phenylpiperidine compound identified chemically as (-)- trans -4 R -(4'-fluorophenyl)-3 S -[(3',4'-methylenedioxyphenoxy) methyl] piperidine hydrochloride hemihydrate and has the empirical formula of C 19 H 20 FNO 3 ·HCl·1/2H 2 O. The molecular weight is 374.8 (329.4 as free base). Paroxetine hydrochloride is an odorless, off-white powder, having a melting point range of 120° to 138°C and a solubility of 5.4 mg/mL in water. Distribution: Paroxetine distributes throughout the body, including the CNS, with only 1% remaining in the plasma. Protein Binding: Approximately 95% and 93% of paroxetine is bound to plasma protein at 100 ng/mL and 400 ng/mL, respectively. Under clinical conditions, paroxetine concentrations would normally be less than 400 ng/mL. Paroxetine does not alter the in vitro protein binding of phenytoin or warfarin. Renal and Liver Disease: Increased plasma concentrations of paroxetine occur in subjects with renal and hepatic impairment. The mean plasma concentrations in patients with creatinine clearance below 30 mL/min. was approximately 4 times greater than seen in normal volunteers. Patients with creatinine clearance of 30 to 60 mL/min. and patients with hepatic functional impairment had about a 2-fold increase in plasma concentrations (AUC, C max ). The initial dosage should therefore be reduced in patients with severe renal or hepatic impairment, and upward titration, if necessary, should be at increased intervals (see DOSAGE AND ADMINISTRATION ). Elderly Patients: In a multiple-dose study in the elderly at daily doses of 20, 30, and 40 mg of the immediate-release formulation, C min concentrations were about 70% to 80% greater than the respective C min concentrations in non-elderly subjects. Therefore the initial dosage in the elderly should be reduced (see DOSAGE AND ADMINISTRATION ). Clinical Trials Major Depressive Disorder: The efficacy of PAXIL CR controlled-release tablets as a treatment for major depressive disorder has been established in two 12-week, flexible-dose, placebo-controlled studies of patients with DSM-IV Major Depressive Disorder. One study included patients in the age range 18 to 65 years, and a second study included elderly patients, ranging in age from 60 to 88. In both studies, PAXIL CR was shown to be significantly more effective than placebo in treating major depressive disorder as measured by the following: Hamilton Depression Rating Scale (HDRS), the Hamilton depressed mood item, and the Clinical Global Impression (CGI)-Severity of Illness score. A study of outpatients with major depressive disorder who had responded to immediate-release paroxetine tablets (HDRS total score <8) during an initial 8-week open-treatment phase and were then randomized to continuation on immediate-release paroxetine tablets or placebo for 1 year demonstrated a significantly lower relapse rate for patients taking immediate-release paroxetine tablets (15%) compared to those on placebo (39%). Effectiveness was similar for male and female patients. Panic Disorder: The effectiveness of PAXIL CR in the treatment of panic disorder was evaluated in three 10-week, multicenter, flexible-dose studies (Studies 1, 2, and 3) comparing paroxetine controlled-release (12.5 to 75 mg daily) to placebo in adult outpatients who had panic disorder (DSM-IV), with or without agoraphobia. These trials were assessed on the basis of their outcomes on 3 variables: (1) the proportions of patients free of full panic attacks at endpoint; (2) change from baseline to endpoint in the median number of full panic attacks; and (3) change from baseline to endpoint in the median Clinical Global Impression Severity score. For Studies 1 and 2, PAXIL CR was consistently superior to placebo on 2 of these 3 variables. Study 3 failed to consistently demonstrate a significant difference between PAXIL CR and placebo on any of these variables. For all 3 studies, the mean dose of PAXIL CR for completers at endpoint was approximately 50 mg/day. Subgroup analyses did not indicate that there were any differences in treatment outcomes as a function of age or gender. Long-term maintenance effects of the immediate-release formulation of paroxetine in panic disorder were demonstrated in an extension study. Patients who were responders during a 10-week double-blind phase with immediate-release paroxetine and during a 3-month double-blind extension phase were randomized to either immediate-release paroxetine or placebo in a 3-month double-blind relapse prevention phase. Patients randomized to paroxetine were significantly less likely to relapse than comparably treated patients who were randomized to placebo. Social Anxiety Disorder: The efficacy of PAXIL CR as a treatment for social anxiety disorder has been established, in part, on the basis of extrapolation from the established effectiveness of the immediate-release formulation of paroxetine. In addition, the effectiveness of PAXIL CR in the treatment of social anxiety disorder was demonstrated in a 12-week, multicenter, double-blind, flexible-dose, placebo-controlled study of adult outpatients with a primary diagnosis of social anxiety disorder (DSM-IV). In the study, the effectiveness of PAXIL CR (12.5 to 37.5 mg daily) compared to placebo was evaluated on the basis of (1) change from baseline in the Liebowitz Social Anxiety Scale (LSAS) total score and (2) the proportion of responders who scored 1 or 2 (very much improved or much improved) on the Clinical Global Impression (CGI) Global Improvement score. PAXIL CR demonstrated statistically significant superiority over placebo on both the LSAS total score and the CGI Improvement responder criterion. For patients who completed the trial, 64% of patients treated with PAXIL CR compared to 34.7% of patients treated with placebo were CGI Improvement responders. Subgroup analyses did not indicate that there were any differences in treatment outcomes as a function of gender. Subgroup analyses of studies utilizing the immediate-release formulation of paroxetine generally did not indicate differences in treatment outcomes as a function of age, race, or gender. Premenstrual Dysphoric Disorder: The effectiveness of PAXIL CR for the treatment of PMDD utilizing a continuous dosing regimen has been established in 2 placebo-controlled trials. Patients in these trials met DSM-IV criteria for PMDD. In a pool of 1,030 patients, treated with daily doses of PAXIL CR 12.5 or 25 mg/day, or placebo the mean duration of the PMDD symptoms was approximately 11 ± 7 years. Patients on systemic hormonal contraceptives were excluded from these trials. Therefore, the efficacy of PAXIL CR in combination with systemic (including oral) hormonal contraceptives for the continuous daily treatment of PMDD is unknown. In both positive studies, patients (N = 672) were treated with 12.5 mg/day or 25 mg/day of PAXIL CR or placebo continuously throughout the menstrual cycle for a period of 3 menstrual cycles. The VAS-Total score is a patient-rated instrument that mirrors the diagnostic criteria of PMDD as identified in the DSM-IV, and includes assessments for mood, physical symptoms, and other symptoms. 12.5 mg/day and 25 mg/day of PAXIL CR were significantly more effective than placebo as measured by change from baseline to the endpoint on the luteal phase VAS-Total score. In a third study employing intermittent dosing, patients (N = 366) were treated for the 2 weeks prior to the onset of menses (luteal phase dosing, also known as intermittent dosing) with 12.5 mg/day or 25 mg/day of PAXIL CR or placebo for a period of 3 months. 12.5 mg/day and 25 mg/day of PAXIL CR, as luteal phase dosing, was significantly more effective than placebo as measured by change from baseline luteal phase VAS total score. There is insufficient information to determine the effect of race or age on outcome in these studies. INDICATIONS AND USAGE Major Depressive Disorder: PAXIL CR is indicated for the treatment of major depressive disorder. The efficacy of PAXIL CR in the treatment of a major depressive episode was established in two 12-week controlled trials of outpatients whose diagnoses corresponded to the DSM-IV category of major depressive disorder (see CLINICAL PHARMACOLOGY -- Clinical Trials ). A major depressive episode (DSM-IV) implies a prominent and relatively persistent (nearly every day for at least 2 weeks) depressed mood or loss of interest or pleasure in nearly all activities, representing a change from previous functioning, and includes the presence of at least 5 of the following 9 symptoms during the same 2-week period: Depressed mood, markedly diminished interest or pleasure in usual activities, significant change in weight and/or appetite, insomnia or hypersomnia, psychomotor agitation or retardation, increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, a suicide attempt, or suicidal ideation. The antidepressant action of paroxetine in hospitalized depressed patients has not been adequately studied. PAXIL CR has not been systematically evaluated beyond 12 weeks in controlled clinical trials; however, the effectiveness of immediate-release paroxetine hydrochloride in maintaining a response in major depressive disorder for up to 1 year has been demonstrated in a placebo-controlled trial (see CLINICAL PHARMACOLOGY-- Clinical Trials ). The physician who elects to use PAXIL CR for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient. Panic Disorder: PAXIL CR is indicated for the treatment of panic disorder, with or without agoraphobia, as defined in DSM-IV. Panic disorder is characterized by the occurrence of unexpected panic attacks and associated concern about having additional attacks, worry about the implications or consequences of the attacks, and/or a significant change in behavior related to the attacks. The efficacy of PAXIL CR controlled-release tablets was established in two 10-week trials in panic disorder patients whose diagnoses corresponded to the DSM-IV category of panic disorder (see CLINICAL PHARMACOLOGY -- Clinical Trials ). Panic disorder (DSM-IV) is characterized by recurrent unexpected panic attacks, i.e., a discrete period of intense fear or discomfort in which 4 (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: (1) palpitations, pounding heart, or accelerated heart rate; (2) sweating; (3) trembling or shaking; (4) sensations of shortness of breath or smothering; (5) feeling of choking; (6) chest pain or discomfort; (7) nausea or abdominal distress; (8) feeling dizzy, unsteady, lightheaded, or faint; (9) derealization (feelings of unreality) or depersonalization (being detached from oneself); (10) fear of losing control; (11) fear of dying; (12) paresthesias (numbness or tingling sensations); (13) chills or hot flushes. Long-term maintenance of efficacy with the immediate-release formulation of paroxetine was demonstrated in a 3-month relapse prevention trial. In this trial, patients with panic disorder assigned to immediate-release paroxetine demonstrated a lower relapse rate compared to patients on placebo (see CLINICAL PHARMACOLOGY -- Clinical Trials ). Nevertheless, the physician who prescribes PAXIL CR for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient. Social Anxiety Disorder: PAXIL CR is indicated for the treatment of social anxiety disorder, also known as social phobia, as defined in DSM-IV (300.23). Social anxiety disorder is characterized by a marked and persistent fear of 1 or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. Exposure to the feared situation almost invariably provokes anxiety, which may approach the intensity of a panic attack. The feared situations are avoided or endured with intense anxiety or distress. The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational or academic functioning, or social activities or relationships, or there is marked distress about having the phobias. Lesser degrees of performance anxiety or shyness generally do not require psychopharmacological treatment. The efficacy of PAXIL CR as a treatment for social anxiety disorder has been established, in part, on the basis of extrapolation from the established effectiveness of the immediate-release formulation of paroxetine. In addition, the efficacy of PAXIL CR was established in a 12-week trial, in adult outpatients with social anxiety disorder (DSM-IV). PAXIL CR has not been studied in children or adolescents with social phobia (see CLINICAL PHARMACOLOGY -- Clinical Trials ). The effectiveness of PAXIL CR in long-term treatment of social anxiety disorder, i.e., for more than 12 weeks, has not been systematically evaluated in adequate and well-controlled trials. Therefore, the physician who elects to prescribe PAXIL CR for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient (see DOSAGE AND ADMINISTRATION ). Premenstrual Dysphoric Disorder: PAXIL CR is indicated for the treatment of PMDD. The efficacy of PAXIL CR in the treatment of PMDD has been established in 3 placebo-controlled trials (see CLINICAL PHARMACOLOGY -- Clinical Trials ). The essential features of PMDD, according to DSM-IV, include markedly depressed mood, anxiety or tension, affective lability, and persistent anger or irritability. Other features include decreased interest in usual activities, difficulty concentrating, lack of energy, change in appetite or sleep, and feeling out of control. Physical symptoms associated with PMDD include breast tenderness, headache, joint and muscle pain, bloating, and weight gain. These symptoms occur regularly during the luteal phase and remit within a few days following the onset of menses; the disturbance markedly interferes with work or school or with usual social activities and relationships with others. In making the diagnosis, care should be taken to rule out other cyclical mood disorders that may be exacerbated by treatment with an antidepressant. The effectiveness of PAXIL CR in long-term use, that is, for more than 3 menstrual cycles, has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use PAXIL CR for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient. CONTRAINDICATIONS Concomitant use in patients taking either monoamine oxidase inhibitors (MAOIs) or thioridazine is contraindicated (see WARNINGS and PRECAUTIONS ). Concomitant use in patients taking pimozide is contraindicated (see PRECAUTIONS ). PAXIL CR is contraindicated in patients with a hypersensitivity to paroxetine or to any of the inactive ingredients in PAXIL CR. WARNINGS Clinical Worsening and Suicide Risk: Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. There has been a long-standing concern that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients. Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Pooled analyses of short-term placebo-controlled trials of 9 antidepressant drugs (SSRIs and others) in children and adolescents with MDD, OCD, or other psychiatric disorders (a total of 24 trials involving over 4,400 patients) have revealed a greater risk of adverse events representing suicidal behavior or thinking (suicidality) during the first few months of treatment in those receiving antidepressants. The average risk of such events in patients receiving antidepressants was 4%, twice the placebo risk of 2%. There was considerable variation in risk among drugs, but a tendency toward an increase for almost all drugs studied. The risk of suicidality was most consistently observed in the MDD trials, but there were signals of risk arising from some trials in other psychiatric indications (obsessive compulsive disorder and social anxiety disorder) as well. No suicides occurred in any of these trials. It is unknown whether the suicidality risk in pediatric patients extends to longer-term use, i.e., beyond several months. It is also unknown whether the suicidality risk extends to adults. All pediatric patients being treated with antidepressants for any indication should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. Such observation would generally include at least weekly face-to-face contact with patients or their family members or caregivers during the first 4 weeks of treatment, then every other week visits for the next 4 weeks, then at 12 weeks, and as clinically indicated beyond 12 weeks. Additional contact by telephone may be appropriate between face-to-face visits. Adults with MDD or co-morbid depression in the setting of other psychiatric illness being treated with antidepressants should be observed similarly for clinical worsening and suicidality, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality. Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms. If the decision has been made to discontinue treatment, medication should be tapered, as rapidly as is feasible, but with recognition that abrupt discontinuation can be associated with certain symptoms (see PRECAUTIONS and DOSAGE AND ADMINISTRATION -- Discontinuation of Treatment With PAXIL CR , for a description of the risks of discontinuation of PAXIL CR). Families and caregivers of pediatric patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to health care providers. Such monitoring should include daily observation by families and caregivers. Prescriptions for PAXIL CR should be written for the smallest quantity of tablets consistent with good patient management, in order to reduce the risk of overdose. Families and caregivers of adults being treated for depression should be similarly advised. Screening Patients for Bipolar Disorder: A major depressive episode may be the initial presentation of bipolar disorder. It is generally believed (though not established in controlled trials) that treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that PAXIL CR is not approved for use in treating bipolar depression. Potential for Interaction With Monoamine Oxidase Inhibitors: In patients receiving another serotonin reuptake inhibitor drug in combination with an MAOI, there have been reports of serious, sometimes fatal, reactions including hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma. These reactions have also been reported in patients who have recently discontinued that drug and have been started on an MAOI. Some cases presented with features resembling neuroleptic malignant syndrome. While there are no human data showing such an interaction with paroxetine hydrochloride, limited animal data on the effects of combined use of paroxetine and MAOIs suggest that these drugs may act synergistically to elevate blood pressure and evoke behavioral excitation. Therefore, it is recommended that PAXIL CR not be used in combination with an MAOI, or within 14 days of discontinuing treatment with an MAOI. At least 2 weeks should be allowed after stopping PAXIL CR before starting an MAOI. Potential Interaction With Thioridazine: Thioridazine administration alone produces prolongation of the QTc interval, which is associated with serious ventricular arrhythmias, such as torsade de pointes-type arrhythmias, and sudden death. This effect appears to be dose related. An in vivo study suggests that drugs which inhibit P 450 IID 6 , such as paroxetine, will elevate plasma levels of thioridazine. Therefore, it is recommended that paroxetine not be used in combination with thioridazine (see CONTRAINDICATIONS and PRECAUTIONS ). PRECAUTIONS General: Activation of Mania/Hypomania: During premarketing testing of immediate-release paroxetine hydrochloride, hypomania or mania occurred in approximately 1.0% of paroxetine-treated unipolar patients compared to 1.1% of active-control and 0.3% of placebo-treated unipolar patients. In a subset of patients classified as bipolar, the rate of manic episodes was 2.2% for immediate-release paroxetine and 11.6% for the combined active-control groups. Among 1,627 patients with major depressive disorder, panic disorder, social anxiety disorder, or PMDD treated with PAXIL CR in controlled clinical studies, there were no reports of mania or hypomania. As with all drugs effective in the treatment of major depressive disorder, PAXIL CR should be used cautiously in patients with a history of mania. Seizures: During premarketing testing of immediate-release paroxetine hydrochloride, seizures occurred in 0.1% of paroxetine-treated patients, a rate similar to that associated with other drugs effective in the treatment of major depressive disorder. Among 1,627 patients who received PAXIL CR in controlled clinical trials in major depressive disorder, panic disorder, social anxiety disorder, or PMDD, 1 patient (0.1%) experienced a seizure. PAXIL CR should be used cautiously in patients with a history of seizures. It should be discontinued in any patient who develops seizures. Discontinuation of Treatment With PAXIL CR: Adverse events while discontinuing therapy with PAXIL CR were not systematically evaluated in most clinical trials; however, in recent placebo-controlled clinical trials utilizing daily doses of PAXIL CR up to 37.5 mg/day, spontaneously reported adverse events while discontinuing therapy with PAXIL CR were evaluated. Patients receiving 37.5 mg/day underwent an incremental decrease in the daily dose by 12.5 mg/day to a dose of 25 mg/day for 1 week before treatment was stopped. For patients receiving 25 mg/day or 12.5 mg/day, treatment was stopped without an incremental decrease in dose. With this regimen in those studies, the following adverse events were reported for PAXIL CR, at an incidence of 2% or greater for PAXIL CR and were at least twice that reported for placebo: Dizziness, nausea, nervousness, and additional symptoms described by the investigator as associated with tapering or discontinuing PAXIL CR (e.g., emotional lability, headache, agitation, electric shock sensations, fatigue, and sleep disturbances). These events were reported as serious in 0.3% of patients who discontinued therapy with PAXIL CR. During marketing of PAXIL CR and other SSRIs and SNRIs (serotonin and norepinephrine reuptake inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, (particularly when abrupt), including the following: Dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms. Patients should be monitored for these symptoms when discontinuing treatment with PAXIL CR. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate (see DOSAGE AND ADMINISTRATION ). See also PRECAUTIONS -- Pediatric Use , for adverse events reported upon discontinuation of treatment with paroxetine in pediatric patients. Akathisia: The use of paroxetine or other SSRIs has been associated with the development of akathisia, which is characterized by an inner sense of restlessness and psychomotor agitation such as an inability to sit or stand still usually associated with subjective distress. This is most likely to occur within the first few weeks of treatment. Hyponatremia: Several cases of hyponatremia have been reported with immediate-release paroxetine hydrochloride. The hyponatremia appeared to be reversible when paroxetine was discontinued. The majority of these occurrences have been in elderly individuals, some in patients taking diuretics or who were otherwise volume depleted. Serotonin Syndrome: The development of a serotonin syndrome may occur in association with treatment with paroxetine, particularly with concomitant use of serotonergic drugs and with drugs which may have impaired metabolism of immediate-release paroxetine hydrochloride. Symptoms have included agitation, confusion, diaphoresis, hallucinations, hyperreflexia, myoclonus, shivering, tachycardia, and tremor. The concomitant use of PAXIL CR with serotonin precursors (such as tryptophan) is not recommended (see WARNINGS -- Potential for Interaction With Monoamine Oxidase Inhibitors and PRECAUTIONS -- Drug Interactions ). Abnormal Bleeding: Published case reports have documented the occurrence of bleeding episodes in patients treated with psychotropic drugs that interfere with serotonin reuptake. Subsequent epidemiological studies, both of the case-control and cohort design, have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding. In 2 studies, concurrent use of a nonsteroidal anti-inflammatory drug (NSAID) or aspirin potentiated the risk of bleeding (see Drug Interactions). Although these studies focused on upper gastrointestinal bleeding, there is reason to believe that bleeding at other sites may be similarly potentiated. Patients should be cautioned regarding the risk of bleeding associated with the concomitant use of paroxetine with NSAIDs, aspirin, or other drugs that affect coagulation. Use in Patients With Concomitant Illness: Clinical experience with immediate-release paroxetine hydrochloride in patients with certain concomitant systemic illness is limited. Caution is advisable in using PAXIL CR in patients with diseases or conditions that could affect metabolism or hemodynamic responses. As with other SSRIs, mydriasis has been infrequently reported in premarketing studies with paroxetine hydrochloride. A few cases of acute angle closure glaucoma associated with therapy with immediate-release paroxetine have been reported in the literature. As mydriasis can cause acute angle closure in patients with narrow angle glaucoma, caution should be used when PAXIL CR is prescribed for patients with narrow angle glaucoma. PAXIL CR or the immediate-release formulation has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease. Patients with these diagnoses were excluded from clinical studies during premarket testing. Evaluation of electrocardiograms of 682 patients who received immediate-release paroxetine hydrochloride in double-blind, placebo-controlled trials, however, did not indicate that paroxe-tine is associated with the development of significant ECG abnormalities. Similarly, paroxetine hydrochloride does not cause any clinically important changes in heart rate or blood pressure. Increased plasma concentrations of paroxetine occur in patients with severe renal impairment (creatinine clearance <30 mL/min.) or severe hepatic impairment. A lower starting dose should be used in such patients (see DOSAGE AND ADMINISTRATION ). Information for Patients: Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with PAXIL CR and should counsel them in its appropriate use. A patient Medication Guide About Using Antidepressants in Children and Teenagers is available for PAXIL CR. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document. Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking PAXIL CR. Clinical Worsening and Suicide Risk: Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should be advised to observe for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient's prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication. PAXIL CR should not be chewed or crushed, and should be swallowed whole. Drugs That Interfere With Hemostasis (NSAIDs, Aspirin, Warfarin, etc.): Patients should be cautioned about the concomitant use of paroxetine and NSAIDs, aspirin, or other drugs that affect coagulation since the combined use of psychotropic drugs that interfere with serotonin reuptake and these agents has been associated with an increased risk of bleeding. Interference With Cognitive and Motor Performance: Any psychoactive drug may impair judgment, thinking, or motor skills. Although in controlled studies immediate-release paroxetine hydrochloride has not been shown to impair psychomotor performance, patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that therapy with PAXIL CR does not affect their ability to engage in such activities. Completing Course of Therapy: While patients may notice improvement with use of PAXIL CR in 1 to 4 weeks, they should be advised to continue therapy as directed. Concomitant Medications: Patients should be advised to inform their physician if they are taking, or plan to take, any prescription or over-the-counter drugs, since there is a potential for interactions. Alcohol: Although immediate-release paroxetine hydrochloride has not been shown to increase the impairment of mental and motor skills caused by alcohol, patients should be advised to avoid alcohol while taking PAXIL CR. Pregnancy: Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during therapy. Nursing: Patients should be advised to notify their physician if they are breast-feeding an infant (see PRECAUTIONS -- Nursing Mothers ). Laboratory Tests: There are no specific laboratory tests recommended. Drug Interactions: Tryptophan: As with other serotonin reuptake inhibitors, an interaction between paroxetine and tryptophan may occur when they are coadministered. Adverse experiences, consisting primarily of headache, nausea, sweating, and dizziness, have been reported when tryptophan was administered to patients taking immediate-release paroxetine. Consequently, concomitant use of PAXIL CR with tryptophan is not recommended (see Serotonin Syndrome ). Monoamine Oxidase Inhibitors: See CONTRAINDICATIONS and WARNINGS . Pimozide: In a controlled study of healthy volunteers, after PAXIL CR was titrated to 60 mg daily, co-administration of a single dose of 2 mg pimozide was associated with mean increases in pimozide AUC of 151% and C max of 62%, compared to pimozide administered alone. Due to the narrow therapeutic index of pimozide and its known ability to prolong the QT interval, concomitant use of pimozide and PAXIL CR is contraindicated (see CONTRAINDICATIONS ). Serotonergic Drugs: Based on the mechanism of action of paroxetine and the potential for serotonin syndrome, caution is advised when PAXIL CR is coadministered with other drugs or agents that may affect the serotonergic neurotransmitter systems, such as tryptophan, triptans, serotonin reuptake inhibitors, linezolid (an antibiotic which is a reversible non-selective MAOI), lithium, tramadol, or St. John's Wort (see Serotonin Syndrome ). Thioridazine: See CONTRAINDICATIONS and WARNINGS . Warfarin: Preliminary data suggest that there may be a pharmacodynamic interaction (that causes an increased bleeding diathesis in the face of unaltered prothrombin time) between paroxetine and warfarin. Since there is little clinical experience, the concomitant administration of PAXIL CR and warfarin should be undertaken with caution (see Drugs That Interfere With Hemostasis ). Triptans: There have been rare postmarketing reports describing patients with weakness, hyperreflexia, and incoordination following the use of an SSRI and sumatriptan. If concomitant treatment with a triptan and an SSRI (e.g., fluoxetine, fluvoxamine, paroxetine, sertraline) is clinically warranted, appropriate observation of the patient is advised (see Serotonin Syndrome ). Drugs Affecting Hepatic Metabolism: The metabolism and pharmacokinetics of paroxetine may be affected by the induction or inhibition of drug-metabolizing enzymes. Cimetidine: Cimetidine inhibits many cytochrome P 450 (oxidative) enzymes. In a study where immediate-release paroxetine (30 mg once daily) was dosed orally for 4 weeks, steady-state plasma concentrations of paroxetine were increased by approximately 50% during coadministration with oral cimetidine (300 mg three times daily) for the final week. Therefore, when these drugs are administered concurrently, dosage adjustment of PAXIL CR after the starting dose should be guided by clinical effect. The effect of paroxetine on cimetidine's pharmacokinetics was not studied. Phenobarbital: Phenobarbital induces many cytochrome P 450 (oxidative) enzymes. When a single oral 30-mg dose of immediate-release paroxetine was administered at phenobarbital steady state (100 mg once daily for 14 days), paroxetine AUC and T ? were reduced (by an average of 25% and 38%, respectively) compared to paroxetine administered alone. The effect of paroxetine on phenobarbital pharmacokinetics was not studied. Since paroxetine exhibits nonlinear pharmacokinetics, the results of this study may not address the case where the 2 drugs are both being chronically dosed. No initial dosage adjustment with PAXIL CR is considered necessary when coadministered with phenobarbital; any subsequent adjustment should be guided by clinical effect. Alcohol: Although paroxetine does not increase the impairment of mental and motor skills caused by alcohol, patients should be advised to avoid alcohol while taking PAXIL CR. Lithium: A multiple-dose study with immediate-release paroxetine hydrochloride has shown that there is no pharmacokinetic interaction between paroxetine and lithium carbonate. However, due to the potential for serotonin syndrome, caution is advised when immediate-release paroxetine hydrochloride is coadministered with lithium. Digoxin: The steady-state pharmacokinetics of paroxetine was not altered when administered with digoxin at steady state. Mean digoxin AUC at steady state decreased by 15% in the presence of paroxetine. Since there is little clinical experience, the concurrent administration of PAXIL CR and digoxin should be undertaken with caution. Diazepam: Under steady-state conditions, diazepam does not appear to affect paroxetine kinetics. The effects of paroxetine on diazepam were not evaluated. Procyclidine: Daily oral dosing of immediate-release paroxetine (30 mg once daily) increased steady-state AUC 0-24 , C max , and C min values of procyclidine (5 mg oral once daily) by 35%, 37%, and 67%, respectively, compared to procyclidine alone at steady state. If anticholinergic effects are seen, the dose of procyclidine should be reduced. Beta-Blockers: In a study where propranolol (80 mg twice daily) was dosed orally for 18 days, the established steady-state plasma concentrations of propranolol were unaltered during coadministration with immediate-release paroxetine (30 mg once daily) for the final 10 days. The effects of propranolol on paroxetine have not been evaluated (see ADVERSE REACTIONS -- Postmarketing Reports ). Theophylline: Reports of elevated theophylline levels associated with immediate-release paroxetine treatment have been reported. While this interaction has not been formally studied, it is recommended that theophylline levels be monitored when these drugs are concurrently administered. Electroconvulsive Therapy (ECT): There are no clinical studies of the combined use of ECT and PAXIL CR. Carcinogenesis, Mutagenesis, Impairment of Fertility: Carcinogenesis: Two-year carcinogenicity studies were conducted in rodents given paroxetine in the diet at 1, 5, and 25 mg/kg/day (mice) and 1, 5, and 20 mg/kg/day (rats). These doses are up to approximately 2 (mouse) and 3 (rat) times the maximum recommended human dose (MRHD) on a mg/m 2 basis. There was a significantly greater number of male rats in the high-dose group with reticulum cell sarcomas (1/100, 0/50, 0/50, and 4/50 for control, low-, middle-, and high-dose groups, respectively) and a significantly increased linear trend across dose groups for the occurrence of lymphoreticular tumors in male rats. Female rats were not affected. Although there was a dose-related increase in the number of tumors in mice, there was no drug-related increase in the number of mice with tumors. The relevance of these findings to humans is unknown. Mutagenesis: Paroxetine produced no genotoxic effects in a battery of 5 in vitro and 2 in vivo assays that included the following: Bacterial mutation assay, mouse lymphoma mutation assay, unscheduled DNA synthesis assay, and tests for cytogenetic aberrations in vivo in mouse bone marrow and in vitro in human lymphocytes and in a dominant lethal test in rats. Impairment of Fertility: A reduced pregnancy rate was found in reproduction studies in rats at a dose of paroxetine of 15 mg/kg/day, which is approximately twice the MRHD on a mg/m 2 basis. Irreversible lesions occurred in the reproductive tract of male rats after dosing in toxicity studies for 2 to 52 weeks. These lesions consisted of vacuolation of epididymal tubular epithelium at 50 mg/kg/day and atrophic changes in the seminiferous tubules of the testes with arrested spermatogenesis at 25 mg/kg/day (approximately 8 and 4 times the MRHD on a mg/m 2 basis). Pregnancy: Pregnancy Category C. Reproduction studies were performed at doses up to 50 mg/kg/day in rats and 6 mg/kg/day in rabbits administered during organogenesis. These doses are approximately 8 (rat) and 2 (rabbit) times the MRHD on an mg/m 2 basis. These studies have revealed no evidence of teratogenic effects. However, in rats, there was an increase in pup deaths during the first 4 days of lactation when dosing occurred during the last trimester of gestation and continued throughout lactation. This effect occurred at a dose of 1 mg/kg/day or approximately one-sixth of the MRHD on an mg/m 2 basis. The no-effect dose for rat pup mortality was not determined. The cause of these deaths is not known. There are no adequate and well-controlled studies in pregnant women. This drug should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Nonteratogenic Effects: Neonates exposed to PAXIL CR and other SSRIs or SNRIs, late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Such complications can arise immediately upon delivery. Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying. These features are consistent with either a direct toxic effect of SSRIs and SNRIs or, possibly, a drug discontinuation syndrome. It should be noted that, in some cases, the clinical picture is consistent with serotonin syndrome (see WARNINGS -- Potential for Interaction With Monoamine Oxidase Inhibitors ). There have also been postmarketing reports of premature births in pregnant women exposed to paroxetine or other SSRIs. When treating a pregnant woman with paroxetine during the third trimester, the physician should carefully consider the potential risks and benefits of treatment (see DOSAGE AND ADMINISTRATION ). Labor and Delivery: The effect of paroxetine on labor and delivery in humans is unknown. Nursing Mothers: Like many other drugs, paroxetine is secreted in human milk, and caution should be exercised when PAXIL CR is administered to a nursing woman. Pediatric Use: Safety and effectiveness in the pediatric population have not been established (see BOX WARNING and WARNINGS -- Clinical Worsening and Suicide Risk ). Three placebo-controlled trials in 752 pediatric patients with MDD have been conducted with PAXIL, and the data were not sufficient to support a claim for use in pediatric patients. Anyone considering the use of PAXIL CR in a child or adolescent must balance the potential risks with the clinical need. In placebo-controlled clinical trials conducted with pediatric patients, the following adverse events were reported in at least 2% of pediatric patients treated with immediate-release paroxetine hydrochloride and occurred at a rate at least twice that for pediatric patients receiving placebo: emotional lability (including self-harm, suicidal thoughts, attempted suicide, crying, and mood fluctuations), hostility, decreased appetite, tremor, sweating, hyperkinesia, and agitation. Events reported upon discontinuation of treatment with immediate-release paroxetine hydrochloride in the pediatric clinical trials that included a taper phase regimen, which occurred in at least 2% of patients who received immediate-release paroxetine hydrochloride and which occurred at a rate at least twice that of placebo, were: emotional lability (including suicidal ideation, suicide attempt, mood changes, and tearfulness), nervousness, dizziness, nausea, and abdominal pain (see Discontinuation of Treatment With PAXIL CR ). Geriatric Use: In worldwide premarketing clinical trials with immediate-release paroxetine hydrochloride, 17% of paroxetine-treated patients (approximately 700) were 65 years or older. Pharmacokinetic studies revealed a decreased clearance in the elderly, and a lower starting dose is recommended; there were, however, no overall differences in the adverse event profile between elderly and younger patients, and effectiveness was similar in younger and older patients (see CLINICAL PHARMACOLOGY and DOSAGE AND ADMINISTRATION ). In a controlled study focusing specifically on elderly patients with major depressive disorder, PAXIL CR was demonstrated to be safe and effective in the treatment of elderly patients (>60 years) with major depressive disorder. (See CLINICAL PHARMACOLOGY -- Clinical Trials and ADVERSE REACTIONS --Table 2.) ADVERSE REACTIONS The information included under the " Adverse Findings Observed in Short-Term, Placebo-Controlled Trials With PAXIL CR " subsection of ADVERSE REACTIONS is based on data from 11 placebo-controlled clinical trials. Three of these studies were conducted in patients with major depressive disorder, 3 studies were done in patients with panic disorder, 1 study was conducted in patients with social anxiety disorder, and 4 studies were done in female patients with PMDD. Two of the studies in major depressive disorder, which enrolled patients in the age range 18 to 65 years, are pooled. Information from a third study of major depressive disorder, which focused on elderly patients (60 to 88 years), is presented separately as is the information from the panic disorder studies and the information from the PMDD studies. Information on additional adverse events associated with PAXIL CR and the immediate-release formulation of paroxetine hydrochloride is included in a separate subsection (see Other Events). Adverse Findings Observed in Short-Term, Placebo-Controlled Trials With PAXIL CR: Adverse Events Associated With Discontinuation of Treatment: Major Depressive Disorder: Ten percent (21/212) of patients treated with PAXIL CR discontinued treatment due to an adverse event in a pool of 2 studies of patients with major depressive disorder. The most common events (>/=1%) associated with discontinuation and considered to be drug related (i.e., those events associated with dropout at a rate approximately twice or greater for PAXIL CR compared to placebo) included the following: In a placebo-controlled study of elderly patients with major depressive disorder, 13% (13/104) of patients treated with PAXIL CR discontinued due to an adverse event. Events meeting the above criteria included the following: Panic Disorder: Eleven percent (50/444) of patients treated with PAXIL CR in panic disorder studies discontinued treatment due to an adverse event. Events meeting the above criteria included the following: Social Anxiety Disorder: Three percent (5/186) of patients treated with PAXIL CR in the social anxiety disorder study discontinued treatment due to an adverse event. Events meeting the above criteria included the following: Premenstrual Dysphoric Disorder: Spontaneously reported adverse events were monitored in studies of both continuous and intermittent dosing of PAXIL CR in the treatment of PMDD. Generally, there were few differences in the adverse event profiles of the 2 dosing regimens. Thirteen percent (88/681) of patients treated with PAXIL CR in PMDD studies of continuous dosing discontinued treatment due to an adverse event. Metabolic and Nutritional Disorders: Infrequent were generalized edema, hyperglycemia, hypokalemia, peripheral edema, SGOT increased, SGPT increased, thirst; rare were bilirubinemia, dehydration, hyperkalemia, obesity; also observed were alkaline phosphatase increased, BUN increased, creatinine phosphokinase increased, gamma globulins increased, gout, hypercalcemia, hypercholesteremia, hyperphosphatemia, hypocalcemia, hypoglycemia, hyponatremia, ketosis, lactic dehydrogenase increased, non-protein nitrogen (NPN) increased. Musculoskeletal System: Infrequent were arthritis, bursitis, tendonitis; rare were myasthenia, myopathy, myositis; also observed were generalized spasm, osteoporosis, tenosynovitis, tetany. Nervous System: Frequent were depression; infrequent were amnesia, convulsion, depersonalization, dystonia, emotional lability, hallucinations, hyperkinesia, hypesthesia, hypokinesia, incoordination, libido increased, neuralgia, neuropathy, nystagmus, paralysis, vertigo; rare were ataxia, coma, diplopia, dyskinesia, hostility, paranoid reaction, torticollis, withdrawal syndrome; also observed were abnormal gait, akathisia, akinesia, aphasia, choreoathetosis, circumoral paresthesia, delirium, delusions, dysarthria, euphoria, extrapyramidal syndrome, fasciculations, grand mal convulsion, hyperalgesia, irritability, manic reaction, manic-depressive reaction, meningitis, myelitis, peripheral neuritis, psychosis, psychotic depression, reflexes decreased, reflexes increased, stupor, trismus. Respiratory System: Frequent were pharyngitis; infrequent were asthma, dyspnea, epistaxis, laryngitis, pneumonia; rare were stridor; also observed were dysphonia, emphysema, hemoptysis, hiccups, hyperventilation, lung fibrosis, pulmonary edema, respiratory flu, sputum increased. Skin and Appendages: Frequent were rash; infrequent were acne, alopecia, dry skin, eczema, pruritus, urticaria; rare were exfoliative dermatitis, furunculosis, pustular rash, seborrhea; also observed were angioedema, ecchymosis, erythema multiforme, erythema nodosum, hirsutism, maculopapular rash, skin discoloration, skin hypertrophy, skin ulcer, sweating decreased, vesiculobullous rash. Special Senses: Infrequent were conjunctivitis, earache, keratoconjunctivitis, mydriasis, photophobia, retinal hemorrhage, tinnitus; rare were blepharitis, visual field defect; also observed were amblyopia, anisocoria, blurred vision, cataract, conjunctival edema, corneal ulcer, deafness, exophthalmos, glaucoma, hyperacusis, night blindness, parosmia, ptosis, taste loss. Urogenital System: Frequent were dysmenorrhea* ; infrequent were albuminuria, amenorrhea* , breast pain*, cystitis, dysuria, prostatitis*, urinary retention; rare were breast enlargement*, breast neoplasm*, female lactation, hematuria, kidney calculus, metrorrhagia*, nephritis, nocturia, pregnancy and puerperal disorders*, salpingitis, urinary incontinence, uterine fibroids enlarged*; also observed were breast atrophy, ejaculatory disturbance, endometrial disorder, epididymitis, fibrocystic breast, leukorrhea, mastitis, oliguria, polyuria, pyuria, urethritis, urinary casts, urinary urgency, urolith, uterine spasm, vaginal hemorrhage. * Based on the number of men and women as appropriate. Postmarketing Reports: Voluntary reports of adverse events in patients taking immediate-release paroxetine hydrochloride that have been received since market introduction and not listed above that may have no causal relationship with the drug include acute pancreatitis, elevated liver function tests (the most severe cases were deaths due to liver necrosis, and grossly elevated transaminases associated with severe liver dysfunction), Guillain-Barre syndrome, toxic epidermal necrolysis, priapism, syndrome of inappropriate ADH secretion, symptoms suggestive of prolactinemia and galactorrhea, neuroleptic malignant syndrome-like events, serotonin syndrome; extrapyramidal symptoms which have included akathisia, bradykinesia, cogwheel rigidity, dystonia, hypertonia, oculogyric crisis which has been associated with concomitant use of pimozide; tremor and trismus; status epilepticus, acute renal failure, pulmonary hypertension, allergic alveolitis, anaphylaxis, eclampsia, laryngismus, optic neuritis, porphyria, ventricular fibrillation, ventricular tachycardia (including torsade de pointes), thrombocytopenia, hemolytic anemia, events related to impaired hematopoiesis (including aplastic anemia, pancytopenia, bone marrow aplasia, and agranulocytosis), and vasculitic syndromes (such as Henoch-Schonlein purpura). There has been a case report of an elevated phenytoin level after 4 weeks of immediate-release paroxetine and phenytoin coadministration. There has been a case report of severe hypotension when immediate-release paroxetine was added to chronic metoprolol treatment. DRUG ABUSE AND DEPENDENCE Controlled Substance Class: PAXIL CR is not a controlled substance. Physical and Psychologic Dependence: PAXIL CR has not been systematically studied in animals or humans for its potential for abuse, tolerance or physical dependence. While the clinical trials did not reveal any tendency for any drug-seeking behavior, these observations were not systematic and it is not possible to predict on the basis of this limited experience the extent to which a CNS-active drug will be misused, diverted, and/or abused once marketed. Consequently, patients should be evaluated carefully for history of drug abuse, and such patients should be observed closely for signs of misuse or abuse of PAXIL CR (e.g., development of tolerance, incrementations of dose, drug-seeking behavior). OVERDOSAGE Human Experience: Since the introduction of immediate-release paroxetine hydrochloride in the United States, 342 spontaneous cases of deliberate or accidental overdosage during paroxetine treatment have been reported worldwide (circa 1999). These include overdoses with paroxetine alone and in combination with other substances. Of these, 48 cases were fatal and of the fatalities, 17 appeared to involve paroxetine alone. Eight fatal cases that documented the amount of paroxetine ingested were generally confounded by the ingestion of other drugs or alcohol or the presence of significant comorbid conditions. Of 145 non-fatal cases with known outcome, most recovered without sequelae. The largest known ingestion involved 2,000 mg of paroxetine (33 times the maximum recommended daily dose) in a patient who recovered. Commonly reported adverse events associated with paroxetine overdosage include somnolence, coma, nausea, tremor, tachycardia, confusion, vomiting, and dizziness. Other notable signs and symptoms observed with overdoses involving paroxetine (alone or with other substances) include mydriasis, convulsions (including status epilepticus), ventricular dysrhythmias (including torsade de pointes), hypertension, aggressive reactions, syncope, hypotension, stupor, bradycardia, dystonia, rhabdomyolysis, symptoms of hepatic dysfunction (including hepatic failure, hepatic necrosis, jaundice, hepatitis, and hepatic steatosis), serotonin syndrome, manic reactions, myoclonus, acute renal failure, and urinary retention. Overdosage Management: Treatment should consist of those general measures employed in the management of overdosage with any drugs effective in the treatment of major depressive disorder. Medication Guide PAXIL CR® (PAX-il) (paroxetine hydrochloride) Controlled-Release Tablets About Using Antidepressants in Children and Teenagers What is the most important information I should know if my child is being prescribed an antidepressant? Parents or guardians need to think about 4 important things when their child is prescribed an antidepressant: There is a risk of suicidal thoughts or actions How to try to prevent suicidal thoughts or actions in your child You should watch for certain signs if your child is taking an antidepressant There are benefits and risks when using antidepressants There is a Risk of Suicidal Thoughts or Actions Children and teenagers sometimes think about suicide, and many report trying to kill themselves. Antidepressants increase suicidal thoughts and actions in some children and teenagers. But suicidal thoughts and actions can also be caused by depression, a serious medical condition that is commonly treated with antidepressants. Thinking about killing yourself or trying to kill yourself is called suicidality or being suicidal. A large study combined the results of 24 different studies of children and teenagers with depression or other illnesses. In these studies, patients took either a placebo (sugar pill) or an antidepressant for 1 to 4 months. No one committed suicide in these studies, but some patients became suicidal. On sugar pills, 2 out of every 100 became suicidal. On the antidepressants, 4 out of every 100 patients became suicidal. For some children and teenagers, the risks of suicidal actions may be especially high. These include patients with Bipolar illness (sometimes called manic-depressive illness) A family history of bipolar illness A personal or family history of attempting suicide If any of these are present, make sure you tell your healthcare provider before your child takes an antidepressant. How to Try to Prevent Suicidal Thoughts and Actions To try to prevent suicidal thoughts and actions in your child, pay close attention to changes in her or his moods or actions, especially if the changes occur suddenly. Other important people in your child's life can help by paying attention as well (e.g., your child, brothers and sisters, teachers, and other important people). The changes to look out for are listed in Section 3, on what to watch for. Whenever an antidepressant is started or its dose is changed, pay close attention to your child. After starting an antidepressant, your child should generally see his or her healthcare provider: Once a week for the first 4 weeks Every 2 weeks for the next 4 weeks After taking the antidepressant for 12 weeks After 12 weeks, follow your healthcare provider's advice about how often to come back More often if problems or questions arise (see Section 3) You should call your child's healthcare provider between visits if needed. You Should Watch for Certain Signs If Your Child is Taking an Antidepressant Contact your child's healthcare provider right away if your child exhibits any of the following signs for the first time, or if they seem worse, or worry you, your child, or your child's teacher: Thoughts about suicide or dying Attempts to commit suicide New or worse depression New or worse anxiety Feeling very agitated or restless Panic attacks Difficulty sleeping (insomnia) New or worse irritability Acting aggressive, being angry, or violent Acting on dangerous impulses An extreme increase in activity and talking Other unusual changes in behavior or mood Treatment Options - Trustworthy, Current Report. www.bipolardisorder-guidebook.com Phentermine -Reviewed Is Phentermine the right diet aid for you? A revealing inside look. ConsumerHealthDigest.com Are you depressed? Symptoms, diagnosis, treatments, tools and other help. www.psychiatry24x7.com

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We collect facts from name-brand reference titles for you, for free. http://www.answers.com [today's views: 1] Drug Strength Quantity Price Status Pharmacy Info PHENTERMINE 30 mg 30 * $69.00 In Stock PHENTERMINE 30 mg 60 * $87.00 In Stock PHENTERMINE 30 mg 90 * $103.00 In Stock * indicates generic Additional Information Why is this medication prescribed Phentermine is used, in combination with diet and exercise, to help you lose weight. It works by decreasing your appetite. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information. What other information should I know Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to phentermine. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. In case of emergency overdose In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Copyright 2005 © BestMedValues All rights reserved The products mentioned are trademarks of their respective owners and are not affiliated with or owned by BestMedValues or any of it's affiliated companies. Privacy Policy (as of 04/10/2006) | Terms Of Use Phentermine From Wikipedia, the free encyclopedia Jump to: navigation, search Phentermine Systematic (IUPAC) name 2-methyl-1-phenyl-propan-2-amine Identifiers CAS number 122-09-8 ATC code A08AA01 C01CA11 PubChem 4771 DrugBank APRD00093 Chemical data Formula C10H15N Mol. weight 149.233 g/mol Pharmacokinetic data Bioavailability Peak plasma levels occur within 1 to 3 hours. Absorption is usually complete by 4 to 6 hours Protein binding Approximately 96.3% Metabolism hepatic Half life 16 to 31 hours Excretion Urinary elimination Therapeutic considerations Pregnancy cat. C(United States); ? (Australia) Legal status C-IV (US) Routes Oral Phentermine is a phenethylamine primarily used as an appetite suppressant. It is typically prescribed for individuals who are at increased medical risk because of their weight, as opposed to cosmetic weight loss. Phentermine is sold either as an immediate-release formulation (Adipex®) or as a slow-release resin (Ionamin®, Duromine® in Australia and New Zealand). Contents [hide] 1 History 2 Mechanism of action 3 Clinical use 4 Side effects 5 Contraindications 6 Internet Notoriety 7 Related Article 8 External links 9 References and End Notes [edit] History Phentermine is one of two drugs in the Fen-phen anti-obesity medication, the other being fenfluramine or dexfenfluramine. Fenfluramine was withdrawn from the U.S. market in 1997 after reports of valvular heart disease and pulmonary hypertension. Phentermine is still available by itself in most countries, including the U.S. However, because it is similar to the amphetamines, individuals may develop an addiction to it. Hence, it is classified as a controlled substance in many countries. Internationally, phentermine is a schedule IV drug under the Convention on Psychotropic Substances (PDF file). In the United States, it is classified as a Schedule IV controlled substance under the Controlled Substances Act. [edit] Mechanism of action Phentermine, as many other prescription drugs, works with neurotransmitters in the brain. It is a centrally-acting stimulant chemically related to the amphetamines. It stimulates neuron bundles to release a particular group of neurotransmitters known as catecholamines; these include dopamine, epinephrine (also known as adrenalin), and norepinephrine (noradrenaline). The anorectic activity seen with these compounds would thus seem likely due to this effect on Central Nervous System, which is consistent with current knowledge about Central Nervous System systems and feeding behavior. This is the same mechanism of action as other stimulant appetite suppresants such as diethylpropion, and phendimetrazine. The neurotransmitters signal a fight-or-flight response in the body which, in turn, puts a halt to the hunger signal. As a result, it causes a loss in appetite because the brain does not receive the hunger message. [edit] Clinical use Generally, it is recommended by the Food and Drug Administration (FDA) that phentermine should be used short-term (usually interpreted as 'up to 12 weeks'), while following nonpharmacological approaches to weight loss such as healthy dieting and exercise. However, recommendations limiting its use for short-term treatment may be controversial. One reason given behind limiting its use to 12 weeks is drug tolerance, whereby phentermine loses its appetite-suppressing effects after the body adjusts to the drug. On the contrary, it has been shown that phentermine did not lose effectiveness in a 36-week trial (PMID 11054601). Due to the risk of insomnia, it is generally recommended that the drug be taken either before breakfast or 1-2 hours after breakfast. [edit] Side effects Generally, phentermine appears to be relatively well tolerated.[1] It can produce side effects consistent with its chycardia]], increased alertness, but the incidence and magnitude of these appear to be less than with the amphetamines. Because phentermine acts through sympathomimetic pathways, the drug ug on a long-term basis may develop euphoria and a psychological addiction [edit] Contraindications Phentermine should generally be avoided in patients with: Agitation Allergy/Hypersensitivity to other sympathomimetic amines Atherosclerosis Cardiovascular disease Glaucoma High blood pressure Hyperthyroidism Previous history of drug abuse Additionally, this drug should not be used at the same time or within 14 days following the use of monoamine oxidase inhibitors. [edit] Internet Notoriety Recently, phentermine has drawn the ire of many internet users. The medication is one of the most commonly used terms in spam e-mails and bulletin board postings by bots. [edit] Related Article Obesity Anti-obesity drug [edit] External links MedLine Plus - Phentermine International Programme on Chemical Safety - Phentermine DrugBank:Phentermine TOXNET phentermine on pharmacywebsearch.com Link page to external chemical sources. [edit] References and End Notes ^ Nelson DL, Gehlert DR. (2006). Central nervous system biogenic amine targets for control of appetite and energy. Endocrine. 2006 Feb;29(1):49-60. PubMed. Retrieved on 6 May 2006. Sympathomimetic amines (R01, A08, and others) - edit Benzylpiperazine | Cathinone | CFT | Chlorphentermine | Cocaine | Cyclopentamine | Diethylpropion | Ephedrine | Fenfluramine | Mazindol | 4-Methyl-aminorex | Methylone | Methylphenidate | Pemoline | Phendimetrazine | Phenmetrazine | Phentermine | Phenylephrine | Propylhexedrine | Pseudoephedrine | Sibutramine | Synephrine • Phentermine Direct • Phentermine Prescription • Phentermine Ovulation • Buy Phentermine • Cheap Phentermine • Order Phentermine • Phentermine Order • Phentermine Online • Xenical Phentermine Low as $12.00 37.5mg x14 pills $12.00 Free FedEx Shipping on All orders. US Pharmacy. US orders only. 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Phentermine (Blue) 30mg (30 caps) 21.9 Phentermine (Blue) 30mg (60 pills) 38.9 Phentermine (Blue) 30mg (90 pills) 56.9 Phentermine (Yellow) 30mg (30 pills) 14.9 Phentermine (Yellow) 30mg (60 pills) 18.9 Phentermine (Yellow) 30mg (90 pills) 23.9 Phentermine 15mg (30 pills) 19.9 Phentermine 15mg (60 pills) 29.9 Phentermine 15mg (90 pills) 37.9 Phentermine 37.5mg (14 pills) 11.9 Phentermine 37.5mg (30 pills) 19.9 Phentermine 37.5mg (60 pills) 29.9 Phentermine 37.5mg (90 pills) 37.9 PHENTERMINE 30MG CAPSULE IMPORTANT NOTE: The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug. APPETITE SUPPRESSANTS - ORAL COMMON BRAND NAME(S): Fastin, Ionamin, Plegine, Prelu-2, Sanorex, Tenuate. May also be referred to as: Phentermine hci, Phentermine hcl, Phentermine hydrochloride, Adipex, Fastin, Ionamin, Obenix, Obephen, Oby-Cap, Oby-trim, Panshape M, Phentercot, Phenteride, Pro-Fast, Teramine, Zantryl. USES: This medication is used in combination with a diet plan to help you reduce weight. HOW TO USE: This medication is best taken on an empty stomach one hour before meals. Sustained-release or long acting products must be swallowed whole. Crushing or chewing them will destroy the long action and may cause increased side effects. Because this medication may cause sleeplessness, avoid taking a dose late in the day. Take this medication as prescribed. Do not take it more often or longer than directed. It is usually taken for 8 to 12 weeks. Use in combination with other appetite suppressant medicine is generally not recommended. Consult your doctor before such use. SIDE EFFECTS: Blurred vision, dizziness, dry mouth, sleeplessness, irritability, stomach upset or constipation may occur the first few days as your body adjusts to the medication. If these effects persist or become bothersome, inform your doctor. Notify your doctor if you experience: chest pain, nervousness, pounding heart, difficulty urinating, mood changes, breathing difficulties, swelling. If this medication makes you dizzy or lightheaded, avoid driving or engaging in activities requiring alertness. If you notice other effects not listed above, contact your doctor or pharmacist. PRECAUTIONS: Tell your doctor your complete medical history, especially if you have: high blood pressure, an over-active thyroid, glaucoma, diabetes, emotional problems. This medication can be habit forming and must be used with caution. Alcohol can increase unwanted side effects of dizziness. Limit alcohol use. This drug is not recommended for use in children. Consult your doctor or pharmacist for further information. This medication should be used only when clearly needed during pregnancy. Discuss the risk and benefits with your doctor. This drug may be excreted into breast milk. You may have to stop nursing or stop using this drug. Consult your doctor before breast-feeding. DRUG INTERACTIONS: Inform your doctor about all the medicines you use, (prescription and nonprescription) especially if you take: high blood pressure medicine, MAO inhibitors (e.g., furazolidone, linezolid, phenelzine, selegiline, tranylcypromine), any other weight loss medicine. Avoid "stimulant" drugs that may increase your heart rate such as decongestants or caffeine. Decongestants are commonly found in over-the-counter cough-and-cold medicines. Do not start or stop any medicine without doctor or pharmacist approval. OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. 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It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug. APPETITE SUPPRESSANTS - ORAL COMMON BRAND NAME(S): Fastin, Ionamin, Plegine, Prelu-2, Sanorex, Tenuate USES: This medication is used in combination with a diet plan to help you reduce weight. HOW TO USE: This medication is best taken on an empty stomach one hour before meals. Sustained-release or long acting products must be swallowed whole. Crushing or chewing them will destroy the long action and may cause increased side effects. Because this medication may cause sleeplessness, avoid taking a dose late in the day. Take this medication as prescribed. Do not take it more often or longer than directed. It is usually taken for 8 to 12 weeks. Use in combination with other appetite suppressant medicine is generally not recommended. Consult your doctor before such use. 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Upon approval, our US physicians will write an FDA approved prescription for you and the product will be filled and shipped by a US Licensed pharmacist direct to your doorstep, immediately and discreetly. DRUG INTERACTIONS Inform your doctor about all the medicines you use, (prescription and nonprescription) especially if you take high blood pressure medicine or MAO inhibitors (e.g., furazolidone, phenelzine, selegiline, tranylcypromine) or any other weight loss medicine. Avoid "stimulant" drugs that may increase your heart rate or blood pressure such as decongestants or caffeine. Decongestants are commonly found in over-the-counter cough and cold medicine. Phentermine is a generic form of Fastin. HOW TO USE THIS MEDICATION Take on an empty stomach, once daily, 30-60 minutes before breakfast. The tablet may be broken or cut in half. Do not crush or chew tablet. Because this medication may cause sleeplessness, avoid taking a dose late in the day. Take this medication as prescribed. Do not take it more often or longer than directed. MISSED DOSE If you miss a dose of Phentermine, do not double the next dose. Instead, skip the missed dose and resume your usual dosing schedule. NOTES Appetite suppressants are not a substitute for proper diet. For maximum effects, this must be used in conjunction with a diet and exercise program. Do not share this medication with others. PRECAUTIONS Tell your doctor your complete medical history especially if you have high blood pressure, an over-active thyroid, glaucoma, diabetes or emotional problems. Consult with your doctor if you think you are pregnant or before breast-feeding. Alcohol can increase unwanted side effects of dizziness. Limit alcohol use. This drug is not recommended for use in children. Consult your doctor or pharmacist for further information. SIDE EFFECTS Dry mouth, sleeplessness, irritability, stomach upset or constipation may occur the first few days as your body adjusts to Phentermine. If these effects persist or become bothersome, inform your doctor. STORAGE Store at room temperature away from sunlight and moisture. Keep this and all medications out of the reach of children. DISCLAIMER This information is not intended to substitute for professional medical advice. Be sure to contact your physician, pharmacist or other health care provider for more information about this medication. Get Your Cheap Phentermine Prescription Here! Phentermine is an appetite suppressant designed for use as a short term weight loss aid in conjunction with proper diet and exercise. If you are looking to loose weight, Phentermine can be a good solution for you. Through the comprehensive information listed at RxTank, you can find the right pharmacy to buy generic Phentermine online and order a cheap Phentermine prescription at the right price. We can help you find the best pharmacy to buy the medications you rely on. 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Tell your doctor if any of these symptoms are severe or do not go away: dry mouth unpleasant taste diarrhea constipation vomiting If you experience any of the following symptoms, call your doctor immediately: increased blood pressure heart palpitations restlessness dizziness tremor insomnia shortness of breath chest pain dizziness swelling of the legs and ankles difficulty doing exercise that you have been able to do If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/report.htm] or by phone [1-800-332-1088]. What storage conditions are needed for this medicine?Return to top Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication. In case of emergency/overdoseReturn to top In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. What other information should I know?Return to top Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to phentermine. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. Phentermine is used as an appetite suppressant. It is used in conjunction with an overall diet plan to reduce weight. how to take phentermine Phentermine is best taken on an empty stomach one-half hour before breakfast. Because taking it may cause sleeplessness, avoid taking a dose late in the day. Take phentermine as prescribed. Do not take phentermine more often or longer than directed. phentermine side effects Dry mouth, sleeplessness, irritability, stomach upset or constipation may occur the first few days as your body adjusts to the medication. If these effects persist or become bothersome, inform your doctor. phentermine precautions Tell your doctor your complete medical history especially if you have high blood pressure, an over-active thyroid, glaucoma, diabetes or emotional problems. Consult with your doctor if you think you are pregnant or before breast-feeding. Alcohol can increase unwanted side effects of dizziness. Limit alcohol use. Phentermine is not recommended for use in children. Consult your doctor or pharmacist for further information. phentermine interactions Inform your doctor about all the medicines you use, (prescription and nonprescription) especially if you take high blood pressure medicine or MAO inhibitors (e.g., furazolidone, phenelzine, selegiline, tranylcypromine) or any other weight loss medicine. Decongestants are commonly found in over-the-counter cough and cold medicine. phentermine general notes Appetite suppressants are not a substitute for proper diet. For maximum effects, this must be used in conjunction with a diet and exercise program. Do not share these pills with others. missed dosage of phentermine If you miss a dose, do not double the next dose. Instead, skip the missed dose of phentermine and resume your usual dosing schedule. phentermine storage Store phentermine at room temperature away from sunlight and moisture. Keep this and all medications out of the reach of children. Phentermine is not a substitute for a healthy lifestyle Phentermine is a helper. Have you ever thought about your food habits? Perhaps you have some that don't allow you to lose weight? Try to answer the following questions: Do you think you have to eat everything that is on the plate? When at someone's place, do you ask for more just to please the host? Do you often have meals while walking? Are you feeling like eating when in a bad mood? Do you sometimes take more meals even when you are full? Do you eat more than usual when annoyed or excited? Do you have snacks while reading, or watching TV, or surfing the web? Do you finish your meals fast? Looking in the fridge when nothing to do? Can you name all of your yesterday meals? It's not hard to tell that positive answers to all the above (except the last question) prove your habits to be disastrous. You are eating not because you are hungry. E.g. "Yes" to the second and the fifth question mean that you eat when full to please the others. Be strong; remember that friends indeed would always support you in your quest for loosing weight. If you have answered "yes" to the first question then you can't trash the food. You must be often trying the dishes while cooking or just without any schedule. Take a "Carrot or Cookie" test. Ask yourself, what are you feeling like more? If you are really hungry neither would get a favor. Choose a carrot then. If you have positive answers to the third, seventh and eighth question you have to change the style of having meals: when you eat fast or while walking or doing other stuff, it is hard for you to track the amount of food consumed. Serve the table, sit down, relax and start... slowly. "Yes" to #4, #6 and #9 mean that you are ruled by your mood, not your appetite. You better move to get rid of boredom or anxiety. Walking, biking, tennis will help you to relax. There is also another way: warm bathing. And finally, having "No" for the tenth question, you have to think about yesterday menu. Perhaps you had too many tasty things you'd prefer to forget about? Remember them as your yesterday weakness, it'll help you to be more reasonable in your meals today. Do you see now how having an appetite suppressant such as phentermine can help you benefit in loosing weight? Do you see now that it will take some efforts from you too? Starting an Exercise Plan along with phentermine course Beginning and exercise plan can take a little planning on your part if you have not been exercising for some time now. If you are overweight, or if you want to tone your body, starting an exercise plan is always a great topic to think about. If you want to start an exercise plan, and lose weight, Phentermine is a diet aid that works wonders in controlling your appetite, giving you extra energy, and it has a way of keeping you on track focusing on your exercise plan. First, you need to sit down and think about what you want to accomplish. If it has been a long time since you have done any type of exercising you will want to start out slowly and then build up to more exercises and more demanding exercises to get your body moving. It is important to start out slowly because your body is not accustomed to movements and stress. The additional movements and stress on your body urge your muscles to work, and in turn, you will burn calories. Through diet and exercise, your body will burn calories and will help you slim down, losing weight to hit the goals you have set for yourself. No one can do the exercise for you, this is something you have to plan and follow through with. Setting goals for an exercise plan can boost your health for years to come! A combination of exercise and the use of Phentermine does produce results. It is important to realize there is no magic pills that will help you lose weight without adding exercise to your plan. Exercise is a major fundamental in burning calories. Burning calories is going to help you to shed weight and it will tone your muscles. As you begin your exercise program you may feel the need to eat more but Phentermine controls that hunger so you eat less, and burn more calories during your exercise routines. The second step in a successful exercise plan is to form goals such as when you will exercise, what exercises you will be doing, and how you are going to track yourself. When you will exercise, can be any time of the day. If you need to make more time, make more time! Exercise can be something you perform, in your home, in the office, in the gym or even at a friend's house. Exercise should become a regular part of your day, even if it is just for ten minutes a day - which will be all you need it you stick to it. Now you have set times when you are going to exercise. This could be three times a week, four times a week or even every day depending on how long you are going to exercise. Exercising shorter amounts of time will require you to exercise more days per week. If you were to dedicate twenty minutes three times a week you can stick to that three days a week and lose weight, meeting your goals. Setting goals is another thing you should do when starting an exercise plan. What you will do is set your goal at a good pace. Say, three pounds a week, or so many hours a week, or you want to be down a size per month. Phentermine controls your appetite, so when you exercise you are burning calories from your body, which is how the overall plan of diet and exercise works together to help you meet your exercise goals. Exercise can be done right in your home or in your office. Stretching exercises are simple exercises that will help you stay loose, tone muscles, and you will feel more energetic as you will be pushing the blood through your body just by stretching and more oxygen gets to the portions of your body that will make you feel more awake. Exercise can be done right in your home. Simple additions to your day like toe touches, waist bends and even sit-ups are a great start. No one is going to start off doing aerobics, or running for miles, that comes months later as you rebuild the muscles in your body for a great calorie burning start. Exercise is something you will do in small steps building up your endurance and your abilities. Get on the move, set goals for your exercise plan and start meeting them using phentermine and exercise in combination to control your hunger while you burn calories. Your goals will be easier to meet, you will find more energy in your day and you will feel great all the while! Thousands and thousands of overweight people, who are obese are looking for the cure needed to lose weight for their fit future. With no confidence to approach the doctor, one can never lose the weight needed to be healthy. Having phentermine available on the internet they can purchase drugs online without facing embarrassing (yes, embarrassing!) conversations in person. It is much more cheaper on the internet sites than it is at the pharmacy next street. Phentermine is a drug that can be very dear per tablet but with the competition between online drugstores the prices are being kept low as possible. You need not to pay more for the same pillpack onlin. The OPs (which is common abbreviation for "online pharmacies") regulated by the FDA (Federal Drug Association) and run by licensed pharmacists are offering more savings and confidence for those who really want to lose weight. How does Phentermine work best for your personal needs? Phentermine helps you to control your hunger yet it helps provide you with additional energy so you can exercise. Exercising is a vital part of the diet process for everyone. Toning your body and making use of the muscles your body has, prevents additional problems that many who are overweight also suffer. Phentermine is the right choice for those who find they need the extra motivation to lose weight, and to do it in a manner that shows you results faster. We are a society that wants results now, faster which is what Phentermine does provide you when combined with exercise and your personal motivation to lose weight for a healthy you!

Since its launch in 1994 PharmWeb has developed into the premier online community of pharmacy, pharmaceutical and healthcare-related professionals with over 40,000 self-registered users. The first pharmaceutical portal on the Internet has developed into an invaluable directory of information, including a library of archives from over 100 moderated discussion forums. To browse the site either jump to a section using the pull-down menu or scroll down the home page to see what PharmWeb has to offer. PharmWeb is a registered trade mark. Full programs of major pharmacy, pharmaceutical and health-related conferences around the world plus the PharmWeb Conference Calendar. World Wide Pharmacy Colleges/Departments/Schools This is a comprehensive database of world wide pharmacy schools. The schools list is in the form of a searchable database and is regularly updated. The database includes contact names, addresses, telephone and FAX numbers, and Internet addresses where available. 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Pharmacists distribute drugs prescribed by physicians and other health practitioners and provide information to patients about medications and their use. They advise physicians and other health practitioners on the selection, dosages, interactions, and side effects of medications. Pharmacists also monitor the health and progress of patients in response to drug therapy to ensure the safe and effective use of medication. Pharmacists must understand the use, clinical effects, and composition of drugs, including their chemical, biological, and physical properties. Compounding—the actual mixing of ingredients to form powders, tablets, capsules, ointments, and solutions—is a small part of a pharmacist’s practice, because most medicines are produced by pharmaceutical companies in a standard dosage and drug delivery form. Most pharmacists work in a community setting, such as a retail drugstore, or in a health care facility, such as a hospital, nursing home, mental health institution, or neighborhood health clinic. Pharmacists in community and retail pharmacies counsel patients and answer questions about prescription drugs, including questions regarding possible side effects or interactions among various drugs. They provide information about over-the-counter drugs and make recommendations after talking with the patient. They also may give advice about the patient’s diet, exercise, or stress management or about durable medical equipment and home health care supplies. In addition, they also may complete third-party insurance forms and other paperwork. Those who own or manage community pharmacies may sell non-health-related merchandise, hire and supervise personnel, and oversee the general operation of the pharmacy. Some community pharmacists provide specialized services to help patients manage conditions such as diabetes, asthma, smoking cessation, or high blood pressure. Some community pharmacists also are trained to administer vaccinations. Pharmacists in health care facilities dispense medications and advise the medical staff on the selection and effects of drugs. They may make sterile solutions to be administered intravenously. They also assess, plan, and monitor drug programs or regimens. Pharmacists counsel hospitalized patients on the use of drugs and on their use at home when the patients are d