Two medicines, side by side
Escitalopram vs fluoxetine
Escitalopram and fluoxetine are both labeled for depression and anxiety. Drugs@FDA records approvals of escitalopram since 2002 and of fluoxetine since 1987. Pharmacies paid $0.0632 per escitalopram 20 mg tablet and $0.0519 per fluoxetine HCl 40 mg capsule (NADAC, October 7, 2026); the strengths differ, so the two prices are not like for like. 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) …”; Fluoxetine, “Although the exact mechanism of PROZAC is unknown, it is presumed to be linked to its inhibition of CNS neuronal uptake of serotonin.”
Check it at the source: the escitalopram FDA label on DailyMed (effective October 1, 2023); the fluoxetine FDA label on DailyMed (effective January 8, 2026).
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 fluoxetine record
Fluoxetine (Prozac) · label of January 8, 2026
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: indicationsPROZAC ® is indicated for the treatment of: Acute and maintenance treatment of Major Depressive Disorder [see Clinical Studies ( 14.1 )]. Acute and maintenance treatment of obsessions and compulsions in patients with Obsessive Compulsive Disorder (OCD) [see Clinical Studies ( 14.2 )]. […]
On the market
- Earliest approval on file
- December 29, 1987
- Generic labelers
- 58 labelers
- Pharmacy cost
- $0.0519 per capsule
Supply and safety
- Shortage
- No current entry
- Recalls
- 9
Source: FDA drug labels via openFDA (Escitalopram label of October 1, 2023, Fluoxetine label of January 8, 2026); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do escitalopram and fluoxetine differ on the record?
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) …”; Fluoxetine, “Although the exact mechanism of PROZAC is unknown, it is presumed to be linked to its inhibition of CNS neuronal uptake of serotonin.”
Both are in FDA's class serotonin reuptake inhibitors.
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.”; Fluoxetine, “Its mean terminal half-life after a single dose was 8.6 days and after multiple dosing was 9.3 days.”
Both labels carry a boxed warning; the records quote them.
Generics: escitalopram since 2007; fluoxetine since 2001 (Drugs@FDA).
| Escitalopram | Fluoxetine | |
|---|---|---|
| Labeled for | Depression, Anxiety | Depression, Anxiety, Bipolar disorder |
| Pharmacologic class | Serotonin Reuptake Inhibitor | Serotonin 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 mechanism of PROZAC is unknown, it is presumed to be linked to its inhibition of CNS neuronal uptake of serotonin. |
| Half-life (label) | Elimination Biotransformation of escitalopram is mainly hepatic, with a mean terminal half-life of about 27-32 hours. | Its mean terminal half-life after a single dose was 8.6 days and after multiple dosing was 9.3 days. |
| Earliest approval on file (Drugs@FDA) | August 14, 2002 | December 29, 1987 |
| First generic approved | July 31, 2007 | August 2, 2001 |
| Generic labelers (NDC) | 43 labelers | 58 labelers |
| Pharmacy cost (NADAC, each one's most listed form; strengths differ) | $0.0632 per tablet (Escitalopram 20 mg tablet) | $0.0519 per capsule (Fluoxetine HCl 40 mg capsule) |
| 12-month price change | -12% | -20% |
| Boxed warning | Yes | Yes |
| Shortage now | No current entry | No current entry |
| Recalls recorded | 1 | 9 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 139,519 | 131,827 |
| 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.
Fluoxetine label, warnings and precautionsSerotonin syndrome has been reported with SSRIs and SNRIs, including PROZAC, both when taken alone, but especially when co-administered with other serotonergic agents.
Source: FDA drug labels via openFDA
What next?
- Alternatives to escitalopram
- every medicine labeled for the same conditions