amitriptyline vs paroxetine
Side-by-side comparison of amitriptyline and paroxetine. Data from FDA drug databases (Orange Book, NDC Directory, recalls, shortages) covering 20,000+ approved drugs, plus CMS pricing; see our methodology.
minor Known Drug Interaction
While all the selective serotonin reuptake inhibitors (SSRIs), e.g., fluoxetine, sertraline, and paroxetine, inhibit P450 2D6, they may vary in the extent of inhibition.
Recommendation: Your doctor should monitor you for side effects and may need to lower your amitriptyline dose.
Elavil
Paxil
Amitriptyline is a medicine used to treat depression. It may take up to 30 days to feel the full effect.
Paroxetine (Paxil) is a medicine that can help treat depression and anxiety disorders. It belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs).
Amitriptyline is used to relieve the symptoms of depression. It works best for a type of depression called endogenous depression. This is depression that comes from within, rather than being caused by outside events.
Paroxetine is used to treat several conditions in adults. These include major depressive disorder (MDD), obsessive compulsive disorder (OCD), panic disorder (PD), social anxiety disorder (SAD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). It helps to improve mood and reduce anxiety and panic feelings.
Amitriptyline belongs to a class of drugs called tricyclic antidepressants (TCAs). It works by increasing the levels of certain chemicals in your brain. These chemicals help improve your mood.
Paroxetine works by increasing the amount of serotonin in your brain. Serotonin is a natural substance that helps regulate mood. By increasing serotonin levels, paroxetine can help improve symptoms of depression and anxiety.
- • Drowsiness
- • Dizziness
- • Weakness
- • Fatigue
- • Headache
- • Abnormal ejaculation
- • Weakness or fatigue
- • Constipation
- • Decreased appetite
- • Diarrhea
- Pain 1,564
- Feeling sick to your stomach 1,434
- Head pain 1,380
- Tiredness 1,369
- Shortness of breath 1,340
- Reaction with another medicine 1,825
- Tiredness 1,821
- Feeling sick to your stomach 1,738
- Harmful effect from different substances 1,579
- Worry or nervousness 1,476
Antidepressants may increase the risk of suicidal thoughts or actions in children, teens, and young adults. Your doctor should closely monitor you for worsening depression or unusual changes in behavior. Amitriptyline is not approved for use in children.
Antidepressants may increase the risk of suicidal thoughts and behaviors in young adults. Your doctor will monitor you closely for worsening depression or suicidal thoughts. Paroxetine is not approved for use in children.
Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. It is not known if amitriptyline will harm your unborn baby. Amitriptyline can pass into breast milk.
Paroxetine may cause harm to your unborn baby. Talk to your doctor if you are pregnant or plan to become pregnant. Taking paroxetine later in pregnancy may cause problems for the newborn.
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How to Read This amitriptyline vs paroxetine Comparison
amitriptyline is classified in the Tricyclic Antidepressant (TCA) drug class, while paroxetine sits within the Selective Serotonin Reuptake Inhibitor (SSRI) class. Drugs from different classes work through distinct mechanisms, so a head-to-head comparison illustrates trade-offs rather than equivalence. Both drugs are prescription-only, so a licensed provider must authorize use.
Adverse event totals above are pulled from the FDA's Adverse Event Reporting System (FAERS). For these top-ranked reactions alone, amitriptyline has 7,087 submissions while paroxetine has 8,439. Those figures reflect cumulative reporting volume, not per-patient risk, so older, widely dispensed drugs typically look worse on count alone. These two drugs have a known minor interaction flagged in FDA labeling, attributed to paroxetine interferes with the liver enzyme that clears amitriptyline from your body. this makes the amitriptyline stay in your blood longer than it should.. Serious warnings, pregnancy guidance, and contraindications can differ even when indications overlap.
A table cannot substitute for clinical judgment. Effectiveness, tolerability, drug-drug interactions with your other medications, kidney and liver function, pregnancy status, insurance formulary, and price all feed into a decision that only a licensed prescriber can make responsibly. Data here is sourced from FDA Structured Product Labels (SPL) and FAERS, both of which update as manufacturers and clinicians submit new information. This page is for educational purposes only, is not medical advice, and should not be used to self-switch between amitriptyline and paroxetine - always consult your physician or pharmacist first.
Important: This comparison is for informational purposes only. Drug effects vary between individuals. Always consult your doctor or pharmacist for personalized medical advice.