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Escitalopram Vs. Xanax: Drug Comparison

Compare common side effects, interactions, warnings, and more.

Medical Review byMike Bohl, MD, MBA, MPH, MS, ALMNov 4, 2024

Medication Name

Escitalopram

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Xanax

*image for illustrative purpose only

Summary

Prescription only

Escitalopram is the active ingredient in the brand-name medication Lexapro®. The information below is about brand name Lexapro. According to the FDA, “Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.”

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat anxiety and depression by increasing available serotonin levels in the brain, which helps improve mood and reduce anxiety. Its FDA-approved indications include the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in adults and adolescents. Off-label uses may include treating panic disorder, obsessive-compulsive disorder (OCD), and social anxiety disorder. Lexapro is available in tablet and oral solution forms, taken once daily. Common side effects include nausea, insomnia, and sexual dysfunction, and it carries a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults, particularly during the initial stages of treatment.

Prescription only

Xanax® (alprazolam) is a benzodiazepine medication used to treat anxiety and panic disorders by enhancing the activity of GABA, a neurotransmitter that calms the nervous system. Its FDA-approved indications include the treatment of generalized anxiety disorder (GAD) and panic disorder with or without agoraphobia. Xanax is available in tablet, extended-release tablet, and oral solution forms, typically taken once to multiple times daily depending on the dose. Common side effects include impaired coordination, low blood pressure, difficulty speaking, and increased libido. Serious risks include dependence, withdrawal, and respiratory depression, especially when combined with opioids or alcohol. Xanax carries a boxed warning for the risk of abuse, dependence, and potentially fatal respiratory depression when used with other central nervous system (CNS) depressants.

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Drug Category

Selective serotonin reuptake inhibitor (SSRI)

Benzodiazepine

Approved Uses

Lexapro (escitalopram) is indicated for the:

  • Treatment of major depressive disorder (MDD) in adults and pediatric patients 12 years of age and older

  • Treatment of generalized anxiety disorder (GAD) in adults and pediatric patients 7 years and older

Xanax (alprazolam) is indicated for the:

  • Acute treatment of generalized anxiety disorder in adults

  • Treatment of panic disorder with or without agoraphobia in adults

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Dosage

  • Typically taken orally once daily

  • Comes in 5 mg, 10 mg (scored), and 20 mg (scored) tablets

  • Typically taken orally three times daily

  • Comes in 0.25 mg, 0.5 mg, 1 mg, and 2 mg tablets

Known Common Side Effects

Most commonly observed adverse reactions (incidence ≥ 5% and at least twice the incidence of placebo patients) are:

  • Insomnia

  • Ejaculation disorder (primarily ejaculatory delay),

  • Nausea

  • Sweating increased

  • Fatigue and sleepiness

  • Decreased libido

  • Inability to orgasm

The most common adverse reactions reported in clinical trials for generalized anxiety disorder and panic disorder (incidence >5% and at least twice that of placebo) include:

  • Impaired coordination

  • Low blood pressure

  • Difficulty forming or pronouncing words

  • Increased libido

Interactions & Contraindications

Concomitant use with SSRIs, SNRIs or Tryptophan is not recommended 
Use caution when concomitant use with drugs that affect Hemostasis (NSAIDs, Aspirin, Warfarin)

  • Do not use MAOIs intended to treat psychiatric disorders with Lexapro or within 14 days of stopping treatment with Lexapro. Do not use Lexapro within 14 days of stopping an MAOI intended to treat psychiatric disorders. In addition, do not start Lexapro in a patient who is being treated with linezolid or intravenous methylene blue

  • Concomitant use of pimozide

  • Known hypersensitivity to escitalopram or citalopram or any of the inactive ingredients

  • Drug interactions: SSRIs, SNRIs, tryptophan, drugs that affect hemostasis (NSAIDs, aspirin, warfarin)

  • Known hypersensitivity to alprazolam or other benzodiazepines

  • Concomitant use with strong cytochrome P450 3A (CYP3A) inhibitors, except ritonavir

  • Drug interactions: Opioids, other central nervous system (CNS) depressants, digoxin, CYP3A inhibitors (except ritonavir), CYP3A inducers

Warnings & Precautions

  • Serotonin syndrome

  • Discontinuation syndrome

  • Seizures

  • Activation of mania/hypomania

  • Low blood sodium: Can occur in association with syndrome of inappropriate antidiuretic hormone secretion

  • Increased risk of bleeding

  • Interference with cognitive and motor performance

  • Angle closure glaucoma

  • Use in patients with concomitant illness

  • Sexual dysfunction

  • Pregnancy: SSRI use, particularly later in pregnancy, may increase the risk for persistent pulmonary hypertension and symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulties, hypotonia, tremor, irritability) in the neonate

  • Effects on driving and operating machinery

  • Patients with depression: Exercise caution in patients with signs or symptoms of depression

  • Neonatal sedation and withdrawal syndrome

  • Breastfeeding: Breastfeeding not recommended

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Boxed Warning

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thoughts and behavior in pediatric and young adult patients taking antidepressants. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors. Lexapro is not approved for use in pediatric patients less than 7 years of age.

WARNING: RISKS FROM CONCOMITANT USE WITH OPIOIDS; ABUSE, MISUSE, AND ADDICTION; and DEPENDENCE AND WITHDRAWAL REACTIONS

Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation.

The use of benzodiazepines, including Xanax, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. Before prescribing Xanax and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction.

  • Abrupt discontinuation or rapid dosage reduction of Xanax after continued use may precipitate acute withdrawal reactions, which can be life-threatening. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue Xanax or reduce the dosage.

References

*This information is from the label for brand name Lexapro®. See the Full Prescribing Information for more complete information. Escitalopram, the active ingredient in Lexapro, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient escitalopram.

*This information is from the label for brand name Xanax®. See the Full Prescribing Information for more complete information. Alprazolam, the active ingredient in Xanax, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient alprazolam.

The information provided here is NOT MEDICAL ADVICE and is for informational and educational purposes only. The drug comparison tool does not determine eligibility for medications or treatments provided via the Hims/Hers platform. Consultation with a healthcare provider is required to assess suitability for any medical treatment based on individual health and medical history. All product names and associated trademarks are the property of their respective owners.

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