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
Paxil
Cymbalta vs. Paxil Dosage
Cymbalta
Paxil
| 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 |
| 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
| 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
| 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
Common Symptoms and Related Diseases You Can Explore
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