Paxil vs Zoloft —  what's the difference?

If you’re exploring treatment options for depression or anxiety, you’ve probably wondered about Paxil vs Zoloft. Both are commonly prescribed selective serotonin reuptake inhibitors (SSRIs) approved by the U.S. Food and Drug Administration (FDA) to treat depression and other mental health disorders. While they both increase serotonin levels in the brain, certain factors can make 1 more suitable for you than the other.

In this comparison, we delve into the similarities and differences between Paxil (paroxetine) and Zoloft (sertraline), including their uses, dosages, side effects, interactions, and costs.

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Paxil vs Zoloft — is one better?

When talking to your provider about Paxil vs Zoloft, you want to consider several factors.

Effectiveness

• Both medications are effective for depression, OCD, PTSD, and anxiety disorders.
• Paxil is FDA-approved to treat several anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder (PD). Its effectiveness in these conditions has been demonstrated in clinical trials.

Side effects

• Paxil may cause weight gain and sexual dysfunction, potentially affecting physical health or sexual well-being.
• Zoloft is associated with sexual dysfunction and gastrointestinal issues

Drug interactions

• Both Paxil and Zoloft have similar drug interactions. But Paxil has a higher potential for drug interactions because it affects liver enzymes.

Withdrawal symptoms

• Paxil is known for more severe withdrawal symptoms when discontinued abruptly.
• Zoloft generally has milder withdrawal effects.

Neither Paxil or Zoloft should be stopped quickly. If you take either, work with your provider to taper your dose gradually.

Individual response

• Personal response varies; some people can tolerate 1 medication better than the other.
• Genetics, other health conditions, and other medications can influence effectiveness and side effects.

Consult with a healthcare provider to determine the most suitable medication for your symptoms, if any, based on your specific medical needs, symptoms, and circumstances.

What is Paxil?

Paxil (paroxetine) is a brand-name SSRI medication available by prescription. Its active ingredient is paroxetine, which is also available as a generic. It’s available as a standard release form called Paxil, and an extended-release brand name form called Paxil CR or generic paroxetine extended-release. 

As an SSRI, Paxil prevents nerve cells in the brain from reabsorbing serotonin too quickly, which helps stabilize mood, improve concentration, and regulate sleep. By increasing available serotonin levels, Paxil also helps alleviate symptoms, such as persistent sadness, excessive worry, and intrusive thoughts.

Conditions Paxil is FDA-approved to treat

Paxil tablets and oral suspension are FDA-approved to treat the following in adults:

• Major depressive disorder (MDD
• Obsessive-compulsive disorder (OCD)
• Panic disorder (PD)
• Social anxiety disorder (SAD)
• Generalized anxiety disorder (GAD)
• Post-traumatic stress disorder (PTSD) 

Paxil CR is approved to treat:

• MDD
• PD
• SAD
• Premenstrual dysphoric disorder (PMDD)

Paxil forms and dosages

Brand-name Paxil, Paxil CR, and generic paroxetine come in the following forms and strengths:

• Paxil and paroxetine tablets: 10, 20, 30, and 40 milligrams
• Extended-release Paxil CR tablets: 12.5, 25, and 37.5 milligrams
• Oral paroxetine suspension: 10 milligrams per 5 milliliters

Immediate-release Paxil tablets and oral suspension dosages: 

• For MDD and PTSD, the typical starting dose of Paxil is 20 milligrams once daily with a maximum dose of 50 milligrams a day
• For OCD, the starting dose is usually 20 milligrams once a day with a maximum dose of 60 milligrams a day
• For PD, the starting dose is typically 10 milligrams a day with a maximum daily dose of 60 milligrams

Paxil CR dosages:

• For MDD, the starting dose is typically 25 milligrams once daily with a maximum daily dose of 62.5 milligrams
• For PD, the starting dose is usually 12.5 milligrams once a day with a maximum daily dose of 75 milligrams
• For SAD and PMDD, the starting dose is usually 12.5 milligrams a day with a maximum daily dose of 37.5 milligrams

Your healthcare provider will work with you on the appropriate dosage based on your condition and how you respond.

Paxil costs

The cost of Paxil varies based on the dosage strength, formulation, and whether it’s the brand-name or generic version. According to drugs.com, with its discount Paxil costs are:

Brand-name Paxil (immediate-release oral tablets)

• 10 milligrams: $319.62 for 30 tablets 
• 20 milligrams: $333.07 for 30 tablets 
• 30 milligrams: $342.85 for 30 tablets 
• 40 milligrams: $361.67 for 30 tablets 

Brand-name Paxil CR (extended-release oral tablets)

• 12.5 milligrams: $328.91 for 30 tablets 
• 25 milligrams:  $342.84 for 30 tablets
• 37.5 milligrams:  $352.85 for 30 tablet

Generic paroxetine (immediate-release oral tablets)

• 10 milligrams:  $18.73 for 30 tablets
• 20 milligrams:  $19.67 for 30 tablets
• 30 milligrams:  $21.69 for 30 tablets
• 40 milligrams:  $21.19 for 15 tablets

Generic paroxetine oral suspension

• 250-milliliter bottle: $285.32

Generic Paroxetine (extended-release oral tablets)

• 12.5 milligrams:  $29.90 for 30 tablets
• 25 milligrams:  $31.43 for 30 tablets
• 37.5 milligrams:  $32.96 for 30 tablets

Paxil side effects

Common side effects of Paxil and Paxil CR include:

• Male and female sexual function problems
• Blurred vision
• Weakness (asthenia)
• Constipation
• Decreased appetite
• Diarrhea
• Dizziness
• Dry mouth
• Problems sleeping (insomnia)
• Nausea
• Sleepiness (drowsiness)
• Sweating
• Tremor

Paxil immediate-release tablets may also cause:

• Nervousness
• Yawning
• Infection
• Shaking (tremor)

Serious side effects of Paxil tablets and Paxil CR can include:

• Serotonin syndrome: Symptoms include agitation, hallucinations, rapid heart rate, and fever.
• Eye problems (angle-closure glaucoma)
• Medicine interactions
• Seizures
• Manic episodes
• Discontinuation syndrome
• Hyponatremia (low sodium levels in the blood): Can cause headaches, confusion, difficulty concentrating, memory changes, weakness, unsteadiness, seizures, hallucinations, fainting, coma, and respiratory arrest.
• Abnormal bleeding: Increased risk when taken with NSAIDs or blood thinners.
• Bone fractures
• Sexual problems (dysfunction)
• Male and female sexual function problems
• Blurred vision
• Weakness (asthenia)
• Constipation
• Decreased appetite
• Diarrhea
• Dizziness
• Dry mouth
• Problems sleeping
• Nausea
• Sleepiness
• Sweating
• Tremor

Paxil also has an FDA-boxed warning for suicidal risks ands behaviors in pediatric and young adults.

Consider reporting any negative side effects to the FDA by visiting MedWatch or calling 1-800-FDA-1088. And if you experience severe side effects, contact your healthcare provider immediately.

Paxil warnings and precautions

Don’t take Paxil if:

• You’ve taken a monoamine oxidase inhibitors (MAOIs) within 14 days
• You are taking thioridazine or pimozide 
•  Are taking the antibiotic linezolid or intravenous methylene blue
• Are allergic to paroxetine or any ingredients in Paxil or generic paroxetine

Before taking Paxil, tell your provider if you have:

• Heart problems
• Bleeding problems
• Bipolar disorder, mania, or hypomania or a family history of any of these
• Seizure disorders or convulsions
• Glaucoma
• Low sodium levels in your blood
• Bone problems
• Liver or kidney problems

Pregnancy and nursing

• Paxil can cause harm to an unborn baby, particularly in the first trimester.
• Paxil passes into breast milk; discuss risks and benefits with your provider.

Paxil drug interactions

Paxil can interact with:

• MAOIs and other SSRIs or serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Pimozide and thioridazine
• Antiplatelet agents and anticoagulants, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and blood thinners
• Drugs metabolized by CYP2D6, such as venlafaxine, risperidone, atomoxetine, and others
• Tamoxifen
• Fosamprenavir/rotonavir
• Alcohol: Can enhance side effects like drowsiness

Always provide your provider with a complete list of medications and supplements.

What Is Zoloft?

Zoloft (sertraline) is a prescription SSRI (selective serotonin reuptake inhibitor) medication. It works by increasing serotonin levels in the brain, which helps stabilize mood, reduce anxiety, and manage other mental health symptoms.

Conditions Zoloft treats

Zoloft is FDA-approved to treat the following conditions:

• Major depressive disorder (MDD)
• Obsessive-compulsive disorder (OCD)
• Panic disorder (PD)
• Posttraumatic stress disorder (PTSD)
• Social anxiety disorder (SAD)
• Premenstrual dysphoric disorder (PMDD)

While not officially FDA-approved for generalized anxiety disorder (GAD), Zoloft is often prescribed off-label due to its effectiveness in managing symptoms.

Zoloft forms and dosages

Zoloft is available as a brand-name medication and generic sertraline in the following forms:

• Tablets: 25, 50, and 100 milligrams
• Oral concentrate: 20 milligrams per milliliter

Zoloft tablets and oral suspension dosages: 

• MDD and OCD: Starting dose is typically 50 milligrams once daily with a maximum dose of 200 milligrams.
• PD, PTSD, and SAD: Starting dose is usually 25 milligrams once daily, increasing to 50 milligrams after one week with a maximum dose of 200 milligrams.

Your healthcare provider will determine the appropriate dosage based on your condition, symptoms, and treatment response.

Zoloft costs

The cost for Zoloft varies depending on the dosage and formulation. On drugs.com with its discount:

Brand-name Zoloft tablets

• 25milligrams: $475.80 for 30 tablets
• 50 milligrams: $475.80  for 30 tablets
• 100 milligrams: $475.80  for 30 tablets

Brand-name Zoloft oral concentrate

• 60-milliliter bottle: $305.80

Generic sertraline tablets

• 25milligrams:  $10.31 for 30 tablets
• 50 milligrams:  $9.52 for 30 tablets
• 100 milligrams:  $9.62 for 30 tablets

Generic sertraline oral concentrate

• 60-milliliter bottle: $42.26

Zoloft side effects

Common side effects of Zoloft and sertraline include:

• Nausea, loss of appetite, diarrhea, or indigestion
• Increased sweating
• Tremor or shaking
• Agitation
• Change in sleep habits including increased sleepiness or insomnia
• Sexual problems including decreased libido and ejaculation failure
• Feeling tired or fatigued
• Anxiety

Serious side effects of Zoloft and sertraline can include:

• Suicidal thoughts or actions: particularly in young adults and children starting treatment.
• Serotonin syndrome: symptoms include agitation, hallucinations, fever, and muscle stiffness.
• Mania episodes
• Seizures or convulsions
• Glaucoma (angle-closure glaucoma)
• Changes in appetite or weight
• Low salt sodium levels
• Sexual problems or dysfunction

If you experience severe side effects, call 911 or seek immediate medical attention. Report any adverse reactions to the FDA through MedWatch or by calling 1-800-FDA-1088.

Zoloft warnings and precautions

Before starting Zoloft, inform your healthcare provider if you have:

• Take a monoamine oxidase inhibitor (MAOI) or have taken one in the last 14 days
• Take any other medicines that contain sertraline
• Take the antipsychotic medicine pimozide (Orap)
• Are allergic to sertraline or any of the ingredients in Zoloft
• Take Antabuse (disulfiram)
• Have liver problems
• Have heart problems
• Have bipolar disorder or mania
• Have kidney problems
• Have had seizures or convulsions
• Have low sodium levels in your blood
• Have a history of a stroke
• Have high blood pressure
• Have had bleeding problems

Pregnancy and nursing

• Zoloft may pose risks during pregnancy, particularly in the third trimester. Discuss the benefits and risks with your provider.
• Zoloft passes into breast milk, so consult your provider if you’re breastfeeding.

Zoloft drug interactions

Zoloft can interact with certain medications and substances, including:

• MAOIs: Avoid combining with Zoloft, as it can be life-threatening.
• Pimozide: Can increase the risk of heart problems.
• NSAIDs, antiplatelet agents, or anticoagulants (blood thinners): Can increase the risk of bleeding.
• Other SSRIs or SNRIs: Can increase serotonin syndrome risk.
• Drugs highly bound to plasma protein: may increase the concentration of Zoloft
• Drugs Metabolized by CYP2D6 such as atomoxetine, desipramine, dextromethorphan, flecainide, metoprolol, nebivolol, perphenazine,  propafenone, thioridazine, tolterodine, or venlafaxine may cause increased exposure
• Phenytoin: may cause increased Phenytoin concentrations
• Drugs that prolong the QTc interval
• Alcohol: May enhance side effects like drowsiness and dizziness

Give your healthcare provider a full list of medications, vitamins, and supplements you’re taking to avoid harmful interactions.

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If you’re struggling with anxiety or depression and wondering whether Paxil vs Zoloft is right for you, a provider on Klarity Health can help. Connect with a licensed healthcare provider who can assess your symptoms, provide a diagnosis, and develop a personalized treatment plan that may or may not include medication online in as little as 24 hours.* No insurance needed.

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