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Paxil vs Pristiq
Introduction
For patients struggling with major depressive disorder (MDD) or other types of depression, certain medications that modify the levels of specific neurotransmitters in the brain can help manage these symptoms and stabilize mood disorders. Paxil and Pristiq are two such medications often recommended for treating depression. Both function by influencing different neurotransmitters within the brain but share a common purpose: to regulate mood disorders in patients dealing with depression.
Paxil is classified as a selective serotonin reuptake inhibitor (SSRI), primarily affecting serotonin levels in the brain – a key compound linked to mood regulation. On the other hand, Pristiq is categorized as a Serotonin and Norepinephrine Reuptake Inhibitor (SNRI). It works on both norepinephrine and serotonin levels, offering an additional therapeutic approach for managing depressive symptoms.
Paxil vs Pristiq Side By Side
| Attribute | Paxil | Pristiq |
|---|---|---|
| Brand Name | Paxil | Pristiq |
| Contraindications | Should not be taken with or within 14 days of taking MAO inhibitors. | Should not be taken with or within 14 days of taking MAO inhibitors. |
| Cost | For brand name: around $220 for 60 tablets of 20 mg. For generic (Paroxetine): between $0.15 and $1 per day. | For brand name: about $330 for 30 capsules of 50 mg. For generic (Desvenlafaxine ER): between $.90 and $2 per day. |
| Generic Name | Paroxetine | Desvenlafaxine |
| Most Serious Side Effect | Suicidal thoughts or tendencies, severe skin reactions, visual disturbances, heart problems, low levels of sodium, severe nervous system reactions. | Signs of an allergic reaction, unusual bleeding or bruising, changes in vision, hallucinations and confusion, seizures, increased suicidal thoughts, serotonin syndrome symptoms, abnormal liver function. |
| Severe Drug Interactions | MAO inhibitors. | MAO inhibitors. |
| Typical Dose | Starts at 20 mg/day, up to a maximum of 50 mg/day. | Typically initiated at 50 mg/day, may increase to a maximum of 100mg/day if needed. |
What is Paxil?
Paroxetine (the generic name for Paxil) is a type of SSRI antidepressant that was a significant advancement from the earlier class of antidepressants, namely tricyclic antidepressants. Paroxetine received FDA approval in 1992 and operates by increasing levels of free serotonin. It does this by inhibiting its reuptake, essentially allowing it to remain in the brain longer than usual. This drug is most commonly prescribed for various forms of depression as well as anxiety disorders.
On the other hand, Desvenlafaxine (Pristiq) belongs to a slightly newer class of drugs known as SNRIs or Serotonin-Norepinephrine Reuptake Inhibitors. Approved by the FDA in 2008, Pristiq works similarly to Paxil but also affects norepinephrine levels along with serotonin. While both medications are effective at treating depression and anxiety, patients may experience different side effects due to their influence on these two neurotransmitters.
What conditions is Paxil approved to treat?
Paxil has been approved for the treatment of various forms of depression and anxiety disorders:
- Unipolar depression, also known as major depressive disorder (MDD)
- Panic disorder
- Social anxiety disorder (SAD)
- Generalized anxiety disorder (GAD)
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive Disorder (OCD)
On the other hand, Pristiq is approved for:
- Major depressive Disorder (MDD)
How does Paxil help with these illnesses?
Paxil is another medication that manages depression by increasing the amount of serotonin available in the brain's synapses. Like Prozac, it prevents serotonin from being reabsorbed by neurons, thus maintaining higher levels for longer periods. Serotonin plays an integral role not only in mood but also cognition, memory, sleep patterns and more. For patients with depression who are believed to have lower levels of serotonin, Paxil can help alleviate their depressive symptoms and stabilize their mood.
On the other hand, Pristiq works a bit differently as it increases both serotonin and norepinephrine in the brain's synapses. Norepinephrine is another neurotransmitter involved in regulating attention and responses actions such as fight or flight response along with playing a role in mood regulation. By increasing these two neurotransmitters, Pristiq aids patients manage their depressive symptoms potentially offering benefits over medications that only increase one type of neurotransmitter.
What is Pristiq?
Pristiq is a brand name for desvenlafaxine, which is a serotonin-norepinephrine reuptake inhibitor (SNRI). This means it increases the levels of serotonin and norepinephrine in the brain by reducing their reabsorption. Desvenlafaxine was first approved by the FDA in 2008. Unlike Paxil, an SSRI antidepressant that primarily focuses on inhibiting serotonin reuptake, Pristiq impacts both serotonin and norepinephrine levels. This dual action can make Pristiq beneficial for treating depression, especially in patients who do not respond well to typical SSRIs like Paxil. Its side-effect profile also differs from that of SSRIs; while it may still cause some degree of sexual dysfunction or weight changes (common with many antidepressants), its impact on energy levels and focus - thanks to increased norepinephrine - could be viewed as advantageous over common SSRIs.
What conditions is Pristiq approved to treat?
Pristiq is approved for the treatment of:
- Major depressive disorder (MDD)
It's important to note that while both Paxil and Pristiq are used to treat major depressive disorder, they belong to different classes of antidepressants. Pristiq belongs to a group called serotonin-norepinephrine reuptake inhibitors (SNRIs), which work by influencing chemicals in the brain that may be unbalanced in people with depression.
How does Pristiq help with these illnesses?
Desvenlafaxine, commonly known as Pristiq, is a type of medication that primarily acts on the neurotransmitter serotonin and to a lesser extent norepinephrine. These chemicals are thought to be imbalanced in individuals suffering from depression. Pristiq works by inhibiting the reuptake of these neurotransmitters back into nerve cells after they have been released, thus boosting their levels within the brain's synaptic clefts (spaces between nerve cells). This mechanism has been shown to alleviate symptoms associated with depressive disorders. Compared to other selective serotonin reuptake inhibitors (SSRIs) like Paxil, Pristiq affects both serotonin and norepinephrine but does not affect dopamine significantly. It may therefore offer an alternative for patients who do not respond well or experience unwanted side effects with typical SSRIs.
How effective are both Paxil and Pristiq?
Both Paroxetine (Paxil) and Desvenlafaxine (Pristiq) have a proven track record in managing depression, with their respective FDA approvals coming within 15 years of each other. They act on different neurotransmitters and therefore may be prescribed under varying circumstances. The effectiveness of Paxil and Pristiq was directly analyzed in a double-blind clinical trial conducted in 2008; both drugs demonstrated comparable efficacy in managing depressive symptoms, along with similarly encouraging safety data. In this study, none of the metrics used to measure efficacy differed between patients receiving Paxil or Pristiq.
A review from 2001 highlighted that Paroxetine is effective at relieving symptoms of depression from the very first week of treatment, its side effect profile compares favorably against many other antidepressants, and it is well-tolerated even among elderly populations. This review also noted that Paxil had become one of the most widely-prescribed SSRI-class antidepressant medications worldwide due to its established history as an effective treatment for depression. With an optimal dose thought to be around 20 mg/day for adults, Paxil not only alleviates depressive symptoms but appears to reduce suicidal ideation.
On the other hand, a meta-analysis conducted in 2015 indicated that desvenlafaxine seems more potent than placebo when treating depression and performs comparably to other common antidepressants when considering general efficacy measures. However, Pristiq is typically considered after SSRIs or as an adjunctive therapy rather than as a first-line option because it's often co-prescribed alongside another SSRI class medication meaning there are fewer standalone studies confirming its independent effectiveness compared with fluoxetine or paroxetine. Nonetheless - given its unique pharmacology - Desvenlafaxine provides potential benefits for those who have not responded optimally to SSRIs alone or those who need specific avoidance such as sexual dysfunction commonly associated with SSRIs.
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At what dose is Paxil typically prescribed?
Oral dosages of Paxil for the treatment of depression typically start at 20 mg/day, but can be increased up to a maximum dose of 50 mg/day. On the other hand, Pristiq is usually started at 50 mg/day and studies have shown that this dosage is generally effective in treating major depressive disorder in most people. However, if there's no significant improvement seen after several weeks, the dosage may be increased up to a maximum of 100 mg/day according to your doctor's recommendation. In any case, exceeding these suggested maximum doses should not happen without medical supervision due to potential side effects.
At what dose is Pristiq typically prescribed?
Pristiq treatment is typically initiated at a dose of 50 mg/day. For some patients, it may be desirable to start with 25 mg/day for several days before increasing to the regular daily dose of 50 mg. Depending on tolerance and effectiveness, your doctor may later increase the dosage to a maximum of 100mg/day if needed. This single daily dose can be taken at any time during the day, but should ideally be taken at the same time each day for consistency's sake. It's also important to note that Pristiq tablets must not be chewed, divided or crushed; they should always be swallowed whole with water because breaking them open can lead to an overdose or increased side effects.
What are the most common side effects for Paxil?
Common side effects of Paxil and Pristiq can include:
- Nausea
- Dizziness or light-headedness
- Sweating, dry mouth
- Sleep problems (insomnia)
- Weight changes
- Weakness, tired feeling
- Nervousness, anxious feelings
- Decreased sex drive, impotence or difficulty having an orgasm
- Tremors or shaking, Yawning.
However, it's important to note that not all people will experience these side effects. The response to medication is very individualized and dependent on a variety of factors such as age, overall health status, presence of other health conditions etc. Always consult your healthcare provider for the best treatment options.
Are there any potential serious side effects for Paxil?
In the case of Paxil and Pristiq, it's important to be mindful of potential severe side effects. These might include:
- Suicidal thoughts or tendencies
- Signs of an allergic reaction such as hives, difficulty breathing, swelling in your face or throat
- Symptoms of a severe skin reaction like fever, sore throat, burning in your eyes, skin pain followed by a red or purple rash that spreads and leads to blistering and peeling
- Visual disturbances including blurred vision or seeing halos around lights
- Heart problems signified by fast pounding heartbeats, feeling like you might pass out
- Low levels of sodium resulting in headache, confusion, slurred speech
- Severe reactions affecting the nervous system leading to muscle rigidity,stiffness , high fever sweating ,confusion ,tremors. -Symptoms suggestive of serotonin syndrome which can cause agitation hallucinations increased body temperature shivering rapid heart rate muscle stiffness twitching loss of coordination nausea vomiting diarrhea.
If you experience any such symptoms while taking either Paxil or Pristiq it is crucial that you seek immediate medical attention.
What are the most common side effects for Pristiq?
When comparing Paxil to Pristiq, it's important to note the potential side effects of Pristiq. These can include:
- Dry mouth and throat
- Increased blood pressure (which can manifest as a fast heartbeat)
- Blurred vision or eye problems
- Nausea and vomiting, along with stomach pain
- Loss of appetite leading potentially to weight loss
- Constipation
- Sleep disturbances or insomnia
- Sweating more than usual, accompanied by feelings of nervousness or anxiety
- Headache and dizziness
- Muscle stiffness or joint pain
It is also possible for some individuals taking Pristiq to experience increased urination or skin rashes. In rare cases, users may report confusion or agitation. Always consult your healthcare provider if you notice any unusual changes while on medication.
Are there any potential serious side effects for Pristiq?
While Pristiq is generally well-tolerated, it can sometimes cause serious side effects. These may include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat.
- Unusual bleeding or bruising under the skin
- Changes in vision including blurred vision and seeing halos around lights
- Hallucinations and confusion
- Seizures (convulsions)
- Increased suicidal thoughts or feelings of self-harm particularly among those 24 years old and younger
- Serotonin syndrome symptoms: agitation, hallucinations, rapid heartbeat, fever, excessive sweating
- Abnormal liver function tests indicating possible damage to the organ
If you experience any of these outcomes while taking Pristiq, cease its use immediately and consult a healthcare professional.
Contraindications for Paxil and Pristiq?
Both Paxil and Pristiq, like most other antidepressant medications, can potentially exacerbate symptoms of depression in certain individuals. If you notice your depressive symptoms worsening or experience an increase in suicidal thoughts or behaviors, seek instant medical help.
Neither Paxil nor Pristiq should be taken if you are currently on monoamine oxidase (MAO) inhibitors or have been taking them recently. It is crucial that you keep your physician updated about all the medications you're currently on; MAOIs will need approximately 14 days to fully clear from your system before starting either Paxil or Pristiq to prevent dangerous drug interactions.
How much do Paxil and Pristiq cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Paxil (20 mg) averages around $220, which works out to $3.66–$7.33/day, depending on your dose.
- The price of 30 capsules of Pristiq (50 mg) is about $330, working out to approximately $11/day.
Thus, if you are in the higher dosage range for Paxil (i.e., 40 mg/day or higher), then brand-name Pristiq is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
For the generic versions - Paroxetine (Paxil) and Desvenlafaxine ER (Pristiq), costs are significantly lower:
- Paroxetine is available in packs ranging from 10 up to several hundreds with an average cost between $0.15 and $1 per day depending on dosages varying from 10mg up to typically maximum recommended dose being 60mg daily.
- Desvenlafaxine comes also in various pack sizes with typical costs running at about between $.90 and $2 per day based upon typical doses ranging from approximately 50mg up to no more than around 400mg daily.
As always, it's important that patients discuss all options thoroughly with their healthcare provider before making any decisions regarding medication use; cost considerations should only play secondary role compared against efficacy profile and individual tolerance towards side effects associated with each drug option.
Popularity of Paxil and Pristiq
Paroxetine, commonly known by the brand name Paxil, was prescribed to approximately 3.8 million people in the U.S. in 2020. Paroxetine is an SSRI (Selective Serotonin Reuptake Inhibitor) and accounted for about 7% of all antidepressant prescriptions that year. Over recent years, its use has been declining due to concerns over side effects like weight gain and withdrawal symptoms.
Desvenlafaxine, sold under the brand name Pristiq among others, is a newer generation antidepressant that was prescribed to approximately 2.6 million people in the U.S in 2020. As a SNRI (Serotonin-Norepinephrine Reuptake Inhibitor), it accounts for just around 5% of total antidepressant prescriptions but has seen a steady increase since its introduction to market in mid-2008.
Conclusion
Paxil (paroxetine) and Pristiq (desvenlafaxine) have a well-established history of use in the treatment of depression, with numerous clinical trials and meta-analyses demonstrating their efficacy over placebo treatments. Both medications can be used together under strict physician supervision as they may contradict each other due to their different modes of action. Paxil primarily works by inhibiting serotonin reuptake while Pristiq works on both serotonin and norepinephrine.
Generally, Paxil is seen as a first-line treatment for depression whereas Pristiq tends to be employed either in conjunction with an SSRI like Paxil or in patients who did not respond optimally to initial SSRI therapy or need to avoid common sexual side effects associated with SSRIs.
Both drugs are available generically which means significant cost savings for patients, especially those paying out-of-pocket. It's important to note that both Paxil and Pristiq might necessitate an adjustment period - meaning that therapeutic benefits may not be immediately noticeable.
In terms of side effects, both drugs share a similar profile but differ slightly: While generally well-tolerated, Paxil has more reported cases related to sexual dysfunction compared to Pristiq. As always, it is crucial for patients starting these medications monitor any mood changes closely; immediate medical help should be sought if one notices worsening depression or starts having suicidal thoughts or self-harm ideations.
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Refrences
- Dunner, D., & Kumar, R. (1998, May). Paroxetine: a Review of Clinical Experience. Pharmacopsychiatry. Georg Thieme Verlag KG.http://doi.org/10.1055/s-2007-979307
- Wagstaff, A. J., Cheer, S. M., Matheson, A. J., Ormrod, D., & Goa, K. L. (2002). Paroxetine. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-200262040-00010
- Sproule, A.B., Hazra, M., & Pollock, G.B. (2008). Desvenlafaxine succinate for major depressive disorder. Drugs of Today. Portico.http://doi.org/10.1358/dot.2008.44.7.1227147
- Liebowitz, M. R., Manley, A. L., Padmanabhan, S. K., Ganguly, R., Tummala, R., & Tourian, K. A. (2008, May 22). Efficacy, safety, and tolerability of desvenlafaxine 50 mg/day and 100 mg/day in outpatients with major depressive disorder. Current Medical Research and Opinion. Informa Healthcare.http://doi.org/10.1185/03007990802161923
- Chen, Y., Kelton, C. M. L., Jing, Y., Guo, J. J., Li, X., & Patel, N. C. (2008, September). Utilization, price, and spending trends for antidepressants in the US Medicaid program. Research in Social and Administrative Pharmacy. Elsevier BV.http://doi.org/10.1016/j.sapharm.2007.06.019