*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Lexapro and Paxil are used to treat anxiety and depression disorders and have many differences.1 The advantages of Lexapro include being more effective and better tolerated. Paxil’s advantages are that it has many approved uses.
If you’re considering a prescription for Paxil or Lexapro or want to discuss your current prescription with a provider, an online psychiatry platform is a good place to start. Platforms like Talkiatry and Brightside Health can connect you with a provider quickly and offer assessments and prescription consultation.
Boxed Warning: Paroxetine (Paxil) – Risk of suicidal thoughts and behaviors in certain people
Paroxetine, the active ingredient in Paxil, has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA). Paroxetine can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Regardless of your age, you should talk with your doctor about serious risks with paroxetine and any other medications before starting treatment.
Boxed Warning: Escitalopram (Lexapro) - Risk of suicidal thoughts and behaviors in certain people
Escitalopram, the active ingredient in Lexapro, has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA). Escitalopram can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Regardless of your age, you should talk with your doctor about serious risks with escitalopram and any other medications before starting treatment.
Main Differences Between Lexapro & Paxil
Lexapro (escitalopram) and Paxil (paroxetine) are both selective serotonin reuptake inhibitors (SSRIs) antidepressants but not interchangeable. They have different approved uses, side effects, warnings and precautions, and drug interactions. They also have different doses and are approved for different age groups.
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The key differences between Lexapro and Paxil include:
Conditions Treated
Lexapro is FDA-approved for the treatment of generalized anxiety disorder and major depressive disorder.2 FDA-approved means a medication has shown in clinical trials that it is safe and effective for a certain use. Paxil is FDA-approved for major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder (PD), social anxiety disorder (SAD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). 3
Lexapro also has non-FDA-approved or off-label uses for PD, OCD, PTSD, SAD, and premenstrual dysphoric disorder (PMDD). 4,5,6,7,8 An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone. Paxil has off-label uses for irritable bowel syndrome (IBS) and OCD in children.9,10
Standard Dosages & Forms
Lexapro comes in tablets of 5 mg, 10 mg, and 20 mg.2 It also comes in a solution of 1 mg/mL. Typically, children and adults take 10 mg daily. Factors that can affect dosages for individuals include the condition you are using escitalopram for or if you are having side effects.
Paxil comes in tablets of 10 mg, 20 mg, 30 mg, and 40 mg, and also as an oral suspension.3 The medication is fully dissolved in liquid form, but not in suspension form. These differences affect the absorption and shelf life.
Side Effects
Side effects specific to Lexapro include light-headedness, gastrointestinal hemorrhage, hot flushes, toothache, severe muscle breakdown, menstrual disorders, and flu-like symptoms.2 Other side effects include anger, irritability, restlessness, neck and shoulder pain, inability to relax muscles, lack of emotion, disorientation, feeling unreal, and mood swings. Additional side effects of Lexapro include heart pumping/QT prolongation, nightmares, brain tissue death, heart tissue death, liver tissue death, and increased INR and falls.
Side effects specific to Paxil include taste and smell alteration, decreased sweating, acne, eczema, increased hair in unwanted places, increased libido, back pain, asthma, coughing up blood, and hyperventilation.3 Other side effects include emphysema, lung scarring, hiccups, voice alteration, feeling drugged, and bone fracture. Additional side effects include hyper- and hypothyroidism, alcohol abuse, drug dependence, paranoia, antisocial reaction, inflammation or pain in various areas, abnormal bleeding, kidney stones, and infections.
The table below summarizes the key differences between Lexapro versus Paxil:2,3
| Key Components | Lexapro | Paxil |
|---|---|---|
| What is the generic name? | Escitalopram | Paroxetine |
| What forms does it come in? | Tablets and liquid solution | Tablets and liquid suspension |
| What are the typical dosages? | 10 mg and 20 mg | 20 mg and 40 mg |
| Who is approved to take it? | MDD: Children 12 years older and adults GAD: Children 7 years older and adults | Adults 18 years and older |
| Potential for withdrawal symptoms | Less potential | More potential |
What Are Lexapro & Paxil Used to Treat?
Lexapro is FDA-approved for treating generalized anxiety disorder and major depressive disorder.2 Paxil is FDA-approved for these as well as several other disorders. Both medications also have several non-FDA-approved (off-label) uses. An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may benefit someone.
The table below compares the medical and mental health conditions Lexapro and Paxil are used to treat:2,3
| Condition | Lexapro | Paxil |
|---|---|---|
| Depression | FDA-approved | FDA-approved |
| Generalized anxiety disorder | FDA-approved | FDA-approved |
| Panic disorder | Off-label | FDA-approved |
| Social anxiety disorder | Off-label | FDA-approved |
| Obsessive-compulsive disorder | Off-label | FDA-approved, off-label in children |
| Posttraumatic stress disorder (PTSD) | Off-label | FDA-approved |
| Premenstrual dysphoric disorder (PMDD) | Off-label | No |
| Irritable bowel syndrome | No | Off-label |
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Side Effects of Lexapro & Paxil
Common side effects of Lexapro include trouble sleeping, male sexual issues, nausea, increased sweating, and excessive tiredness.2 Side effects of Paxil that are common include extreme tiredness, sweating, nausea, decreased appetite, dizziness, trouble sleeping, tremor, nervousness, sexual issues, dry mouth, constipation, diarrhea, yawning, and infection.3 Commonly experienced side effects are often mild, though some may require medical attention.
The table below compares the possible side effects of Lexapro and Paxil:2,3
| Side Effects | Lexapro | Paxil |
|---|---|---|
| Nausea | Yes | Yes |
| Light-headedness | Yes | No |
| Headache | Yes | Yes |
| Sweating | Yes | Yes |
| Male sexual dysfunction | Yes | Yes |
| Female sexual issues | Yes | Yes |
| Decreased libido | Yes | Yes |
| Dry mouth | Yes | Yes |
| Muscle weakness | Yes | Yes |
| Neck pain | Yes | No |
Warnings & Precautions for Lexapro & Paxil
Warnings and precautions for antidepressants, including Lexapro & Paxil, include interactions with alcohol, use while pregnant or breastfeeding, serotonin syndrome, and allergic reactions.2,3 Other warnings include suicidal thoughts and behaviors in adolescents and young adults, discontinuation syndrome, seizures, and mania. Additional precautions include low blood sodium levels, increased risk of bleeding, interference with cognitive and motor performance, angle-closure glaucoma, and sexual dysfunction.
Risks to consider when taking Lexapro and Paxil include:2,3
- Interactions with alcohol: Alcohol with antidepressants may risk seizures and bleeding in the intestines.
- Use while pregnant or breastfeeding: Only certain antidepressants during pregnancy or breastfeeding are recommended. It is not recommended to take Lexapro or Paxil while pregnant, as serious side effects can occur.
- Antidepressant withdrawal: If you suddenly stop or drastically decrease the dose that you have been taking for several months, you may experience antidepressant withdrawal. Symptoms may include nausea, irritability or agitation, flu-like symptoms (body aches, sweating, lethargy), headache, and dizziness.
- Serotonin syndrome: When there is too much serotonin in the body, symptoms occur such as shaking, fever, sweating, fast or irregular heartbeat, and loss of muscle function. These symptoms typically only occur when combined with other medications that affect serotonin.
- Allergic reactions: Like other medications, you can have a serious allergic reaction to Lexapro or Paxil, including difficulty breathing, hives, and fainting. These reactions are rare but if they occur, seek medication attention immediately.
- Suicidal thoughts and behaviors in adolescents and young adults: In patients 24 years and younger, there is an increased risk of suicidal ideation and behaviors for those that take Lexapro or Paxil. Monitor for symptoms of worsening depression.
- Discontinuation syndrome: Discontinuation of SSRIs can result in side effects, such as trouble sleeping, irritability, nausea, dizziness, headache, and confusion. Doses should be slowly decreased over time to prevent symptoms from occurring.
- Seizures: Lexapro and Paxil may cause seizures and should be avoided in patients with a seizure disorder.
- Mania or hypomania: Though rare, patients with untreated or a family history of bipolar disorder can experience mania or hypomania caused by Lexapro or Paxil.
- Low blood sodium levels: Lexapro and Paxil risk Syndrome of Inappropriate Antidiuretic Hormone secretion, which can lead to lowered blood sodium levels. Patients at increased risk of lowered sodium levels include those taking diuretics or those who are volume depleted.
- Increased risk of bleeding: Serotonin plays a role in reducing blood clotting, which can increase the risk of bleeding. Severe side effects and drug interactions exist, such as gastrointestinal bleeding and use with non-steroids anti-inflammatory drugs (NSAIDs).
- Interference with cognitive and motor performance: Lexapro and Paxil can impair decision-making and motor skills. Heavy machinery, such as cars and forklifts, should not be operated while taking these medications until you know how they will affect you.
- Angle-closure glaucoma: Lexapro and Paxil should not be used in patients with narrow angles in the eye, as an angle closure attack can occur and is a medical emergency. If you experience unilateral eye pain with a headache, rainbow vision, and nausea or vomiting, seek medical care immediately.
- Use in patients with concomitant illness: Patients with reduced kidney function should use Lexapro with caution when used long-term.
- Sexual dysfunction: Many symptoms of sexual dysfunction can occur in men and women, and this side effect is very common with SSRIs. If you experience this, ask your doctor if you can try a different SSRI.
- Drug interactions leading to QT prolongation: Paxil can have interactions with medications, leading to increased Paxil levels and risking irregular heart rhythm.
- Embryofetal and neonatal toxicity: Serious side effects can occur for fetuses or newborns if Paxil is taken at any point during pregnancy.
- Reduction of efficacy of tamoxifen: Paxil may reduce the effectiveness of tamoxifen and risk the relapse of breast cancer.
- Bone fracture: Paxil may be associated with an elevated risk of bone fractures.
Online Psychiatry and Medication Management Covered by Insurance
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Potential Drug Interactions With Lexapro & Paxil
Lexapro and Paxil can have interactions with various substances. Substances include monoamine oxidase inhibitors (MAOIs), other drugs that affect serotonin, antiplatelets, and anticoagulants including NSAIDs and warfarin.2,3 Other drugs that interact include pimozide, drugs metabolized by CYP2D6, carbamazepine, sumatriptan, drugs highly bound by plasma protein, tamoxifen, thioridazine, and fosamprenavir/ritonavir.
Disclaimer: Taking certain medications, herbs, or supplements alongside Lexapro and Paxil can change how these medications work in your body or increase the risk for serious side effects. This article does not consider all the possible interactions. Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
Medications and substances that have harmful interactions with Lexapro and Paxil include:2,3
| Complicating Interactions | Lexapro | Paxil |
|---|---|---|
| Monoamine Oxidase Inhibitors (MAOIs) | X | X |
| Other drugs affecting serotonin | X | X |
| Pimozide | X | X |
| NSAIDs, aspirin, warfarin, and other antiplatelets and anticoagulants | X | X |
| Drugs metabolized by CYP2D6 | X | X |
| Carbamazepine | X | |
| Sumatriptan | X | |
| Drugs highly bound by plasma protein | X | |
| Tamoxifen | X | |
| Thioridazine | X | |
| Fosamprenavir/ritonavir | X |
Lexapro Vs Paxil: Which Is More Effective?
In treating GAD, Lexapro is more effective than Paxil.11 Lexapro has also been shown to be effective for more patients at treating MDD.12 Also, Lexapro is better tolerated during discontinuation. Both drugs are well tolerated in general.
In addition, Lexapro is more effective at treating SAD than Paxil.13 However, both are effective treatments. Other factors that can influence why one may work better for you include the amount of time you have taken them, as Paxil can reach its maximum effectiveness over time sooner.3
Which Is Right for You: Lexapro or Paxil?
The medication best for your needs can depend on many factors, and you may need to consider online psychiatry services if seeing a doctor in person isn’t feasible. They can help you consider the benefits and risks of each medication. You may consider one over the other due to the condition you are treating, side effects, or drug interactions, or the fact that studies have shown Lexapro to be more effective and tolerable.
How to Get a Prescription for Lexapro or Paxil
Doctors will typically consider SSRIs as one of the first treatment options for anxiety or depression, and Lexapro or Paxil may be one of the first medications they try. You can get antidepressants only by prescription from your primary care doctor, psychiatrist, or nurse practitioner.
Questions to Ask Your Health Team About Lexapro & Paxil
It’s important to have open communication with your doctor and come to your appointment prepared with any questions or concerns you have. It is also important to discuss with them your lifestyle so they can properly decide which medications are safe for you. You should expect to learn how long it will take the medication to start working and any common side effects it may have.
Questions to ask your prescriber about Lexapro and Paxil include:
- Is it safe to take Lexapro or Paxil with my other medications?
- Will Lexapro or Paxil be covered by my insurance?
- Which one has the best results as a treatment for depression?
- Does my medical history increase my risk of side effects for either?
- How long can I expect side effects to last?
- Which one is the best for my treatment of anxiety?
- How often should I see you for checkups while taking Lexapro or Paxil?
- What should I do if I am unsure if antidepressants are right for me?
- How long does it take for SSRIs to work?
- What side effects should I expect?
- Which side effects will go away over time?
- What are some natural ways I can use with my medication to help treat my anxiety/depression?
- How often can my dose be increased?
- What are some alternatives to Lexapro or Paxil?
In My Experience
In my experience, patients tolerate SSRIs rather well. If you are having side effects with each SSRI, let your doctor know so they can try other antidepressants. Also, natural methods like therapy, supplements, and daily lifestyle changes can be really impactful on your mental health along with your medication. If you have specific concerns about your treatment, reach out to your doctor or pharmacist for advice.
Additional Resources
To help our readers take the next step in their mental health journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy is compensated for marketing by the companies included below.
Virtual Psychiatry
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Best Online Psychiatry Services
Online psychiatry, sometimes called telepsychiatry, platforms offer medication management by phone, video, or secure messaging for a variety of mental health conditions. In some cases, online psychiatry may be more affordable than seeing an in-person provider. Mental health treatment has expanded to include many online psychiatry and therapy services. With so many choices, it can feel overwhelming to find the one that is right for you.
