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Paxil vs. Prozac: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Paxil (paroxetine) and Prozac (fluoxetine) are two prescription medications used to treat depression and other psychiatric disorders. Both medications work as selective serotonin reuptake inhibitors (SSRIs). Serotonin is a chemical neurotransmitter in the brain that plays an important role in mood. SSRIs work by increasing the amount of serotonin in the brain to exert antidepressant effects. Although they are in the same drug class, Paxil and Prozac have some differences.

What are the main differences between Paxil vs. Prozac?

Paxil (What is Paxil?) is also known by its chemical name paroxetine. Like other SSRIs, Paxil is primarily used to treat depression in adults 18 years and older. It can also treat other conditions such as obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), anxiety, and panic attacks. Paxil is available as an oral tablet or liquid suspension.

Prozac (What is Prozac?) is also known by its chemical name, fluoxetine. Unlike Paxil, Prozac can treat depression in adults and children aged 8 years and older and obsessive compulsive disorder (OCD) in adults and children 7 years and older. It can also treat panic attacks and bulimia. Prozac comes as a daily or weekly oral capsule and has a long half-life of 4 to 6 days.

Main differences between Paxil vs. Prozac
Paxil Prozac
Drug class Selective serotonin reuptake inhibitor (SSRI) Selective serotonin reuptake inhibitor (SSRI)
Brand/generic status Generic version available Generic version available
What is the generic name?
What is the brand name?
What form(s) does the drug come in? Oral tablet
Oral liquid suspension
Oral capsule,
What is the standard dosage? 20 mg once per day 20 mg once per day
How long is the typical treatment? Long term depending on the condition being treated Long term depending on the condition being treated
Who typically uses the medication? Adults 18 years and older Adults and children 8 years and older

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Conditions treated by Paxil vs. Prozac

Paxil and Prozac can both treat similar mental health conditions including major depressive disorder and obsessive compulsive disorder. They are also prescribed to treat panic attacks stemming from panic disorders. While Paxil is approved to treat PTSD, Prozac can also be used off-label to treat symptoms of PTSD.

Paxil and Prozac can treat symptoms of premenstrual dysphoric disorder (PMDD), or depression during periods. Paxil CR is a controlled release form of Paxil that is specifically approved for PMDD.

Paxil is prescribed to treat anxiety from different anxiety disorders such as generalized anxiety disorder and social phobias. While Prozac can be prescribed for anxiety, it is not FDA-approved for these specific disorders.

Prozac can be taken in combination with another drug called olanzapine for depressive symptoms from bipolar I disorder.

Condition Paxil Prozac
Major depressive disorder (MDD) Yes Yes
Obsessive compulsive disorder (OCD) Yes Yes
Panic disorder Yes Yes
Social anxiety disorder (SAD) Yes Off-label
Generalized anxiety disorder (GAD) Yes Off-label
Post-Traumatic stress disorder (PTSD) Yes Off-label
Premenstrual dysphoric disorder (PMDD) Yes Yes
Bipolar I disorder Off-label Yes

Is Paxil or Prozac more effective?

Paxil and Prozac are similarly effective for treating symptoms of depression. Their main differences lie in how they’re used and the side effects they may have.

In a randomized trial from the Journal of the American Medical Association, paroxetine and fluoxetine were found to have similar effectiveness over 9 months of use. The study included 573 adults with symptoms of depression. Over the length of the trial, they experienced similar improvements in quality of life. Another similar trial showed no significant differences between the active ingredients of Paxil and Prozac for depression.

In one comparative study, paroxetine and fluoxetine were found to have similar efficacy after 6 weeks of treatment. However, some users of paroxetine had a greater response after 3 weeks and reported fewer side effects compared to fluoxetine. Overall, they worked in similar ways.

One treatment option may be preferred over the other depending on your condition. Consult a doctor to determine the right antidepressant to help you.

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Coverage and cost comparison of Paxil vs. Prozac

Paxil is a brand-name medication. The generic form of Paxil, paroxetine, is covered by most Medicare and insurance plans. The average retail price of generic Paxil is around $39.99. With a SingleCare discount card, you can expect to reduce this cost to $4-20.

Prozac is a brand-name medication. The generic form of Prozac, fluoxetine, is covered by most Medicare and insurance plans. The average retail price of generic Prozac is around $28.99. With a SingleCare savings card, you can expect to pay around $4-20.

  Paxil Prozac
Typically covered by insurance? Yes Yes
Typically covered by Medicare? Yes Yes
Standard dosage 20 mg tablets (supply of 30) 20 mg tablets (supply of 30)
Typical Medicare copay $12 $12
SingleCare cost $4-20 $4-20

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Common side effects of Paxil vs. Prozac

Paxil and Prozac share similar side effects. Common side effects of Paxil and Prozac include headache, asthenia (general weakness or lack of energy), and dry mouth.

Both drugs can cause side effects involving the central nervous system (CNS). These CNS side effects include insomnia, anxiety, drowsiness, and dizziness. Other digestive side effects include nausea, diarrhea, constipation, indigestion, and flatulence (gas).

Both Paxil and Prozac can also cause some degree of weight-loss or weight gain. Prozac may cause more negative changes in eating resulting in anorexia. Paxil, on the other hand, may be more likely to cause weight gain out of the two.

Paxil may cause some muscle pain whereas Prozac rarely causes this side effect.

Prozac is a more stimulating SSRI and may be more likely to cause insomnia. For this reason, it is often taken in the morning or afternoon rather than at night.

Both Paxil and Prozac may cause sexual problems including decreased libido (sex drive), sexual dysfunction, delayed orgasm, and delayed ejaculation.

Both Paxil and Prozac are SSRIs that are on the BEERS list. This list includes drugs that may not be recommended in certain people 65 years and older. CNS side effects may occur more in older adults and should be monitored.

  Paxil Prozac
Side Effect Applicable? Frequency Applicable? Frequency
Headache Yes 18% Yes 21%
Weakness or lack of energy Yes 15% Yes 11%
Heart palpitations Yes 3% Yes 1%
Vasodilation Yes 3% Yes 2%
Nausea Yes 26% Yes 22%
Dry mouth Yes 18% Yes 9%
Indigestion Yes 2% Yes 8%
Constipation Yes 14% Yes 5%
Diarrhea Yes 12% Yes 11%
Decreased appetite/weight loss Yes 6% Yes 2%
Anorexia No Yes 10%
Flatulence Yes 4% Yes 3%
Insomnia Yes 13% Yes 19%
Nervousness Yes 5% Yes 13%
Anxiety Yes 5% Yes 12%
Drowsiness Yes 23% Yes 12%
Dizziness Yes 13% Yes 9%
Decreased libido Yes 3% Yes 4%
Muscle pain Yes 2% No
Flu syndrome Yes N/A Yes 5%
Rash Yes 2% Yes 4%

*This may not be a complete list. Consult a doctor or pharmacist for possible side effects.

Source: DailyMed (Paxil), DailyMed (Prozac)

Drug interactions of Paxil vs. Prozac

As SSRIs, Paxil and Prozac have similar drug interactions. Both drugs can interact with monoamine oxidase inhibitors (MAOIs) such as selegiline and phenelzine. MAOIs need to be stopped for at least 14 days before starting an SSRI. Taking these medications can increase the risk of serotonin syndrome, a serious set of symptoms that can include fever, agitation, and diarrhea.

Taking other serotonergic drugs like other SSRIs, SNRIs, and some opioids with Paxil or Prozac can also increase the risk of serotonin syndrome. These drugs should be monitored if taken together.

Paxil and Prozac are not recommended to be taken with pimozide or thioridazine. Taking these medications together can increase the risk of QT prolongation, or an abnormal heart rhythm.

Paxil and Prozac can interact with other drugs that cause CNS side effects. Taking these medications with drugs like benzodiazepines, anticonvulsants, and opioids can increase adverse effects such as drowsiness and dizziness.

These SSRIs should be monitored in those taking NSAIDs and other blood thinners like warfarin. These medications can interact and increase the risk of bleeding.

Drug Drug Class Paxil Prozac
Monoamine oxidase inhibitor (MAOI) Yes Yes
Antipsychotic Yes Yes
Triptan Yes Yes
Tricyclic  antidepressant (TCA) Yes Yes
Serotonin-norepinephrine reuptake inhibitor (SNRI) Yes Yes
Benzodiazepine Yes Yes
Anticonvulsant Yes Yes
Lithium Mood stabilizer Yes Yes
Opioid Yes Yes
St. John’s Wort Herbal Yes Yes
NSAIDs Yes Yes
Warfarin Anticoagulant Yes Yes

*This may not be a complete list of all possible drug interactions. Consult a doctor with all medications you may be taking.

Warnings of Paxil vs. Prozac

Paxil and Prozac both have black box warnings on their labels about potential suicidal thoughts and behaviors. SSRIs can cause suicidal thinking, especially in children, adolescents, and young adults. Therefore, these drugs should be monitored in some people.

Taking Paxil or Prozac may trigger manic episodes in those with bipolar disorder. They should also be used with caution in those who experience or have experienced seizures since SSRIs may increase seizure risk.

Paxil or Prozac may cause withdrawal symptoms if discontinued abruptly. These medications should only be stopped with professional guidance. These medications will be tapered off slowly in order to decrease or prevent withdrawal symptoms.

Pregnant women should not take Paxil (Pregnancy Category D). Pregnant women may take Prozac only if the benefits outweigh the risks (Pregnancy Category C).

Frequently asked questions about Paxil vs. Prozac

What is Paxil?

Paxil is a selective serotonin reuptake inhibitor (SSRI). Paxil is the brand name for paroxetine. It is used to treat mental health conditions including depression, OCD, panic attacks, and anxiety in adults 18 years and older. It is often taken as 20 mg once per day.

What is Prozac?

Prozac is a selective serotonin reuptake inhibitor (SSRI). Prozac is the brand name for fluoxetine. It is used to treat depression, OCD, and premenstrual dysphoric disorder in adults and children over 8 years old. It can also treat depressive episodes of bipolar I disorder. The usual dosage is 20 mg once daily.

Are Paxil vs. Prozac the same?

Paxil and Prozac are not the same. Though they belong to the SSRI drug class, they have different uses and side effects.

Is Paxil vs. Prozac better?

Paxil and Prozac are both effective SSRI medications. Paxil may be preferred for its approved uses for anxiety disorders and less stimulating side effects. Prozac may be chosen for children or for its weekly dose option.

Can I use Paxil vs. Prozac while pregnant?

Paxil should not be used in pregnant women. Prozac may be used in pregnant women only if the benefits outweigh the risks. Consult your healthcare provider if you are pregnant or breastfeeding.

Can I use Paxil vs. Prozac with alcohol?

It is not recommended to consume alcohol with SSRIs like Paxil or Prozac. Drinking alcohol with these medications may increase side effects such as drowsiness or dizziness.

Is Paxil good for anxiety?

Paxil is FDA approved to treat anxiety. Paxil can be used for generalized anxiety disorder, social phobia, and panic disorder. Studies have shown that Paxil is effective for these conditions.

What is the most common side effect of Prozac?

The most common side effects of Prozac include anxiety, nervousness, and insomnia. Other common side effects include headache, nausea, and dry mouth. However, these side effects are usually mild and go away over time.