Two medicines, side by side
Escitalopram vs duloxetine
Escitalopram and duloxetine are both labeled for depression and anxiety. Drugs@FDA records approvals of escitalopram since 2002 and of duloxetine since 2004. Pharmacies paid $0.0632 per escitalopram 20 mg tablet and $0.102 per duloxetine HCl DR 30 mg capsule (NADAC, October 7, 2026); the strengths differ, so the two prices are not like for like. In FDA's classes, escitalopram is a serotonin reuptake inhibitor and duloxetine a serotonin and norepinephrine reuptake inhibitor.
Check it at the source: the escitalopram FDA label on DailyMed (effective October 1, 2023); the duloxetine FDA label on DailyMed (effective May 14, 2024).
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
Highlights of the duloxetine record
Duloxetine (Cymbalta) · label of May 14, 2024
SUICIDAL THOUGHTS AND BEHAVIORS Antidepressants increased the risk of suicidal thoughts and behavior 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)]. WARNING: SUICIDAL THOUGHTS AND BEHAVIORS See full prescribing information for complete boxed warning.
Used for
From the label: indicationsDRIZALMA SPRINKLE is indicated for the treatment of: • Major Depressive Disorder in adults • Generalized Anxiety Disorder in adults and pediatric patients 7 years of age and older • Diabetic Peripheral Neuropathy in adults • Fibromyalgia in adults • Chronic Musculoskeletal Pain in adults Additional pediatric use information is approved for Eli Lilly and Company, Inc.’s CYMBALTA (duloxetine delayed-release capsules). […]
On the market
- Earliest approval on file
- August 3, 2004
- Generic labelers
- 45 labelers
- Pharmacy cost
- $0.102 per capsule
Supply and safety
- Shortage
- No current entry
- Recalls
- 56
Source: FDA drug labels via openFDA (Escitalopram label of October 1, 2023, Duloxetine label of May 14, 2024); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do escitalopram and duloxetine differ on the record?
In FDA's classes, escitalopram is a serotonin reuptake inhibitor and duloxetine a serotonin and norepinephrine reuptake inhibitor.
How each works, in its label's words: 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) …”; Duloxetine, “Although the exact mechanisms of the antidepressant, central pain inhibitory and anxiolytic actions of duloxetine in humans are unknown, these actions are believed to be related to its potentiation …”
Half-life, in each label's words: Escitalopram, “Elimination Biotransformation of escitalopram is mainly hepatic, with a mean terminal half-life of about 27-32 hours.”; Duloxetine, “Mean terminal half-life was 12.4 hours (range 7.8 to 22.2 hour) in subjects receiving a single dose DRIZALMA SPRINKLE.”
Both labels carry a boxed warning; the records quote them.
Generics: escitalopram since 2007; duloxetine since 2013 (Drugs@FDA).
| Escitalopram | Duloxetine | |
|---|---|---|
| Labeled for | Depression, Anxiety | Depression, Anxiety, Nerve pain and fibromyalgia, Pain |
| Pharmacologic class | Serotonin Reuptake Inhibitor | Serotonin and Norepinephrine Reuptake Inhibitor |
| How it works (label) | 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 … | Although the exact mechanisms of the antidepressant, central pain inhibitory and anxiolytic actions of duloxetine in humans are unknown, these actions are believed to be related to its potentiation of serotonergic and noradrenergic … |
| Half-life (label) | Elimination Biotransformation of escitalopram is mainly hepatic, with a mean terminal half-life of about 27-32 hours. | Mean terminal half-life was 12.4 hours (range 7.8 to 22.2 hour) in subjects receiving a single dose DRIZALMA SPRINKLE. |
| Earliest approval on file (Drugs@FDA) | August 14, 2002 | August 3, 2004 |
| First generic approved | July 31, 2007 | December 11, 2013 |
| Generic labelers (NDC) | 43 labelers | 45 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.0632 per tablet (Escitalopram 20 mg tablet) | $0.102 per capsule (Duloxetine HCl DR 30 mg capsule) |
| 12-month price change | -12% | +31% |
| Boxed warning | Yes | Yes |
| Shortage now | No current entry | No current entry |
| Recalls recorded | 1 | 56 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 139,519 | 69,298 |
| 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?
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.
Duloxetine label, drug interactionsExamples Selegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, intravenous methylene blue Other Serotonergic Drugs Clinical Impact Concomitant use of duloxetine with other serotonergic drugs increases the risk of serotonin syndrome.
Source: FDA drug labels via openFDA
What next?
- Alternatives to escitalopram
- every medicine labeled for the same conditions