AN UPDATE ON MALE SEXUAL DYSFUNCTION

Important new information regarding the numbers of men who experience sexual problems emerged in 1994 with the publication of the Massachusetts Male Aging Study (MMAS). The respondents, 1290 men forty to seventy years old, answered a brief sexual questionnaire and indicated whether they had: no “sexual problems” (never impotent) or “minimal impotence” (rare erectile failures but still able to have sexual intercourse most of the time); “moderate impotence” (difficulty acquiring or maintaining an erection but still able to have sexual intercourse periodically); or “complete” impotence (never able to acquire or maintain an erection and unable to have sexual intercourse).

The MMAS results were surprising, for it turned out that impotence surfaces as a problem for more men much earlier in life than expected. Forty percent of men admitted to minimal, moderate, or complete impotence at age forty. The numbers of men plagued by some degree of erectile dysfunction increase by about 10 percent with each succeeding decade, so that at age fifty, no less than 50 percent of men admitted to some erectile failures, 60 percent acknowledged some sexual problem at age sixty, and 70 percent were sexually impaired at age 70.

Complete impotence — present in only 5.1 percent of forty-year-olds, increased threefold to 15 percent for seventy-year-old men. The numbers of men describing moderate impotence increased from 17 percent to 34 percent between age 40 and 70, and episodes of minimal impotence remained remarkably constant at 17 percent for all age groups studied. Although 60 percent of forty-year-old men could say they were “not impotent,” only 33 percent of the seventy-year-olds could provide a similar answer.

Increasing age is not the only problem. Several factors — some within, and others beyond the individual man’s control — increase the impotence risk. In this survey, the probability of developing complete impotence was 56 percent for current smokers compared to 8.5 percent for nonsmokers. Diabetes mellitus, high blood pressure, use of antihypertensive medications, and cardiac drugs independently and collectively augmented the chances of developing impotence. Only a few men go through life without ever having experienced one or more episodes of impotence.

DOES AGING CONTRIBUTE TO IMPOTENCE?

Kinsey’s observation that older men experience problems with sex more often than younger men is accurate. But the reasons remain the subject of considerable controversy. Gerontologists have been studying a group of healthy older men age sixty to seventy-nine as part of the Baltimore Longitudinal Study (BLS) on aging. Men in the study were queried about their sexual activity during the course of a year. They were then divided into those who had “least,” “medium,” and “most” sexual events (intercourse and/or masturbation). Roughly equal numbers of men fell into each category. This suggested that some independent factor — not age alone — determines the level of sexual vigor for men over sixty. In this population of healthy men, only 25 to 35 percent reported difficulty achieving a functional erection.

Other investigators have challenged the BLS observations, maintaining that they are not reproducible. Dr. Alexander Vermeulen of Belgium arrived at a diametrically opposite conclusion. His data indicate that among sixty-o eighty-year-old men, only 25 to 35 percent do not have problems; rather, fully 65 to 75 percent do have problems. Some argue that it is not the aging process per se but other concomitant factors that are responsible for the diminished sexual ability of older men. The BLS study may be faulted because only men who were unusually healthy and free of common medical problems such as high blood pressure and diabetes mellitus qualified for inclusion. Since both high blood pressure and diabetes are common in older men, many investigators believe it is inappropriate to generalize observations from the BLS experience to other geriatric populations.

HOW COMMON IS IMPOTENCE?

It was not until the middle of the twentieth century that reliable information on the prevalence of impotence was available. As previously noted, Dr. Alfred Kinsey, in his Sexual Behavior in the Human Male, estimated that impotence occurred in less than 2 percent of men under the age of forty. The incidence increased gradually with age, so that, according to Kinsey, 6.7 percent of men were impotent by age fifty-five and almost 25 percent at seventy. Recent data suggest that Kinsey’s report significantly underestimated the total. Current surveys indicate that impotence plagues 30 million American men.

Part of the problem in collecting accurate data relates to men’s lack of candor when discussing sexual problems. Most men are more than willing to answer questions about their income, general health, smoking, and drinking habits. They are often disarmingly frank about their extramarital relationships, sexual preferences, and sex life. Still, the same men are recalcitrant when confronted with a questionnaire asking for truthful and accurate answers regarding sexual impairment. As noted, in a prior chapter, these times of extraordinary sexual enlightenment, impotence may be the only subject remaining in the closet.

Because it is important to have some estimate of the prevalence of impotence, investigators have devised a series of questionnaires with sufficient ingenuity to provide information that may have been overlooked in the past.

For example, two investigators, Drs. Anthony Reading and William Weist, recruited subjects in London, England, by proposing to examine attitudes relating to the development of a male contraceptive. During the course of the extensive interview, information was elicited relative to the volunteers’ current sexual function and dysfunction. The investigators found that among a group of presumably healthy, sexually active, heterosexual Englishmen (age twenty to thirty-five) involved in a stable relationship, 8.25 percent admitted having difficulty achieving and maintaining an erection satisfactory for sexual intercourse, and 18.5 percent said that they did not achieve an erection satisfactory for masturbation.

Dr. Ellen Frank and her associates at the University of Southern California decided that the optimal way to verify descriptions of male sexual function was to direct the same questions to both husband and wife. Dr. Frank, like others, recognized that reliable descriptions of sexual function are most  likely to be obtained by using a subtle approach. Her extensive fifteen-page questionnaire, therefore, contained only one and one-half pages relating to sex. In her survey of one hundred married couples in their mid-thirties, Dr. Frank identified surprisingly high levels of sexual dysfunction reported by the men and confirmed by their wives. Sixteen percent of the men reported difficulty acquiring or sustaining an erection. In addition, 36 percent felt they ejaculated too quickly, and 4 percent were unable to ejaculate at all. This number is roughly twenty times Kinsey’s estimate for a similar age group.

Dr. Michael Slag of the Minneapolis Veterans Administration expanded on Frank’s observations, providing data from a different perspective. He interviewed men attending a Veterans Administration outpatient clinic for problems unrelated to sexual function and found that of 1,180 men, 401 (34 percent) complained of impotence. But this patient population differed in several respects from the couples studied by Dr. Frank.

The men in Dr. Slag’s study were older; the average age was fifty. In addition, all had some medical problem that prompted them to visit the clinic. In many cases the illness itself was the primary cause of sexual dysfunction. It is also worth noting that men attending any clinic can be expected to receive medication, and many medications can affect sexual function. In fact, Dr. Slag was able to incriminate medications as a direct cause of the impotence in 22 percent of the impotent men in his study.

Dr. Leslie Schover, a psychologist at the State University of New York at Stony Brook, surveyed 300 men with a mean age of 55 and reported that 21 percent of them complained of impotence.

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You Are Not Alone

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Whether he calls it impotence or ED — erectile dysfunction — the man experiencing a sexual problem often believes his predicament is unique to him. As we start to talk honestly about sex, it is becoming increasingly apparent that more and more men and women are having sexual difficulties. This chapter provides answers to the most frequently asked questions about male sexual dysfunction, or ED, including these: How common is it? Is aging a factor? Do common medical problems like hypertension, diabetes, and depression cause impotence, or is it the medications used to treat these conditions that disrupt a man’s sexual function? Can you do anything to prevent impotence?

When a man is unable to achieve an erection satisfactory for intercourse, he is considered impotent. Today the term “erectile dysfunction)” or “ED” has supplanted “impotence,” probably because ED is a less emotionally charged term. This is not surprising because the dictionary defines the word “impotent” as (1) lacking physical strength or vigor: weak, (2) powerless; ineffectual, (3) incapable of sexual intercourse. This definition is more than just demeaning, for it strikes at the very fabric of a man’s maleness.

Generally speaking, the phrase “erectile dysfunction,” or “ED,” has been promulgated by those who are frankly promoting different impotence treatments and are themselves more comfortable saying that they have a new product to correct ED than a novel impotence treatment. However, the individual man with sexual problems rarely comes to the doctor saying, “My primary problem is that I have ED” or “Doc, now that you’ve helped lower my blood pressure, I wonder if I could discuss my erectile dysfunction with you.” Men, if they discuss their sexual difficulties at all, either resort to euphemisms such as “I can’t get it up anymore” or fall back on the embarrassing admission “I guess I’ve become impotent.”

However you choose to label it, the truth is that many men, if not all men, have at one time or another experienced isolated episodes of ED, or impotence. Often this is transient, a result of fatigue, excessive drinking, or preoccupation with business or family problems. Under these circumstances, it would be inappropriate to saddle the man with a diagnosis of complete impotence; instead he is said to have experienced situational erectile dysfunction. Criteria established by Masters and Johnson indicate that a diagnosis of impotence is appropriate only when a man experiences failure more than 25 percent of the time during attempted intercourse.

SEX, MEN’S BODY CHEMISTRY, AND VIAGRA

We know now that there is more to a man’s sexual life than his testosterone. What could be more important than this manliest of all male hormones?Nitric oxide. What is nitric oxide?Nitric oxide (NO) is the chemical instigator of a man’s erection. NO is not a hormone but a neurotransmitter. Unlike hormones, which are produced in endocrine glands and released into a man’s bloodstream to exert their influence all over his body, neurotransmitters have more modest ambitions. Neurotransmitters influence the behavior of neighboring cells. The neurotransmitter NO allows blood to flow into the penile erectile bodies and is crucial for a man to develop early penile swelling, a condition called tumescence.Full rigid erections require a second, locally produced chemical called cyclic GMP (cGMP). A man’s penis remains erect and rigid as long as the local cGMP levels remain elevated. When cGMP levels diminish, so does a man’s erection. Sildenafil (Viagra) increases cGMP, and this is why it works to improve the stamina of a man’s erections.Thus, the combination of locally produced NO is needed to initiate a man’s erection, and cGMP is required to sustain it. When cGMP levels fall, a man’s erection fades. As long as penile-tissue cGMP levels remain high, erectile vigor persists. Sildenafil (Viagra) is effective because it helps maintain high cGMP levels.It is as simple as this.

Is Viagra foolproof and guaranteed to improve every impotent man’s erections and sexual performance all the time? Unfortunately not.

There is a yin and yang to a man’s erections. Just as some neurotransmitters turn the erectile process on, others turn it off. For example, adrenalinelike chemicals (always lurking in the body and spewed out during stress) can siphon blood out of a man’s penis with lightning speed, causing his erection to collapse.

Thus, the NO cGMP signal “turns on” a man’s erection, whereas adrenaline “tuns it off.” NO and cGMP, as well as the potential side effects, proper use, cost, and controversy surrounding Viagra.

Sildenafil (Viagra) has been very effective in allowing many impotent men to experience erections and enjoy sexual function once again. However, for the 30-35 percent of impotent men who do not have improved erections with Viagra, other treatment strategies are likely to be more effective.

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Deltasone (Prednisone) Generic name: Prednisone; Other brand names: Orasone
Is a steroid drug, which is used to reduce inflammation and alleviate symptoms in a variety of disorders.

When is Prednisone prescribed?

Deltasone, a steroid drug, is used to reduce inflammation and alleviate symptoms in a variety of disorders, including rheumatoid arthritis and severe cases of asthma. It may be given to treat primary or secondary adrenal cortex insufficiency (lack of sufficient adrenal hormone in the body). It is used in treating all of the following:

• Abnormal adrenal gland development
• Allergic conditions (severe)
• Blood Disorders
• Certain cancers (along with other drugs)
• Diseases of the connective tissue including systemic lupus erythematosus
• Eye diseases of various kinds
• Flare-ups of multiple sclerosis
  Fluid retention due to “nephrotic syndrome” (a condition in which damage to the kidneys causes protein to be lost in the urine)
• Lung diseases, including tuberculosis
• Meningitis (inflamed membranes around the brain)
• Prevention of organ rejection

• Rheumatoid arthritis and related disorders
• Severe flare-ups of ulcerative colitis or enteritis (inflammation of the intestines)
• Skin diseases
• Thyroid gland inflammation

Prednisone side effects

Deltasone may cause euphoria, insomnia, mood changes, personality changes, psychotic behavior, or severe depression. It may worsen any existing emotional instability.
At a high dose, Deltasone may cause fluid retention and high blood pressure. If this happens, you may need a low-salt diet and a potassium supplement.

With prolonged Deltasone treatment, eye problems may develop (e.g. a viral or fungal eye infection, cataracts, or glaucoma).
If you take Deltasone over the long term, the buildup of adrenal hormones in your body may cause a condition called Cushing’s syndrome, marked by weight gain, a “moon-faced” appearance, thin, fragile skin, muscle weakness, brittle bones, and purplish stripe marks on the skin. Women are more vulnerable to this problem than men. Alternate-day therapy may help prevent its development.
Steroids main side effect is to increase many parameters of aging. This includes arthritis, degenerative changes of joints, etc. These are all well documented. As to the specifics of your problem, it would be hard to say without examining the problem by your doctor.

This drug should be avoided it there is any other treatment option available. However, for many medical conditions there are no alternatives. Side effects depend on dosage and length of time taken and generally are equivalent to early aging: cataracts, osteoporosis, diabetes mellitus, muscle weakness, etc.
Steroids can produce a wide variety of psychological changes. Clinically you see this in about 5% of patients. It seems to be dose related and high IV doses cause more problem than small oral doses. Many patients will experience euphoria and some difficulty sleeping. Anger, delusions, and paranoia are less common. An occasional patient will become psychotic on these drugs.

Patient Information about PROSCAR

Patient Information about PROSCAR

Generic name: finasteride

while you take PROSCAR. PROSCAR is not a treatment for prostate cancer.

• About Prostate Specific Antigen (PSA). Your doctor may have done a blood test called PSA. PROSCAR can alter PSA values. For more information, talk to your doctor.

• A warning about PROSCAR and pregnancy.

PROSCAR is for use by MEN only.
PROSCAR is generally well tolerated in men. However, women who ere pregnant, or women who could become pregnant, should avoid the active ingredient
in PROSCAR.

If the active ingredient is absorbed by a woman who is pregnant with a male baby, it may cause the male baby to be born with abnormalities of the sex organs. Therefore, any woman who is pregnant or who could become pregnant must not come into direct contact with the active ingredient in PROSCAR.

Two of the ways in which a woman might absorb the active ingredient in PROSCAR are:
Sexual Contact. Your semen may contain a small amount of the active ingredient of the drug. If your partner Is pregnant, or if you and your partner decide to have a baby, you must stop taking PROSCAR and talk to your doctor. If your partner could become pregnant, proper use of a condom can reduce the risk of exposing her to your semen (discuss this further with your doctor).

Handling broken tablets. Women who are pregnant or who could become pregnant must not handle broken tablets of PROSCAR. PROSCAR tablets arc coated to prevent contact with the active ingredient during normal handling. If this coating is broken, the tablets should not be handled by women who are pregnant or who could become pregnant. If a woman who is pregnant comes into contact with the active ingredient in PROSCAR, a doctor should be consulted.
Remember, these warnings apply only if the woman exposed to PROSCAR is pregnant or could become pregnant.

How to take PROSCAR

Follow your doctor’s advice about how to take PROSCAR. You must take it every day. You may take it with or between meals. To avoid forgetting to take PROSCAR, it may be helpful to take it the same time every day.
Do not share PROSCAR with anyone else; it was prescribed only for you. Keep PROSCAR and all medicines out of the reach of children.

PROSCAR is for use by men only.

Please read this leaflet before you start taking PROSCAR. Also, read it each time you renew your prescription, just in case anything has changed. Remember, this leaflet does not take the place of careful discussions with your doctor. You and your doctor should discuss PROSCAR when you start taking your medication and at regular checkups.
Why your doctor has prescribed PROSCAR
Your doctor has prescribed PROSCAR because you have a medical condition called benign prostatic hyperplasia or BPH This occurs only in men.

What is BPH?
BPH is an enlargement of the prostate gland. After age 50. most men develop enlarged prostates. The prostate is located below the bladder. As the prostate enlarges, it may slowly restrict the flow of urine. This con lead to symptoms such as:

• a weak or interrupted urinary stream
• a feeling that you cannot empty your bladder completely
• a feeling of delay or hesitation when you start to urinate
• a need to urinate often, especially at night
• a feeling that you must urinate right away.
• a feeling that you must urinate right away.

Treatment options for BPH

There are three main treatment options for BPH:

• Program of monitoring or “Watchful Watting”. If a man has an enlarged prostate gland and no symptoms or if his symptoms do not bother him, he and his doctor may decide on a program of monitoring which would include regular checkups, instead of medication or surgery.
• Medication. Your doctor may prescribe PROSCAR for BPH. See “What PROSCAR docs” below.
• Surgery. Some patients may need surgery. Your doctor can describe several different surgical procedures for BPH. Which procedure is best depends on your symptoms and medical condition.

What PROSCAR does

PROSCAR lowers levels of a key hormone called DHT (dihydrotestosterone), which is a major cause of prostate growth. Lowering DHT leads to shrinkage of the enlarged prostate gland in most men. This can lead to gradual improvement in urine flow and symptoms over the next several months. However, since each case of BPH is different, you should know that:

• Even though the prostate shrinks, you may NOT see an improvement in urine flow or symptoms.
• You may need to take PROSCAR for six (6) months or more to see whether it helps you.
• Even though you take PROSCAR and it may help you, it is not known whether PROSCAR reduces the need for surgery.

What you need to know while taking PROSCAR

• You must see your doctor regularly.
While taking PROSCAR, you must have regular checkups. Follow your doctor’s advice about when to have these checkups.
• About side effects. Like all prescription drugs. PROSCAR may cause side effects. Side effects due to PROSCAR may include impotence (or inability to have an erection) and less desire for sex. Each of these side effects occurred in less than 4% of patients in clinical studies. In some cases side effects went away while the patient continued to take PROSCAR.

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WHO IS PIAVIX FOR?

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PIAVIX is a prescription-only medicine that helps keep blood platelets from sticking together and forming clots.

PLAVIX is for patients who have

• had a recent heart attack
• had a recent stroke
• poor circulation in their legs (Peripheral Artery Disease)

PLAVIX in combination with aspirin is for patients hospitalized with:

• heart-related chest pain (unstable angina – heart attack.

Donors may refer to these conditions as ACS (Acute Coronary Syndrome).

Clots can become dangerous when they form inside your arteries. These clots form when blood platelets stick together, forming a blockage within your arteries, restricting blood flow to your heart or brain, causing a heart attack or stroke

WHO SHOULD NOT TAKE PLAVIX?

You should NOT take PLAVIX if you.

• are allergic to clopidogrel (the active ingredient in PIAVIX).
• have a stomach ulcer
• have another condition that causes bleeding
• are pregnant or may become pregnant
• are breast feeding

WHAT SHOULD I TELL MY DOCTOR BEFORE TAKING PLAVIX?

Before taking PLAVIX tell your doctor if you’re pregnant or are breast feeding or have any of the following.

• gastrointestinal ulcer

• stomach ulcers

• liver problems

• kidney problems

• a history of bleeding conditions

WHAT IMPORTANT INFORMATION SHOULD I KNOW ABOUT PLAVIX?

TTP. A very serious blood condition called TTP (Thrombotic Thrombocytopenic Purpura) has been rarely reported in people taking PLAVIX. TIP is a potentially life-threatening condition that involves low blood platelet and red blood cell levels, and requires urgent referral to a specialist for prompt treatment once a diagnosis is suspected Warning signs of TTP may include fever, unexplained confusion or weakness (due to a low blood count, what doctors call anemia). To make an accurate diagnosis, your doctor will need to order blood tests. TTP has been reported rarely, sometimes in less than 2 weeks after starting therapy.

Gastrointestinal Bleeding: There is a potential risk of gastrointestinal (stomach and intestine) bleeding when taking PLAVIX. PLAVIX should be used with caution in patients who have lesions that may bleed (such as ulcers), along with patients who take drugs that cause such lesions

Bleeding you may bleed more easily and it may take you longer than usual to slop bleeding when you take PLAVIX alone or in combination with aspirin. Report any unusual bleeding to your doctor.

Geriatrics: When taking aspirin with PIAV1X the risk of serious bleeding increases with age in patients 65 and over.

Stroke Patients: If you have had a recent TIA (also known as a mini-stroke) or stroke taking aspirin with PLAVIX has not been shown to be more effective than taking PLAVIX alone, but taking aspirin with PLAVIX has been shown to increase the risk of bleeding compared to taking PLAVIX alone.

Surgery: Inform doctors and dentists well in advance of any surgery that you are taking PLAVIX so they can help you decide whether or not 1o discontinue your PLAVIX treatment prior to surgery.

WHAT SHOULD I KNOW ABOUT TAKING OTHER MEDICINES WITH PLAVIX?

You should only take aspirin with PLAVIX when directed to do so by your doctor certain other medicines should not be taken with PLAVIX. Be sure to tell your doctor about all of your current medications, especially if you are taking the following.

• aspirin

• no steroidal anti-inflammatory drugs (NSAIDs)

• warfarin

• heparin

Be sure to tell your doctor if you are taking PLAVIX before starting any new medication.

WHAT ARE THE COMMON SIDE EFFECTS OF PLAVIX?

The most common side effects of PLAVIX include gastrointestinal events (bleeding, abdominal pain, indigestion, diarrhea, and nausea) and rash. This is not a complete list of side effects associated with PLAVIX. Ask your doctor or pharmacist for a complete list.

HOW SHOULD I TAKE PLAVIX?

Only take PLAVIX exactly as prescribed by your doctor. Do not change your dose or stop taking PLAVIX without talking to your doctor first.

PLAVIX should be taken around the same time every day, and it can be taken with or without food If you miss a day, do not double up on your medication. Just continue your usual dose. If you have any questions about taking your medications, please consult your doctor.

OVERDOSAGE

As with any prescription medicine, it is possible to overdose on PLAVIX. If you think you may have overdosed, immediately call your doctor or Poison Control Center, or go to the nearest emergency room

Paxil and Paxil CR (paroxetine)

Paxil and Paxil CR (paroxetine)

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Paxil and Paxil CR (paroxetine)
Generic name: Paroxetine
Available strengths: 10 mg, 20 mg, 30 mg, 40 mg tablets;
10 mg/5 mL oral suspension; 12.5 mg, 25 mg.
37.5 mg controlled-release tablets (Paxil CR) Available in generic: Yes, except Paxil CR
Drug class: Selective serotonin reuptake inhibitor antidepressant

Paxil (paroxetine) Overdose

Like other SSRIs Paxil is much safer in overdose than the older TCAs and some of the newer antidepressants. There are no reports of fatality following overdose with Paxil alone. However, fatal outcomes have been reported when Paxil was taken in combination with other medications.
Any suspected overdose should be treated as an emergency. The person should be taken to the emergency room for observation and treatment. The prescription bottle of medication (and any other medication suspected in the overdose) should be brought as well, because the information on the prescription label can be helpful to the treating physician in determining the number of pills ingested.

Paxil (paroxetine) Special Considerations

Most cases of major depression can be treated successfully, usually with medication, psychotherapy, or both. The combination of psychotherapy and antidepressants is very effective in treating moderate to severe depression. The medications improve mood, sleep, energy, and appetite while therapy strengthens coping skills, deals with possible underlying issues, and improves thought patterns and behavior.
In general, antidepressants alone help about 60%-70% of those taking them. Although a few individuals may experience some improvement from antidepressants by the end of the first week, most people do not see significant benefits from their antidepressants until after 3-4 weeks, and it can sometimes take as long as 8 weeks for the medication to produce its full effects. Thus it is critical that patients continue to take their antidepressant long enough tor the medication to be beneficial and that patients not get discouraged and stop their medication prematurely if they do not feel better immediately.
In short-term studies, antidepressants were found to increase the risk of suicidal thinking and behavior in children and adolescents with major depression and other psychiatric disorders. The FDA requires the prescriber to warn of this risk in children and adolescents when starting antidepressant therapy. According to the FDA findings, the risk of suicidal thoughts and behaviors associated with antidepressants is age-related. This phenomenon tends to occur in the younger population and is most likely to occur early in the course of treatment. In adults over 24 years of age, there did not appear to be an increased risk of suicidality with antidepressants compared with placebo. In patients over age 65, the findings showed that antidepressants had a “protective effect” against suicidal thoughts and behavior Other studies have found that when more people in a community are taking antidepressants, the suicide rate is lower.

The risk of suicide is inherent in depression and may persist until the individual responds to treatment. Alter starting or changing antidepressant therapy, the person, especially a child or adolescent, should be closely observed for worsening signs of depression, and the family or caregiver should communicate any concerns to the physician.

Warning: Always let your physician or a family member know if you have suicidal thoughts. Notify your psychiatrist or your family physician whenever your  depressive symptoms worsen or whenever you feel unable to control suicidal urges or thoughts.
Do not discontinue Paxil abruptly. Your dosage should be tapered gradually to prevent discontinuation symptoms.
If you miss a dose, take it as soon as possible, within 2-3 hours of the scheduled dose. If it is close to the next scheduled dose, skip the missed dose and continue on your regular dosing schedule. Do not take double doses. Paxil may be taken with or without food.
Swallow tablets of Paxil CR whole, and do not crush or chew the tablet.
Store the medication in its originally labeled, light-resistant container, away from heat and moisture. Heat and moisture may precipitate breakdown of your medication, and the medication may lose its therapeutic effects. Keep your medication out of reach of children.
If you have any questions about your medication, consult your physician or pharmacist.

Paxil (paroxetine) General Information

Paxil (paroxetine) was approved by the U.S. Food and Drug Administration (FDA) for treatment of major depressive disorder, panic disorder, obsessive-compulsive disorder (OCD), social anxiety disorder, generalized anxiety disorder, and posttraumatic stress disorder. The use of a medication for its approved indications is called its labelled use. In clinical practice, however, physicians often prescribe medications for unlabeled (“off-label”) uses when published clinical studies, case reports, or their own clinical experiences support the efficacy and safety of those treatments. Paxil may be used to treat other psychiatric disorders, including premenstrual dysphoric disorder and eating disorders such as bulimia nervosa, which is characterized by symptoms of binge eating and vomiting.
Paxil is a serotonin-specific medication that works by blocking the reuptake of the neurotransmitter serotonin back into brain cells, thereby increasing its levels in the brain. Depression and other mental disorders may be caused by abnormally low levels of serotonin. This abnormality may in turn produce changes in affected areas of the brain, resulting in psychiatric symptoms such as depression or anxiety. The presumed action of Paxil and other selective serotonin reuptake inhibitors (SSRIs) is to increase serotonin levels, which may help to restore those areas of the brain to normal functioning.

Dosing Information

For depression, the usual starting dose of Paxil is 20 mg, taken once a day, usually in the morning. With the controlled-release tablet, Paxil CR, the starting dose is 25 mg. taken once a day in the morning. If no improvement is seen after 3-4 weeks, the dosage is incrementally increased to a maximum daily dosage of 50 mg for Paxil and 62.5 mg for Paxil CR. Seniors and people with severe or chronic medical illnesses may require lower starting dosages. Treatment of other psychiatric disorders such as OCD or panic disorder may require initially lower starting dosages of Paxil but require higher ending dosages. For example, in the treatment of panic disorder, the starting dosage is 10 mg/day of Paxil and 12.5 mg/day of Paxil CR, but the maximum dotage for Paxil and Paxil CR is 60mg/day and 75 mg/day, respectively. For patients who cannot take a tablet, Paxil also comes in a liquid form.
Paxil CR is a controlled — release and not a sustained-release, formulation. The controlled — release tablet does not provide a longer duration of action over Paxil but offers a smoother rate of absorption with fewer gastrointestinal side effects, such as nausea. The enteric-coated tablets of Paxil CR should not be chewed, crushed, or cut but swallowed whole, because the tablet structure is what makes the medication controlled — release.
For most people, it may take as long as 3 -4 weeks to experience the optimal effects of the medication. The duration of medication treatment depends on the individual’s personal psychiatric history and family history. For instance, the length of medication treatment will be longer for those who have had two or more previous episodes of major depressive disorder. For most people, the medication may be tapered 6-9 months after their depression responds to treatment.
However, a small percentage of patients will continue to have depressive symptoms after their antidepressant is reduced or stopped. These individuals may benefit from continuing to take Paxil for 1 year or longer.

Common Side Effects

The most frequent complaints reported with Paxil are gastrointestinal side effects, including nausea, vomiting, cramping, diarrhea, and heartburn. These side effects may be dramatically reduced by switching to the controlled — release tablet, Paxil CR. Drowsiness and daytime sedation may be other frequent side effects experienced by individuals taking Paxil. However, a significant number of people taking SSRIs, including Paxil, may experience jitteriness, nervousness, and insomnia, which is common with this class of antidepressants because of its activating properties in the central nervous system.
Paxil is associated with a significant rate of sexual dysfunction in men and women taking the antidepressant. The sexual side effects reported are delayed orgasm in women and retarded ejaculation in men. Some people may experience decreased desire or lack of interest in sexual activity. Occasionally, individuals report headaches, sleepiness, excessive sweating, stomach cramps, diarrhea, and constipation. People taking Paxil may also experience weight gain.
Patients should discuss these side effects with their physician, especially if they continue to be bothersome 3-4 weeks after the medication is started. If a rash or any other severe symptoms develop, patients should contact their physician immediately.

Adverse Reactions and Precautions

Paxil may cause drowsiness in some people. Patients should not drive or operate machinery until they are certain that their alertness or coordination is not affected by the medication. Patients with a known allergy to Paxil or who have experienced a severe reaction after taking it should not take Paxil.

Use in Pregnancy and Breastfeeding: Pregnancy Category C

Paxil has not been tested in women to determine its safety in pregnancy The effects of the medication on the developing fetus in pregnant women are unknown. however, newborn babies exposed to antidepressants such as SSRIs late in the third trimester developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Women who are pregnant or may become pregnant should discuss this with their physician. Some women may experience a recurrence of their depression when they stop their antidepressant. In these circumstances it may be necessary to restart the medication or seek an alternative medication or treatment.
Nursing mothers should not take Paxil because small amounts will pass into breast milk and be ingested by the baby. If stopping the drug is not an alternative, breastfeeding should not be started or should lie discontinued.

Possible Drug Interactions

The combined use or Paxil with certain other medications may result in adverse drug interactions, because one medication may alter the blood levels of the other. The clinically significant drug interactions reportedOther medications, including herbal supplements (such as St. Johns wort), that boost serotonin may result in excessive levels of that neurotransmitter when combined with Paxil and produce a toxic syndrome known as serotonin syndrome. The early signs of serotonin syndrome are restlessness, confusion, tremors, flushing, and involuntary muscle jerks. If the medications are not stopped, the individual may develop more life-threatening complications resulting in muscle disorders, high fever, respiratory problems, clotting problems, and destruction of red blood cells that may lead to acute renal failure. Patients taking Paxil should be alert to the possible signs of serotonin syndrome, which require immediate medical attention and discontinuation of the serotonin-boosting medications.
Antidepressants known as monoamine oxidase inhibitors (MAOIs) should not be taken together with Paxil, because the combination may potentially produce a toxic reaction that includes elevated temperature, high blood pressure, and extreme excitation and agitation. Patients should consult their physician or pharmacist before taking any new medications, including over-the-counter medications and herbal supplements, with Paxil.
Patients taking Paxil should avoid alcohol or should consume it in moderation because the combination may worsen depression.

What are amoxicillin capsules or chewable tablets?

Amoxil (AMOXICILLIN) is a penicillin antibiotic.

Amoxil (AMOXICILLIN) kills, or stops the growth of bacteria that cause infection. It treats many different kinds of infections of the skin, respiratory tract, sinuses, car, and kidney. Amoxicillin also treats some sexually transmitted disease. Generic amoxicillin are available, but not generic chewable tablets.

What should my health care professional know before I take amoxicillin?

They need to know it you have any or these conditions:

• asthma

• kidney disease

• leukemia

• mononucleosis

• intestinal problems (especially colitis)

• other chronic illness

• phenylketonuria

• viral infection

• an unusual or allergic reaction to amoxicillin, other penicillins, cephalosporin antibiotics, other medicines, foods, dyes, or preservatives

• breast-feeding

How should I take this Amoxil (AMOXICILLIN)?

Take amoxicillin capsules or chewable tablets by mouth. Chew or crush the tablets, do not swallow whole. Swallow the capsules or tablets whole with a glass of water, take while in an upright or sitting position. You may take amoxicillin with or without food. Follow the directions on the prescription label. Take your doses at regular intervals. Do not take your medicine more often than directed. Finish the full course prescribed by your prescriber or health care professional even if you think your condition is better. Do not stop taking except on your prscriber’s advice.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses. There should be an interval of at least 6 to 8 hours between doses.

What may interact with Amoxil (AMOXICILLIN)?

• allopurinol

• birth control pills

• methotrexate

• neomycin

• probenecid

Tell health care professional about all other medicines you arc taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking amoxicillin?

Tell your health care professional if your symptoms do not improve in 2 or 3 days. If you are diabetic and taking large doses of amoxicillin, you may get a false-positive result for sugar in your urine with certain brands of urine tests. Check with your health care professional before you change your diet or the dose of your diabetic medicine. If you get severe or watery diarrhea, do not treat yourself. Call your health care professional for advice. If you get a skin rash, do not treat yourself. Call your health care professional for advice.

What side effects may I notice from taking amoxicillin?

Side effects that you should report to your health care professional as soon as possible:

• difficulty breathing, wheeling

• dark yellow or brown urine

• dizziness

• fever or chills, sore throat

• increased thirst

• pain or difficulty passing urine

• pain on swallowing

• redness, blistering, peeling or loosening of the skin, including inside the mouth

• seizures (convulsions)

• skin rash, itching

• stomach pain or cramps

• swollen joints

• severe or watery diarrhea

• unusual bleeding bruising

• unusual weakness or tiredness

• vomiting

• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your health care professional if they continue or are bothersome):

• diarrhea

• headache

• loss of appetite

• nausea

• stomach gas or heartburn

Where can I keep Amoxil (AMOXICILLIN)?

Keep mil of the reach of children in a container that small children cannot open. Store at room temperature between 15 and 30 degrees C (59 and degrees F). Keep container tightly closed. Throw away any unused medicine alter the expiration date.