Paxil vs. Lexapro: 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 and Lexapro are prescription medications used most commonly to treat major depressive disorder (MDD) and generalized anxiety disorder (GAD). MDD is characterized by a low mood for two or more weeks, typically accompanied by a loss of interest in normal activities and low energy. Some patients will experience pain with no obvious source.

Generalized anxiety disorder is characterized by excessive worry about a variety of issues including money, family, health, and work. It is diagnosed once patients display this worry on more days than not for at least six months.

Paxil and Lexapro belong to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Other commonly prescribed SSRIs include Prozac (fluoxetine), Zoloft (sertraline), and Celexa (citalopram).

What are the main differences between Paxil and Lexapro?

Paxil (What is Paxil?) is available as a generic medication called paroxetine, and it belongs to the group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Lexapro (What is Lexapro?) works by blocking the reuptake of the neurotransmitter serotonin at the neuronal membrane transport pump. This action effectively leaves more free serotonin in the neuron synapse. A higher level of serotonin plays a positive role in mood and affect.

Paxil is available by prescription only in regular and controlled-release tablets, as well as an oral solution.

Lexapro is available generically as escitalopram, and it is also an SSRI. Its mechanism is similar to that of paroxetine in that it increases free serotonin. Lexapro is available as an oral tablet and oral solution.

Main differences between Paxil and Lexapro
	Paxil	Lexapro
Drug class	Selective serotonin reuptake inhibitor	Selective serotonin reuptake inhibitor
Brand/generic status	Brand and generic available	Brand and generic available
What is the generic name?	Paroxetine	Escitalopram
What form(s) does the drug come in?	Regular release tablets, controlled-release tablets, and oral solution	Tablets and oral solution
What is the standard dosage?	20 mg once per day	10 mg once per day
How long is the typical treatment?	Long-term (months to years)	Long-term (months to years)
Who typically uses the medication?	Adults	Adolescents and adults

Conditions treated by Paxil and Lexapro

Paxil and Lexapro are both indicated to treat both major depressive disorder and generalized anxiety disorder, but they each treat other types of conditions as well. Paxil is approved in the treatment of obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD). In women specifically, Paxil is used to treat premenstrual dysphoric disorder (PMDD) and hot flashes associated with menopause. It can be used off-label, or without the approval of the Food and Drug Administration (FDA), for premature ejaculation in men.

Lexapro is sometimes used off-label for obsessive-compulsive disorder, bulimia nervosa, and binge eating.

The following chart provides a list of conditions treated by Paxil and Lexapro. It may not include all potential uses, and you should always consult with your mental health or psychiatry professional to see if one of these drugs is right for you.

Condition	Paxil	Lexapro
Major depressive disorder (major depression) (MDD)	Yes	Yes
Generalized anxiety disorder (GAD)	Yes	Yes
Obsessive-compulsive disorder (OCD)	Yes	Off-label
Panic disorder	Yes	No
Social anxiety disorder	Yes	No
Post-traumatic stress disorder (PTSD)	Yes	No
Premenstrual dysphoric disorder (PMDD)	Yes	No
Hot flashes associated with menopause	Yes	No
Premature ejaculation	Off-label	No
Bulimia nervosa	No	Off-label
Binge eating	No	Off-label

Is Paxil or Lexapro more effective?

A meta-analysis compared 12 antidepressants, including Paxil and Lexapro, and their effects on depression. Researchers sought to compare both the efficacy and tolerability of these treatments. The resulting data showed that Lexapro was significantly more efficacious at improving outcomes in MDD. Lexapro also showed a more acceptable tolerability, leading to fewer patients who discontinued therapy. From these results, Lexapro appears to be a preferred choice over Paxil in MDD.

In another meta-analysis study, Paxil and Lexapro were compared for their effects on anxiety. Lexapro was found to be significantly more effective than a placebo and was well-tolerated. Paxil, while effective as well, was poorly tolerated and led to a higher number of discontinuations. Based on this data, Lexapro may be preferred in generalized anxiety disorder.

Coverage and cost comparison of Paxil vs. Lexapro

Paxil is a prescription medication that is typically covered by both commercial and Medicare drug plans. The out-of-pocket price for a one month supply of Paxil 20 mg can be more than $400, but with a coupon from SingleCare, you could get the generic for as low as $4 at participating pharmacies.

Lexapro is also a prescription medication that is typically covered by both commercial and Medicare drug plans. The out-of-pocket price for a 30-day supply of Lexapro 10 mg can be more than $400. SingleCare offers a coupon for generic Lexapro, which can lower the price to $8 or less.

	Paxil	Lexapro
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	Yes	Yes
Standard dosage	30, 20 mg tablets	30, 10 mg tablets
Typical Medicare copay	Less than $10	Less than $10
SingleCare cost	$4+	$8+

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Common side effects of Paxil vs. Lexapro

Paxil and Lexapro are both SSRIs and have a similar side effect profile, though as studies mentioned above suggest, the occurrence of these adverse events may vary a great deal between the two drugs. Nausea is much more common with Paxil than Lexapro, occurring in 26% of patients compared to just 5% with Lexapro.

Somnolence, or drowsiness, is also much more common with Paxil, occurring in 23% of patients, versus just 6% in Lexapro patients.

Side effects are the primary reason patients discontinue treatment with antidepressants, and it is important to know what to expect and have a discussion with your prescriber or pharmacist. This is not a complete list of side effects. A complete list may be obtained from your healthcare provider.

	Paxil		Lexapro
Side effect	Applicable?	Frequency	Applicable?	Frequency
Nausea	Yes	26%	Yes	5%
Dry mouth	Yes	18%	Yes	5%
Sweating	Yes	11%	Yes	5%
Diarrhea	Yes	12%	Yes	8%
Constipation	Yes	14%	Yes	3%
Dyspepsia	No	2%	Yes	3%
Dizziness	Yes	13%	No	n/a
Somnolence	Yes	23%	Yes	6%
Headache	Yes	18%	No	n/a
Decreased appetite	Yes	6%	Yes	3%
Decreased libido	No	3%	Yes	2%

Source: Paxil (DailyMed) Lexapro (DailyMed)

Drug interactions of Paxil vs. Lexapro

Paxil and Lexapro are each metabolized by the cytochrome P-450 enzyme system. Paxil is a strong inhibitor of CYP2D6. Codeine, for instance, is metabolized to morphine by CYP2D6. Patients taking Paxil may require higher doses of codeine to achieve sufficient pain relief. Alternatively, patients taking codeine and Paxil together who discontinue Paxil may need to have their codeine dosage adjusted down to avoid potentially life-threatening adverse events such as decreased respiratory rate.

Lexapro is a major substrate of CYP2C19 and CYP3A4, and a weak inhibitor of CYP2D6. The use of Lexapro with tricyclic antidepressants, such as amitriptyline, may increase the risk of QT prolongation and serotonin syndrome. In general, this combination should be avoided.

The following list is not intended to be a complete list of drug interactions. It is best to consult your provider or pharmacist for a complete list of interactions and medical advice.

Drug	Drug class	Paxil	Lexapro
Almotriptan Eletriptan Oxitriptan	5HT Agonist/Triptans (antimigraine agents)	Yes	Yes
Amphetamine salts Dexmethylphenidate Methylphenidate	Amphetamines	Yes	Yes
Alosetron Ondansetron Ramosetron	5HT3 Antagonists (anti-nausea agents)	Yes	Yes
Aripiprazole	Antipsychotic	Yes	Yes
Aspirin Ibuprofen Naproxen Diclofenac	Nonsteroidal anti-inflammatory drugs (NSAIDs)	Yes	Yes
Bemiparin Enoxaparin Heparin	Anticoagulants	Yes	Yes
Bupropion	Dopamine/norepinephrine reuptake inhibitor	Yes	Yes
Buspirone	Antianxiety	Yes	Yes
Carbamazepine	Anticonvulsant	No	Yes
Esomeprazole Omeprazole	Proton pump inhibitor	No	Yes
Fluconazole	Antifungal	No	Yes
Fluoxetine Citalopram Sertraline	SSRIs	Yes	Yes
Linezolid	Antibiotic	Yes	Yes
Pimozide	Antipsychotic	Yes	Yes
Selegiline Phenelzine Rasagiline	Monoamine oxidase inhibitor (MAOI)	Yes	Yes
St. John’s Wort	Herbal supplement	Yes	Yes
Hydrochlorothiazide Chlorthalidone Metolazone	Thiazide diuretics	Yes	Yes
Codeine Tramadol	Opiate pain reliever	Yes	Yes
Amitriptyline Clomipramine Doxepin Nortriptyline	Tricyclic antidepressants	Yes	Yes
Venlafaxine Desvenlafaxine	Selective norepinephrine/serotonin reuptake inhibitor (SNRIs)	Yes	Yes

Warnings of Paxil and Lexapro

Paxil, Lexapro, and other SSRIs do not provide immediate relief of symptoms of depressive disorder or anxiety disorder. It generally takes two weeks to notice any change in most patients, and up to four to six weeks to realize the full effect of the medication. Patients may discontinue their medication with the belief that it is ineffective if they are unaware of this delay.

Paxil and Lexapro therapy may increase suicidal ideation and thoughts among teens and young adults, especially in the early stages of treatment before any type of remission is achieved. These patients must be monitored closely if this treatment is deemed medically necessary. A therapy change may be necessary if symptoms suddenly arise or get worse. Patients with MDD may experience a worsening of depression or suicidal thoughts whether or not they are taking antidepressant medications.

Serotonin syndrome has been reported with all SSRIs, including Paxil and Lexapro. This is a condition related to abnormally high levels of serotonin and can result in the patient feeling agitated, dizzy, and having an increased heart rate. This can be brought on by the use of two serotonergic drugs together. Refer to the information provided above as well as manufacturers labeling to help avoid these drug interactions.

SSRIs, including Paxil and Lexapro, should not be discontinued suddenly as patients may experience withdrawal symptoms. If discontinuing therapy is deemed necessary by your provider, you should be slowly tapered off these drugs.

Frequently asked questions about Paxil vs. Lexapro

What is Paxil?

Paxil is a prescription antidepressant medication used in the treatment of major depression and generalized anxiety disorder, among other conditions. Lexapro is available as an oral tablet in 10 mg, 20 mg, 30 mg, and 40 mg strengths. It is also available as an oral solution.

What is Lexapro?

Lexapro is a prescription antidepressant medication used in the treatment of major depression and generalized anxiety disorder. Lexapro is available as an oral tablet in 5 mg, 10 mg, and 20 mg strengths. It is also available as an oral solution.

Are Paxil and Lexapro the same?

Paxil and Lexapro are both antidepressants classified as selective serotonin reuptake inhibitors, but they are not the same. They are both used in the treatment of major depressive disorder and generalized anxiety disorder, but Paxil carries additional approved indications.

Is Paxil or Lexapro better?

Data suggests that Lexapro may be preferred over Paxil due to having better clinical outcomes and having a more tolerable side effect profile in treating depression. Efficacy between the two may be similar in anxiety treatment, but Lexapro’s tolerability makes it preferable.

Can I use Paxil or Lexapro while pregnant?

Paxil is a category D drug in pregnancy, meaning it is known to cause fetal harm and should not be used in pregnancy. Lexapro is pregnancy category C, meaning there have not been adequate human studies to determine safety. Lexapro should only be used when the risk of untreated depression in the mother outweighs the risk of fetal harm.

Can I use Paxil or Lexapro with alcohol?

Alcohol can increase the toxic effects of both Paxil and Lexapro. Drinking alcohol while taking these drugs can cause significant psychomotor impairment, and for this reason, patients are advised to avoid alcohol if taking Paxil or Lexapro.

Is Paxil the best SSRI for anxiety?

Studies suggest Paxil may not be the best SSRI choice for anxiety due to its poor tolerability. Paxil causes a much higher incidence of some bothersome side effects and does not necessarily offer higher efficacy.

What is better than Paxil for anxiety?

Lexapro offers similar efficacy to Paxil with a better tolerability profile. Another class of drugs may also be preferable in the treatment of generalized anxiety disorder, selective norepinephrine inhibitors (SNRIs). These include Effexor XR (venlafaxine) and Cymbalta (duloxetine).

How much Paxil should I take for anxiety?

For most patients, 20 mg once daily is an effective dose for anxiety treatment. If an increase is needed, Paxil can be increased by 10 mg per day in weekly intervals up to 50 mg per day.