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

Most common
insomnia (up to 33%)
nausea (up to 21%)
anxiety/nervousness (up to 15%)
diarrhea (up to 12%)

Paxil

Most common
nausea (up to 26%)
somnolence (up to 23%)
dry mouth (up to 18%)
asthenia (up to 15%)

Prozac vs. Paxil Dosage

Prozac

Dosage
Dosage Table
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

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

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

Common Symptoms and Related Diseases You Can Explore

Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.