Paxil vs. Fluoxetine
See how Paxil and Fluoxetine compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Paxil and fluoxetine are both SSRIs used to treat depression, but Paxil also carries specific approvals for generalized anxiety disorder, social anxiety disorder, and PTSD that fluoxetine does not have.
Fluoxetine's long-acting active metabolite makes it less likely than Paxil to cause abrupt discontinuation symptoms if a dose is missed.
Fluoxetine costs roughly $25 to $60 a month as a generic, while Paxil typically runs $300 to $310 a month, a meaningful difference for many patients.
Paxil vs. Fluoxetine Drug Summary
Paxil
Paxil (paroxetine) is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder, obsessive-compulsive disorder, panic disorder, social anxiety disorder, generalized anxiety disorder, and PTSD. It comes as an immediate-release tablet taken once daily, with extended-release and liquid forms also available.
Fluoxetine
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) approved for major depressive disorder, OCD, panic disorder, and bulimia nervosa, plus bipolar depression when combined with olanzapine. It is taken once daily as a capsule, tablet, or liquid, with a once-weekly maintenance option for some patients.
Paxil vs. Fluoxetine Side Effects
Paxil
Fluoxetine
Paxil vs. Fluoxetine Dosage
Paxil
Fluoxetine
| 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 |
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | Week 1 |
| Maximum dose | 90 mg once weekly | If needed |
| Dose changes | 4 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 |
Fluoxetine
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | Week 1 |
| Maximum dose | 90 mg once weekly | If needed |
| Dose changes | 4 increases | Every week |
Paxil vs. Fluoxetine Indications
Paxil
Paxil is FDA-approved for a broad range of psychiatric conditions beyond depression, including several distinct anxiety disorders. It is not approved for use in children or adolescents.
Major depressive disorder
Obsessive-compulsive disorder
Panic disorder
Social anxiety disorder
Post-traumatic stress disorder
Fluoxetine
Fluoxetine covers major depression and OCD in both adults and children, plus approvals not shared by Paxil, such as bulimia nervosa and bipolar depression combined with olanzapine. It also has several off-label uses, including PMDD and binge eating disorder.
Major depressive disorder (adults and children 8-18)
OCD (adults and children 7-17)
Bulimia nervosa
Bipolar I depression (with olanzapine)
Panic disorder
Paxil vs. Fluoxetine Pros and Cons
Paxil
Paxil has specific FDA approval for generalized anxiety disorder, social anxiety disorder, and PTSD, making it a common choice when anxiety symptoms dominate. Its short half-life means missed doses can cause discontinuation symptoms more quickly than with fluoxetine.
Pros
FDA-approved specifically for GAD, social anxiety, and PTSD
Available in extended-release form for steadier dosing
Long clinical track record since 1992
Cons
Strong CYP2D6 inhibitor increases risk of drug interactions
Short half-life often causes more noticeable discontinuation symptoms
Not approved for use in children or adolescents
Fluoxetine
Fluoxetine's long-acting metabolite makes missed doses less likely to cause withdrawal symptoms, and its low cost reflects decades of generic availability. It also carries pediatric approvals for depression and OCD that Paxil does not have.
Pros
Approved for depression and OCD in children as young as 7-8
Long half-life leads to milder discontinuation symptoms
Roughly $25 to $60 per month, far less expensive than Paxil
Cons
Not approved for GAD, social anxiety disorder, or PTSD
More likely to cause activating effects like insomnia than sedation
Higher risk of drug interactions when combined with olanzapine
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