Brief Answer:
Please take 12.5 mg one tablet for a week then take 25 mg as prescribed

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in details.
Hope you are consulting a Psychiatrist and taking medications as prescribed. I have worked in a psychiatry unit for some years and would like to help you with your problem.

PEXEP CR contains controlled-release version of Paroxetin which is given to patients to patients having features of panic attacks, social anxiety disorder, generalized anxiety disorder.

These medications take time to act and at least 15 days to a month is required before the patient starts feeling better and experiences full benefits.

Your symptoms have returned because of stopping the medication on your own. Such medications should not be stopped by yourself without asking your doctors.

Regarding starting PEXEP CR,
Please start taking 12.5 mg one tablet each day for one week.
After one week please take 25 mg one tablet per day as prescribed by your doctor and continue under strict medical supervision of your Psychiatrist..
Further dose changes can be discussed with your doctor.
If you have any discomfort then please consult your doctor immediately.

Side effects are rarely seen after 2 weeks of treatment. You might have some problems in the first 15 days as you have experienced earlier. Persisting side effects might require change in dose or medications. Main side effects of taking PEXEP CR are
(i) vision changes;
(ii) weakness, drowsiness, dizziness;
(iii) sweating, anxiety, shaking;
(iv) sleep problems (insomnia);
(v) loss of appetite, constipation;
(vi) dry mouth, yawning; or
(vii) decreased sex drive, impotence, or difficulty having an orgasm

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
It has to be taken daily dose

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

Feeling weak and panic attacks with dizziness are common side effects after starting this medication and many people experience these side effects. This is also happening to you because you had earlier taken this medication and then stopped it on your own (which should not have been done). So your body needs more time to adjust with the medication.

PEXEP CR must be taken as a daily dose. Taking after one day gap can cause more side effects and difficulty in treatment.

If you feel severe dizziness and panic attacks then please consult your treating doctor.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Carmizyme and pexep 12.5 can be taken together

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

As you have been having frequent panic attacks recently, it is likely that your night time heart beat increase and discomfort is due to anxiety. Please take medications as prescribed by your doctor without missing a dose and this should be soon under control. You can try listening to soft melodious music at bed time or read a book to keep your mind busy and comfortable. If you are afraid of darkness then you can keep a night lamp. The medication carmizyme is for better digestion and does not cause any problems when taking pexep 12.5 mg. You can take both the medications in recommended doses.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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