Does Paxil Cause Altered Taste (Dysgeusia)?
Yes, Paxil (paroxetine) can cause taste perversion (dysgeusia), though it occurs infrequently at approximately 2% in clinical trials, which is still higher than placebo (0%).
Evidence from FDA Drug Label
The official FDA prescribing information for Paxil CR clearly documents "taste perversion" as a treatment-emergent adverse event 1. In controlled clinical trials for major depressive disorder:
- Taste perversion occurred in 2% of patients taking Paxil CR versus 0% on placebo 1
- This adverse effect was specifically tracked under "Special Senses" in the safety profile
- The incidence was consistent across different indications (depression, panic disorder, social anxiety disorder)
Notably, in panic disorder trials, taste perversion was listed among adverse events where the reporting rate for Paxil CR was less than or equal to placebo, suggesting the effect may be more prominent in depression treatment specifically 1.
Clinical Context
While dysgeusia is a documented side effect of paroxetine, it is relatively uncommon compared to other adverse effects like:
- Nausea (22-23%)
- Dry mouth (13-18%)
- Somnolence (20-22%)
- Sexual dysfunction (much higher rates)
The 2% incidence means that for every 50 patients treated with Paxil, approximately one will experience altered taste that they wouldn't have experienced on placebo.
Important Caveats
- The taste alteration is generally mild and does not typically lead to treatment discontinuation
- This side effect was not among the common reasons patients stopped taking Paxil in clinical trials
- The effect appears to be dose-independent based on the available data
- Animal studies showed paroxetine did not alter taste-guided consummatory behavior, suggesting the mechanism may be central rather than peripheral 2
Comparison to Other Antidepressants
The ACP guidelines note differences in adverse effect profiles among second-generation antidepressants but do not specifically highlight dysgeusia as a distinguishing feature between agents 3, 4. When counseling patients about side effects, focus should remain on the more common adverse events like sexual dysfunction, gastrointestinal symptoms, and activation/sedation effects.