Two medicines, side by side
Escitalopram vs paroxetine
Escitalopram and paroxetine are both labeled for depression and anxiety. Drugs@FDA records approvals of escitalopram since 2002 and of paroxetine since 1992. Pharmacies paid $0.0632 per escitalopram 20 mg tablet and $0.0611 per paroxetine HCl 20 mg tablet (NADAC, October 7, 2026). 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) …”; Paroxetine, “The mechanism of action of paroxetine tablets in the treatment of MDD, SAD, OCD, PD, GAD, and PTSD is unknown, but is presumed to be linked to potentiation of serotonergic activity in the central …”
Check it at the source: the escitalopram FDA label on DailyMed (effective October 1, 2023); the paroxetine FDA label on DailyMed (effective February 12, 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 paroxetine record
Paroxetine (Paxil) · label of February 12, 2026
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) ]. Paroxetine tablets are not approved for use in pediatric patients [see Use in Specific Populations (8.4) ].
Used for
From the label: indicationsParoxetine tablets are indicated in adults for the treatment of: • Major depressive disorder (MDD) • Obsessive compulsive disorder (OCD) • Panic disorder (PD) • Social anxiety disorder (SAD) • Generalized anxiety disorder (GAD) • Posttraumatic stress disorder (PTSD) Paroxetine tablets are a selective serotonin reuptake inhibitor (SSRI) indicated in adults for the treatment of ( 1 ): • Major Depressive Disorder (MDD) • Obsessive Compulsive Disorder (OCD) • Panic Disorder (PD) • Social Anxiety Disorder (SAD) • Generalized Anxiety Disorder (GAD) • Posttraumatic Stress Disorder (PTSD) […]
On the market
- Earliest approval on file
- December 29, 1992
- Generic labelers
- 45 labelers
- Pharmacy cost
- $0.0611 per tablet
Supply and safety
- Shortage
- No current entry
- Recalls
- 15
Source: FDA drug labels via openFDA (Escitalopram label of October 1, 2023, Paroxetine label of February 12, 2026); NDC Directory, Drugs@FDA, NADAC, FDA shortages and recalls (October 8, 2026)
How do escitalopram and paroxetine 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) …”; Paroxetine, “The mechanism of action of paroxetine tablets in the treatment of MDD, SAD, OCD, PD, GAD, and PTSD is unknown, but is presumed to be linked to potentiation of serotonergic activity in the central …”
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.”; Paroxetine, “Elimination Metabolism The mean elimination half-life is approximately 21 hours (CV 32%) after oral dosing of 30 mg …”
Both labels carry a boxed warning; the records quote them.
Generics: escitalopram since 2007; paroxetine since 2003 (Drugs@FDA).
| Escitalopram | Paroxetine | |
|---|---|---|
| Labeled for | Depression, Anxiety | Depression, Anxiety, Menopause symptoms |
| 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 … | The mechanism of action of paroxetine tablets in the treatment of MDD, SAD, OCD, PD, GAD, and PTSD is unknown, but is presumed to be linked to potentiation of serotonergic activity in the central nervous system resulting from inhibition of … |
| Half-life (label) | Elimination Biotransformation of escitalopram is mainly hepatic, with a mean terminal half-life of about 27-32 hours. | Elimination Metabolism The mean elimination half-life is approximately 21 hours (CV 32%) after oral dosing of 30 mg tablets daily for 30 days of paroxetine tablets. |
| Earliest approval on file (Drugs@FDA) | August 14, 2002 | December 29, 1992 |
| First generic approved | July 31, 2007 | July 30, 2003 |
| 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) | $0.0611 per tablet (Paroxetine HCl 20 mg tablet) |
| 12-month price change | -12% | -16% |
| Boxed warning | Yes | Yes |
| Shortage now | No current entry | No current entry |
| Recalls recorded | 1 | 15 |
| FAERS reports (a report is not proof of cause; counts follow how widely a medicine is used) | 139,519 | 41,809 |
| 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.
Paroxetine label, warnings and precautionsIncreased risk when co-administered with other serotonergic agents, but also when taken alone.
Source: FDA drug labels via openFDA
What next?
- Alternatives to escitalopram
- every medicine labeled for the same conditions