Last reviewed by Miljan Krcobic on August 28th, 2018.
Chemical and pharmacological differences s between Prozac and Xanax
Prozac and Xanax are chemically different. Alprazolam from Xanax is benzodiazepine’s derivative while Fluoxetine from Prozac is dialkylamino fluoride compound that belong to the class of phenylpropylamines.
Prozac and Xanax also have different mechanisms of action in the body. Fluoxetine from Prozac is antidepressant drug that belongs to the class of selective serotonin reuptake inhibitors (SSRIs). Before its actions, fluoxetine is metabolized to norfluoxetine.
When fluoxetine is used for acute treatment on ocassional basis, it works by blocking reuptake of serotonin and by increasing serotonin stimulation on post synaptic 5-HT1A and terminal autoreceptors.
On the other hand, chronic administration of fluoxetine leads to 5-HT1A and terminal autoreceptors desensitization. The overall clinical effect of increased mood and decreased anxiety is suggested to be caused due to adaptive changes due to enhanced serotonergic neurotransmission.
Alprazolam from Xanax is a benzodiazepine drug that works by nonspecifically binding to the benzodiazepine receptors BNZ1, which are responsible for sleep, and BNZ2, which are responsible for muscle relaxation, motor coordination, anticonvulsant activity and memory.
Alprazolam enhances the effects of GABA in the brain, by increasing GABA affinity for the GABA receptor. GABA is the strongest inhibitory neurotransmitter in the brain. When GABA binds to its receptors, it opens chloride channels, resulting in a membrane hyperpolarization that prevents further cell excitation.
Pharmacotherapy differences and similarities between Prozac and Xanax
Prozac and Xanax are generally different medicines from their chemical, pharmacological and therapy aspects. However, there are some similarities between these two drugs.
The main difference is their therapy group. Alprazolam from Xanax belongs to the group of benzodiazepines, while fluoxetine from Prozac is SSRI – selective serotonin reuptake inhibitors drug. So, Xanax is anxiolytic medicine while Prozac is antidepressant. Xanax is most commonly prescribed to treat anxiety disorders or for the short-term relief of anxiety symptoms of panic disorder, with or without agoraphobia.
Xanax main indications are: Anxiety, Panic Disorder and Generalized Panic Disorder. Prozac’s main indications are: major depressive disorder, moderate to severe bulimia nervosa, obsessive-compulsive disorder, premenstrual dysphoric disorder, panic disorder with or without agoraphobia, and adjunctive therapy with olanzapine for the treatment of resistant or bipolar I depression.
So their common indication is panic disorder, however Prozac is only prescribed for this indication when panic disorders are linked with depression. Xanax can be also used for the treatment of premenstrual disphoric disorder.
Xanax is known as temporary drug. It begins to work 30-60 minutes after administration. Its effects last for four to six hours. Xanax also causes addiction and severe withdrawal symptoms. Different from Xanax, Prozac should be regularly taken in order to gain the desirable results. It is used only for a long-term treatment. It begins to work after some weeks.
Prozac and Xanax side effects
Prozac can cause next side effects:
Very common side effects:
- Headache (20-25%)
- Insomnia (10-33%)
- Nausea (12-29%)
- Anorexia (4-17%)
- Asthenia (10-15%)
- Anxiety (6-15%)
- Diarrhea (8-18%)
- Somnolence (5-17%)
- Nervousness (8-14%)
- Weakness (7-21%)
- Tremor (3-13%)
Common side effects:
- Dizziness (9%)
- Dyspepsia (6-10%)
- Dry mouth (6-10%)
- Sweating (5-10%)
- Decreased libido (2-5%)
- Agitation (>1%)
- Abnormal taste (>1%)
- Chills (>1%)
- Chest pain (>1%)
- Ear pain (>1%)
- Confusion (>1%)
- Hypertension (>1%)
- Palpitation (>1%)
- Increased appetite (>1%)
- Tinnitus (>1%)
- Sleep disorder (>1%)
- Vomiting (>1%)
- Urinary frequency (>1%)
- Weight gain (>1%)
Xanax may cause following side effects with following incidence:
× Drowsiness (41%)
× Headache (10-15%)
× Depression (10-15%)
× Diarrhea (10-15%)
× Dry mouth (10-15%)
× Constipation (10-15%)
× Confusion (5-10%)
× Tachycardia (5-10%)
× Insomnia (5-10%)
× Blurred vision (5-10%)
× Nasal congestion (5-10%)
× Nausea/vomiting (5-10%)
× Hypotension (1-5%)
× Akathisia (1-5%)
× Syncope (1-5%)
× Dizziness (1-5%)
× Increased salivation (1-5%)
× Nervousness (1-5%)
× Tremor (1-5%)
× Weight change (1-5%)
Do Xanax and Prozac cause withdrawal effects?
Prozac may cause severe withdrawal side effects if it is abruptly discontinued after long-term treatment. Withdrawal symptoms include:
- severe headache
- burning or tingling sensations around the body
Many patients who were on Prozac long-term therapy experience unusual neurological symptoms as a result of withdrawal. Patients commonly reports and describes these effects as “brain zaps”, “brain shivers”, “brain shocks” or “brain zings”. These symptoms may also occur when the dosage of Prozac is significantly reduced.
One constant is known about all patients-Prozac should never be discontinued abruptly. The best method for discontinuation of the drug is a slow, methodical decrease, over a period of time.
Xanax may also cause withdrawal symptoms. However in lower rate, because this drug is rarely used for a long-term. Patients who abruptly discontinued Xanax use, in most cases experience rebound symptoms for which the drug was originally prescribed. These symptoms may include:
- increased anxiety
- more frequent panic attacks
- loss of appetite
In some rare and unpredictable cases, patients may also experience high blood pressure and even seizures that may be fatal if not treated quickly. Seizures are among the most dangerous symptoms, as are delirium, delusions and hallucinations.
Many of these symptoms pass with time, however some of them require medical help. One thing is certainly known, Prozac and Xanax should never be discontinued abruptly. The best for discontinuation method of the drug is a slow, methodical decrease, over a period of time, under doctor’s supervision.
Which one is expensive, Prozac or Xanax?
According to drugs.com:
- The cost for Prozac capsule 10 mg is around $1 225 for a supply of 100 capsules,
- The cost for Prozac capsule 20 mg is around $381.5 for a supply of 30 capsules
- The cost for Prozac capsule 40 mg is around $757 for a supply of 30 capsules
- The cost for Xanax tablet 0.25 mg is around $323 for a supply of 100 tablets
- The cost for Xanax tablet 0. 5 mg is around $400 for a supply of 100 tablets
- The cost for Xanax tablet 1 mg is around $533 for a supply of 100 tablets
- The cost for Xanax tablet 2 mg is around $902 for a supply of 100 tablets
Prices depend on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.
What are Prozac and Xanax interactions with other drugs?
Prozac is known to interact with following drugs:
- MAO inhibitors antidepressants such as Nardil, Marplan, selegiline (Emsam, Eldepryl, Zelapar), and Parnate and others. Dangerous interaction may happen, causing a condition known as serotoninergic syndrome. Wait at least 5 weeks after Prozac discontinuation, before beginning treatment with some MAOI.
- Pimozide (Orap). Dangerous drug interaction that may cause irregular heartbeats could occur.
- Thioridazine. Do not take Prozac and wait at least 5 weeks after Prozac discontinuation before beginning treatment with thioridazine, because a dangerous drug interaction that may cause irregular heartbeats could occur.
- Antibiotic Linezolid (Zyvox) or intravenous methylene blue. Dangerous interaction may occur.
- Atidepressants that increase serotonin levels in the body, such as: Lexapro (escitalopram), Celexa (citalopram), Paxil (paroxetine), Zoloft (sertraline), Pristiq (desvenlafaxine), Luvox (fluvoxamine), Fetzima (levomilnacipran), Cymbalta (duloxetine), Savella (milnacipran), and Effexor (venlafaxine).
- Other antidepressants, such as Asendin (amoxapine), Elavil (amitriptyline), Anafranil (clomipramine), Silenor (doxepin), Norpramin (desipramine),Tofranil (imipramine), Vivactil (protriptyline), Aventyl or Pamelor (nortriptyline), and Surmontil (trimipramine)
- Antipsychotics, such as: Haldol (haloperidol), Clozaril (clozapine), Geodon (ziprasidone), Thorazine or Promapar (chlorpromazine), Fanapt (iloperidone), Serentil (mesoridazine), andInapsine (droperidol)
- Blood thinners such as: Coumadin (warfarin), NSAIDs such as Advil or Motrin (ibuprofen) and Aleve or Naprosyn (naproxen) and aspirin.
- Antiarrhythmic drugs such as: Rythmol (propafenone), quinidine, procainamide, Tambocor (flecainide), Betapace or Sorine (sotalol) and Pacerone or Cordarone (amiodarone)
Xanax may interact with following drugs:
- Acid Reducers such as: Prevacid, Prilosec, Zantac, Tums or Rolaids, Nexium, Mylanta and Maalox. These drugs may reduce acid amount in the stomach preventing Xanax absorption in bloodstream.
- Opioid analgesics such as: Codeine, Lortab, Morphine, Vicodin and OxyContin. These drugs may cause sedation and increase drowsiness in patients.
- Allergy and Cold preparations such as: Benadryl, Diabetic Tussin Night Time and Contac Day and Night Cold and Flu. Active ingredient in these products is diphenhydramine, which increases the risk of drowsiness.
- OTC Sleep Aids such as: Melatonin, Simply Sleep, Unisom and Sleep Ease. These products may increase risk of causing sedation.
- Prescription sleep aids such as: Ambien, Lunesta, Sonata and Halcion. Taking these drugs with Xanax may increase the risk of severe side effects such as respiratory depression, bradycardia, coma and even death.
- Medications Containing Propoxyphene such as: Darvocet, Darvon, Balacet and Propacet.
Can Xanax and Prozac be used during pregnancy and breastfeeding?
Xanax has been assigned to Pregnancy Category D by the FDA list of drugs, which means that there is positive evidence of risk to the fetus. The highest risk is if Xanax is used in moderate to large amounts during the first trimester of pregnancy.
Like other drugs in the class, pregnant women should only take Xanax if the benefits of the medication clearly outweigh any of the potential risks to the unborn baby. Babies born to mothers who used Xanax in the days before birth will in most cases have from trace to moderate of Xanax in bloodstreams, as alprazolam may pass through placenta.
There are reported cases of infants who were lethargic and cry less than usual during their first few days of life before becoming irritable and difficult to console for several hours to days. However, there are serious side effects associated with this are very rare, although respiratory depression and low blood pressure do occur on occasion.
All benzodiazepines and also Xanax are excreted into breast milk therefore they can be ingested by infant in very small amounts. Concentrations are usually not lethal, but they can cause sedation and severe respiratory distress.
Prozac (Fluoxetine) has been assigned Pregnancy Category C by the FDA list of drugs, which means that this drug causes side effects to the animal fetus, but there are no relevant studies and it has not been tested fully in pregnant women. The decision to take Prozac during pregnancy should be made by determining if the benefits to the mother outweigh the potential risks to the fetus.
It is known that fluoxetine passes through the placenta but it is still unknown if any long lasting effects may occur to the fetus. However there are some independent reports of causing heart abnormalities in babies born to women who took Prozac during the first and third trimester of pregnancy. The most dangerous side effect that may occur is for certain pulmonary hypertension.
Pulmonary hypertension is a rare lung and heart condition which causes an inability in newborn to breathe normally and may dangerously reduce the amount of oxygen in blood. In the general population, pulmonary hypertension can occur in about 2 out of every 700 births. In women who took Prozac during the 3rd trimester of pregnancy, the risk of developing this condition in the infant is 6 times greater.
Prozac is also excreted into breast milk. Though there is no relevant proof that it may harm infant, it is never recommended.
May Prozac or Xanax be taken together with alcohol?
Moderate amounts of alcohol used occasionally during Prozac therapy aren’t usually a problem.
But, it is known that Prozac can make people drowsy or tired, and alcohol can enhance these side effects. Additionally, alcohol can worsen the symptoms of depression and other mental health conditions. Also daily drinking, binge drinking, and alcoholism will definitely remove Prozac benefits as well as possibly harming the liver.
Xanax and alcohol are both central nervous system depressants, which mean that they will slow down brain activity causing disorientation and slowed reaction times. Patients who use Xanax on regular basis or only occasionally may notice that they are extremely sensitive to alcohol effects and are simply unable to tolerate it.
When Xanax and alcohol are combined, some of the side effects that may occur include:
- loss of coordination
- memory issues
- strange behaviors
Other interactions commonly experienced include:
- cold chills
- hot flashes
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