Two medicines, side by side
Desvenlafaxine vs escitalopram
Desvenlafaxine and escitalopram are both labeled for depression. Drugs@FDA records approvals of desvenlafaxine since 2008 and of escitalopram since 2002. Pharmacies paid $0.396 per unit (Desvenlafaxine succnt ER 50 mg) and $0.0632 per escitalopram 20 mg tablet (NADAC, October 7, 2026); the strengths differ, so the two prices are not like for like. In FDA's classes, desvenlafaxine is a serotonin and norepinephrine reuptake inhibitor and escitalopram a serotonin reuptake inhibitor.
Check it at the source: the desvenlafaxine FDA label on DailyMed (effective January 27, 2023); the escitalopram FDA label on DailyMed (effective October 1, 2023).
Highlights of the desvenlafaxine record
Desvenlafaxine (Pristiq) · label of January 27, 2023
SUICIDAL THOUGHTS AND BEHAVIORS Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk with antidepressant use in patients aged 65 and older [see Warnings and Precautions (5.1)].
Used for
From the label: indicationsDesvenlafaxine, a serotonin and norepinephrine reuptake inhibitor (SNRI), is indicated for the treatment of major depressive disorder (MDD) [see Clinical Studies (14) and Dosage and Administration (2.1)]. The efficacy of desvenlafaxine has been established in four short-term (8-week, placebo-controlled studies) of outpatients who met DSM-IV criteria for major depressive disorder. […]
On the market
- Earliest approval on file
- February 29, 2008
- Generic labelers
- 20 labelers
- Pharmacy cost
- $0.396 per unit
Supply and safety
- Shortage
- No current entry
- Recalls
- 2
Highlights of the escitalopram record
Escitalopram (Lexapro) · label of October 1, 2023
SUICIDAL THOUGHTS AND BEHAVIORS Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and behaviors [see Warnings and Precautions ( 5.1 )]. Lexapro is not approved for use in pediatric patients less than 7 years of age [ s ee Use in Specific Populations ( 8.4 )].
Used for
From the label: indicationsLexapro is indicated for the treatment of: • major depressive disorder (MDD) in adults and pediatric patients 12 years of age and older. • generalized anxiety disorder (GAD) in adults and pediatric patients 7 years of age and older. […]
On the market
- Earliest approval on file
- August 14, 2002
- Generic labelers
- 43 labelers
- Pharmacy cost
- $0.0632 per tablet
Supply and safety
- Shortage
- No current entry
- Recalls
- 1
Source: FDA drug labels via openFDA (Desvenlafaxine label of January 27, 2023, Escitalopram label of October 1, 2023); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do desvenlafaxine and escitalopram differ on the record?
In FDA's classes, desvenlafaxine is a serotonin and norepinephrine reuptake inhibitor and escitalopram a serotonin reuptake inhibitor.
How each works, in its label's words: Desvenlafaxine, “The exact mechanism of the antidepressant action of desvenlafaxine is unknown, but is thought to be related to the potentiation of serotonin and norepinephrine in the central nervous system, through …”; Escitalopram, “The mechanism of antidepressant action of escitalopram, the S-enantiomer of racemic citalopram, is presumed to be linked to potentiation of serotonergic activity in the central nervous system (CNS) …”
Half-life, in each label's words: Desvenlafaxine, “The mean terminal half-life (t 1/2 ) was prolonged from 11.1 hours in the control subjects to approximately 13.5, 15.5 …”; Escitalopram, “Elimination Biotransformation of escitalopram is mainly hepatic, with a mean terminal half-life of about 27-32 hours.”
Both labels carry a boxed warning; the records quote them.
Generics: desvenlafaxine since 2015; escitalopram since 2007 (Drugs@FDA).
| Desvenlafaxine | Escitalopram | |
|---|---|---|
| Labeled for | Depression | Depression, Anxiety |
| Pharmacologic class | Serotonin and Norepinephrine Reuptake Inhibitor | Serotonin Reuptake Inhibitor |
| How it works (label) | The exact mechanism of the antidepressant action of desvenlafaxine is unknown, but is thought to be related to the potentiation of serotonin and norepinephrine in the central nervous system, through inhibition of their reuptake. | The mechanism of antidepressant action of escitalopram, the S-enantiomer of racemic citalopram, is presumed to be linked to potentiation of serotonergic activity in the central nervous system (CNS) resulting from its inhibition of CNS … |
| Half-life (label) | The mean terminal half-life (t 1/2 ) was prolonged from 11.1 hours in the control subjects to approximately 13.5, 15.5, 17.6, and 22.8 hours in mild, moderate, severe renal impairment and ESRD subjects, respectively. | Elimination Biotransformation of escitalopram is mainly hepatic, with a mean terminal half-life of about 27-32 hours. |
| Earliest approval on file (Drugs@FDA) | February 29, 2008 | August 14, 2002 |
| First generic approved | June 29, 2015 | July 31, 2007 |
| Generic labelers (NDC) | 20 labelers | 43 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.396 per unit (Desvenlafaxine succnt ER 50 mg) | $0.0632 per tablet (Escitalopram 20 mg tablet) |
| 12-month price change | -6% | -12% |
| Boxed warning | Yes | Yes |
| Shortage now | No current entry | No current entry |
| Recalls recorded | 2 | 1 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 26,842 | 139,519 |
| DEA schedule | none | none |
Source: Drugs@FDA, FDA NDC Directory, CMS NADAC of October 7, 2026, FDA shortages and recalls, FAERS via openFDA (FDA files October 8, 2026)
What do the labels say about using others of their kind?
Desvenlafaxine label, warnings and precautionsSerotonin syndrome has been reported with SSRIs and SNRIs, including with desvenlafaxine extended-release tablets, both when taken alone, but especially when co-administered with other serotonergic agents (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. John's Wort).
Escitalopram label, drug interactionsConcomitant use of Lexapro and other serotonergic drugs (including other SSRIs, SNRIs, triptans, tricyclic antidepressants, opioids, lithium, buspirone, amphetamines, tryptophan, and St. John's Wort) increases the risk of serotonin syndrome.
Source: FDA drug labels via openFDA
What next?
- Alternatives to desvenlafaxine
- every medicine labeled for the same conditions