Lexapro Vs. Pristiq: Drug Comparison

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.

Pristiq^® (desvenlafaxine) is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat major depressive disorder (MDD) by increasing the available levels of serotonin and norepinephrine in the brain, which helps improve mood and emotional balance. Its FDA-approved indication is for the treatment of major depressive disorder in adults. Off-label uses may include managing anxiety disorders, hot flashes related to menopause, and other mood disorders. Pristiq comes in extended-release tablet form, taken once daily. Common side effects include nausea, dizziness, dry mouth, male sexual dysfunction, and insomnia. 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.

Selective serotonin reuptake inhibitor (SSRI)

Serotonin and norepinephrine reuptake inhibitor (SNRI)

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

Pristiq (desvenlafaxine succinate) is indicated:

• For the treatment of adults with major depressive disorder (MDD)

• Typically taken orally once daily

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

• Typically taken orally once daily

• Comes in 25 mg, 50 mg, and 100 mg extended-release tablets

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

Most common adverse reactions (incidence ≥5% and twice the rate of placebo in the 50 or 100 mg dose groups) were:

• Nausea

• Dizziness

• Insomnia

• Excessive sweating

• Constipation

• Sleepiness

• Decreased appetite

• Anxiety

• Specific male sexual function disorders

• 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)

• Hypersensitivity to desvenlafaxine succinate, venlafaxine hydrochloride, or any excipients in the Pristiq formulation

• Serotonin syndrome and MAOIs

• 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

• Serotonin syndrome

• Elevated blood pressure

• Increased risk of bleeding

• Angle closure glaucoma

• Activation of mania/hypomania

• Discontinuation syndrome

• Seizure

• Low blood sodium: Can occur in association with SIADH.

• Interstitial lung disease and eosinophilic pneumonia

• Sexual dysfunction

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: SUICIDAL THOUGHTS AND BEHAVIORS

Increased the risk of suicidal thoughts and behaviors in children, adolescents and young adults taking antidepressants.

Closely monitor for clinical worsening and emergence of suicidal thoughts and behaviors.

Pristiq is not approved for use in pediatric patients.

*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 Pristiq^®. See the Full Prescribing Information for more complete information. Desvenlafaxine, the active ingredient in Pristiq, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient desvenlafaxine.