Cymbalta vs. Paxil

See how Cymbalta and Paxil compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Cymbalta is an SNRI approved for depression, anxiety, and several chronic pain conditions, while Paxil is an SSRI approved mainly for depression and anxiety disorders.

  • Both drugs carry a boxed warning for increased suicidal thoughts in children, adolescents, and young adults.

  • Paxil's shorter half-life tends to cause more noticeable withdrawal symptoms if a dose is missed or stopped, compared with Cymbalta.

Cymbalta vs. Paxil Drug Summary

Cymbalta

Cymbalta (duloxetine) is a serotonin and norepinephrine reuptake inhibitor (SNRI) used to treat major depressive disorder, generalized anxiety disorder, and chronic pain conditions like diabetic nerve pain and fibromyalgia. It comes as a delayed-release capsule, usually taken once a day.

Paxil

Paxil (paroxetine) is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder along with several anxiety-related conditions, including OCD, panic disorder, and PTSD. It is taken as a tablet, typically once daily, with an extended-release option also available.

Cymbalta vs. Paxil Side Effects

Cymbalta

Most common
nausea (up to 30%)
somnolence (up to 21%)
dry mouth (up to 15%)
constipation (up to 15%)

Paxil

Most common
nausea (up to 26%)
somnolence (up to 23%)
dry mouth (up to 18%)
constipation (up to 14%)

Cymbalta vs. Paxil Dosage

Cymbalta

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 30 mg once daily Week 1
Maximum dose 60 mg twice daily If needed
Dose changes 2 increases Every week

Paxil

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 20 mg once daily At the start
Maximum dose 50 mg once daily If needed
Dose changes 3 increases As tolerated

Cymbalta vs. Paxil Indications

Cymbalta

Cymbalta treats major depressive disorder and generalized anxiety disorder, and it is also approved for chronic pain conditions such as diabetic nerve pain and fibromyalgia. This makes it a common choice when depression or anxiety overlaps with ongoing physical pain.

  • Major depressive disorder

  • Generalized anxiety disorder

  • Diabetic peripheral neuropathic pain

  • Fibromyalgia

  • Chronic musculoskeletal pain

Paxil

Paxil treats major depressive disorder along with several anxiety-related conditions, including OCD, panic disorder, social anxiety disorder, and PTSD. It carries no approval for chronic pain, so its use stays within psychiatric and anxiety disorders.

  • Major depressive disorder

  • Obsessive-compulsive disorder

  • Panic disorder

  • Social anxiety disorder

  • Post-traumatic stress disorder

Cymbalta vs. Paxil Pros and Cons

Cymbalta

Cymbalta's SNRI action gives it added approval for chronic pain syndromes that many SSRIs don't cover, but it requires more caution in people with liver or kidney problems. The twice-daily maximum dose also adds an extra step that Paxil's dosing doesn't have.

Pros

  • FDA-approved for chronic pain, including diabetic nerve pain and fibromyalgia

  • Fewer significant drug-interaction concerns than Paxil

  • Simple once-daily dosing without needing an extended-release version

Cons

  • Must be avoided in liver disease, cirrhosis, or severe kidney impairment

  • Maximum dose requires splitting into two daily doses

  • Not approved for OCD, panic disorder, or PTSD

Paxil

Paxil's long history and multiple formulations give prescribers flexibility, but its strong effect on the CYP2D6 enzyme means many other medications need dose changes when taken alongside it. Its shorter half-life also tends to cause more noticeable withdrawal symptoms if a dose is missed.

Pros

  • Approved for more anxiety-related conditions, including OCD, panic disorder, and PTSD

  • Available in immediate-release, extended-release, and liquid forms

  • Longer track record, on the market since 1992

Cons

  • Strong CYP2D6 inhibitor that can require dose changes for many other drugs

  • Shorter half-life leads to more noticeable withdrawal symptoms if stopped abruptly

  • Not approved for any chronic pain condition

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