Fluoxetine Vs. Xanax: Drug Comparison

Fluoxetine is the active ingredient in the brand-name medication Prozac^®. The information below is about brand name Prozac. 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.”

Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) used to treat depression, anxiety, and other mood disorders by increasing available serotonin levels in the brain, which helps improve mood and reduce anxiety. Its FDA-approved indications include major depressive disorder (MDD), obsessive-compulsive disorder (OCD), bulimia nervosa, panic disorder, and premenstrual dysphoric disorder (PMDD). Off-label uses may include managing post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and borderline personality disorder. Prozac is available in capsule, tablet, and liquid form, typically taken once daily. Common side effects include nausea, insomnia, headache, and sexual dysfunction. It has a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults during the early stages of treatment.

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.

Selective serotonin reuptake inhibitor (SSRI)

Benzodiazepine

Prozac (fluoxetine hydrochloride) is a indicated for:

• Acute and maintenance treatment of major depressive disorder (MDD)

• Acute and maintenance treatment of obsessive compulsive disorder (OCD)

• Acute and maintenance treatment of bulimia nervosa

• Acute treatment of panic disorder, with or without agoraphobia

Prozac and olanzapine in combination for treatment of:

• Acute depressive episodes associated with bipolar I disorder

• Treatment resistant depression

Xanax (alprazolam) is indicated for the:

• Acute treatment of generalized anxiety disorder in adults

• Treatment of panic disorder with or without agoraphobia in adults

• Typically taken orally once daily

• Comes in 10 mg, 20 mg, and 40 mg Pulvules^®

• Typically taken orally three times daily

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

Most common adverse reactions (≥5% and at least twice that for placebo) associated with:

Major depressive disorder, obsessive compulsive disorder, bulimia, and panic disorder:

• Abnormal dreams

• Abnormal ejaculation

• Anorexia

• Anxiety

• Weakness

• Diarrhea

• Dry mouth

• Indigestion

• Flu syndrome

• Impotence

• Insomnia

• Libido decreased

• Nausea

• Nervousness

• Inflammation of the throat

• Rash

• Inflammation of the sinuses

• Sleepiness

• Sweating

• Tremor

• Vasodilatation

• Yawn

Prozac and olanzapine in combination:

• Also refer to the adverse reactions section of the package insert for Symbyax

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

• Serotonin syndrome and MAOIs

• Pimozide

• Thioridazine

• When using Prozac and olanzapine in combination, also refer to the contraindications section of the package insert for Symbyax

• Drug interactions: monoamine oxidase inhibitors (MAOIs), drugs metabolized by CYP2D6, tricyclic antidepressants (TCAs), CNS acting drugs, benzodiazepines, antipsychotics, anticonvulsants, serotonergic drugs, drugs that interfere with hemostasis (e.g., NSAIDs, aspirin, warfarin), drugs tightly bound to plasma proteins, olanzapine, drugs that prolong the QT interval

• 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

• Suicidal thoughts and behaviors in children, adolescents, and young adults

• Serotonin syndrome

• Allergic reactions and rash

• Activation of mania/hypomania

• Seizures

• Altered appetite and weight

• Increased risk of bleeding

• Angle-closure glaucoma

• Low blood sodium

• Anxiety and insomnia

• QT prolongation

• Potential for cognitive and motor impairment

• Long half-life

• Prozac and olanzapine in combination: When using Prozac and olanzapine in combination, also refer to the warnings and precautions section of the package insert for Symbyax

• Sexual dysfunction

• Pregnancy: SSRI use, particularly later in pregnancy, may increase risk for persistent pulmonary hypertension and symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulty, 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

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants.

Monitor for worsening and emergence of suicidal thoughts and behaviors.

When using Prozac and olanzapine in combination, also refer to Boxed Warning section of the package insert for Symbyax.

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.

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

*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.