Shake Well Before Using—Beware of Liquid Paxil Suspension Problems

Sweet M. had been taking Paxil in a liquid suspension for her anxiety and OCD symptoms for a couple of years. When we started on the Paxil she didn't yet know how to swallow a pill, so the liquid seemed like a great idea. And with a liquid, one can adjust the dose carefully as one's doctor directs—or at least that is what we thought.

Last year we were required by our health insurance plan to get our medications from a mail order Rx company and get a ninety day supply, so we stopped using our local pharmacy.

When we changed to the mail order plan the bottles of medication were odd. Sometimes the medication was really thick—almost like yogurt—and sometime it was really thin—almost as thin as water. It didn't matter how much you shook it up—it was never the same thickness.

My husband was giving her medication at night because I was teaching nights at the time so I didn't notice this until one night he was out and I was giving her the medication. I got to the end of one bottle and it was really thin, and had to open a new bottle, where it was really thick. Strange, I thought.

The next day I phoned GlaxoSmithKline and the mail order pharmacy to ask them about it. The pharmacist I spoke to at GSK told me that this is a suspension, not a solution, so it's sometimes difficult to resuspend the mixture when you open a new bottle because there's not enough space in the bottle to really mix it up.

What you need to do, he said, is put it in a bigger bottle and shake it up.

I asked if GSK had been aware of this problem and he asked if he could put me on hold.

Yes, I said.

When he came back he said Yes, we'd been aware of this problem.

I asked if this problem with the suspension could have meant that my daughter was getting a variable dose of the drug over the course of the past year.

Yes, he said.

I was stunned. GSK knew that the suspension formula, which is usually used for your most vulnerable populations—children and elderly adults who can't swallow a pill—was almost impossible to resuspend as packaged, yet they did nothing about it, other than label the bottle Shake Well Before Using.

So for at least one year our Sweet M. was getting a completely unknown and variable dose of Paxil. She could have been getting everything from 3 or 4 times her prescribed dose of the active ingredient, or almost no active ingredient.

Imagine how you'd feel if you were taking a short half-life SSRI like Paxil, only the dose was raised and lowered more or less randomly all the time.

This is when one wishes one had the resources to take on big pharmaceutical companies—not for personal gain—but to force them to relabel or repackage the medication.

Though GSK did send a letter to me asking me to authorize them to speak with M's psychiatrist—I guess to verify that this actually happened—so far as I know, they have not yet done anything to correct this problem with the Paxil suspension and its packaging. They could package the Paxil in a larger bottle, or they could change the labelling, but as far as I know nothing of the sort has happened.

Perhaps I'll give them a call this week to ask them if they've done anything to the packaging. I don't really have the resources to make them change it, but at least I can blog.

Oh, and one final note: I spoke with my local pharmacist about this problem and he told me how you can resuspend a suspension if it's in a too-small bottle, as the Paxil is. Just turn the bottle upside down and tap it gently on a hard surface. The active ingredients will resuspend. How hard would it be for GSK to put those instructions on the bottle?