Prozac vs. Paxil
See how Prozac and Paxil compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Prozac (fluoxetine) and Paxil (paroxetine) are both SSRIs, but Prozac has FDA approval for bulimia and treatment-resistant depression while Paxil covers GAD and PTSD instead.
Prozac's long half-life makes it more forgiving if you miss a dose, while Paxil's short half-life can cause sharper discontinuation symptoms if stopped abruptly.
Both carry a boxed warning for increased suicidal thoughts in children and young adults, and both are contraindicated with MAOIs.
Prozac vs. Paxil Drug Summary
Prozac
Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) used to treat depression, OCD, panic disorder, and bulimia nervosa. It is taken once daily as a capsule, tablet, or liquid, and a once-weekly delayed-release capsule is available for long-term maintenance.
Paxil
Paxil (paroxetine) is an SSRI approved for depression, OCD, panic disorder, social anxiety disorder, generalized anxiety disorder, and PTSD. It is taken once daily as a tablet, usually in the morning, with the dose adjusted based on how well symptoms respond.
Prozac vs. Paxil Side Effects
Prozac
Paxil
Prozac vs. Paxil Dosage
Prozac
Paxil
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 90 mg once weekly | If needed |
| Dose changes | 2 increases | As tolerated |
| 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 |
Prozac
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 90 mg once weekly | If needed |
| Dose changes | 2 increases | As tolerated |
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 |
Prozac vs. Paxil Indications
Prozac
Prozac is FDA-approved for major depressive disorder, OCD, panic disorder, and bulimia nervosa. It is also approved in combination with olanzapine for bipolar I depression and treatment-resistant depression. Doctors sometimes prescribe it off-label for PMDD, binge eating disorder, or social anxiety.
Major depressive disorder
Obsessive-compulsive disorder (OCD)
Bulimia nervosa
Panic disorder
Bipolar I depression (with olanzapine)
Paxil
Paxil is FDA-approved for major depressive disorder, OCD, panic disorder, social anxiety disorder, generalized anxiety disorder, and PTSD. It is not approved for use in children. Its broader anxiety-spectrum approval makes it a common first choice for anxiety-predominant conditions.
Major depressive disorder
Obsessive-compulsive disorder
Panic disorder
Social anxiety disorder
Generalized anxiety disorder
Prozac vs. Paxil Pros and Cons
Prozac
Prozac's long-acting metabolite gives it a wider margin for missed doses and a smoother taper, and its FDA approvals extend into eating disorders and treatment-resistant depression that Paxil does not cover. It can feel activating for some people, which is not ideal for everyone.
Pros
Approved for bulimia nervosa and treatment-resistant depression
Once-weekly maintenance capsule option after stabilization
Long half-life means fewer withdrawal symptoms if a dose is missed
Cons
Not approved for generalized anxiety disorder
Can be activating, sometimes worsening insomnia or anxiety
Off-label uses like PMDD require added clinical judgment
Paxil
Paxil covers a wider range of anxiety disorders on-label, including GAD and PTSD, and its more sedating profile can help with anxious insomnia. It is a strong CYP2D6 inhibitor, so it interacts with more medications, and its short half-life often makes stopping it harder.
Pros
On-label approval for generalized anxiety disorder and PTSD
More sedating effect can help patients with anxious insomnia
Widely used for social anxiety disorder specifically
Cons
Strong CYP2D6 inhibitor with more drug interaction risk
Short half-life often causes more noticeable discontinuation symptoms
Specific pregnancy warning for potential fetal cardiac risk
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