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Dr. Bob is Robert Hsiung, MD,
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Posted by Ritch on June 12, 2002, at 13:43:09
In reply to Rich or Mitch, posted by Bill L on June 12, 2002, at 9:56:55
> Rich or Mitch - you said you take a smidge of Celexa. How much do you take and how long have you been taking it? I take 40 mg. I'm curious about you because I know someone who only takes 10 mg. She has been on 10mg for over 2 years and does not feel the need to increase it. It is mainly for her anxiety.
Bill,When I first tried Celexa it was 10mg/day. Then it got increased to 20mg/day during a major depression. It didn't work that well for that and I had a LOT of side effects that never faded (even after weeks of taking it). So, in the long-haul I found that it works best for anxiety (esp. social anxiety, and OCD-like stuff). It helps for depression too, but mostly just the dysthymic type of mild depression. I found it practically worthless (at least by itself anyway) for a major depression. I have reduced the dose downdowndown to the point that I have found that anywhere from 1.25-2.5 mg/day works just fine for the benefit that it offers me. I am bipolar with panic and attentional probs. I also take Depakote, Neurontin, and Klonopin. I would like to try the Lexapro because my biggest gripe about Celexa is the acid reflux it causes. If I can take half as much and get the anxiolytic benefits with half the reflux I'll change to it immediately. Since I take microdoses of it, cost isn't a concern.
Mitch
Posted by dr. dave on June 19, 2002, at 4:41:27
In reply to Re: Rich or Mitch » Bill L, posted by Ritch on June 12, 2002, at 13:43:09
The research shows Lexapro has no significant benefit over Celexa in terms of side-effects. People taking Lexapro 20mg report side-effects at the same rate as those on Celexa 40mg (86%).In the same study more people stopped taking Lexapro 20mg because of side-effects than those taking Celexa 40mg (10.4% vs 8.8%), but this difference was not statistically significant.
The reason for this is that Lexapro is to all intents and purposes the same thing as Celexa but re-branded and re-patented. There is no evidence of the R-citalopram component they have removed doing anything of significance pharmacologically. To understand this 'new' drug you have to understand that the patent on Celexa just ran out, but the manufacturers can effectively renew the patent by isolating the active component and re-branding it.
See more at http://www.guardian.co.uk/Archive/Article/0,4273,4434943,00.html
The critical comments in the article are mine.
Posted by Ritch on June 19, 2002, at 9:11:56
In reply to Re: Lexapro side-effects, posted by dr. dave on June 19, 2002, at 4:41:27
>
> The research shows Lexapro has no significant benefit over Celexa in terms of side-effects. People taking Lexapro 20mg report side-effects at the same rate as those on Celexa 40mg (86%).
>
> In the same study more people stopped taking Lexapro 20mg because of side-effects than those taking Celexa 40mg (10.4% vs 8.8%), but this difference was not statistically significant.
>
> The reason for this is that Lexapro is to all intents and purposes the same thing as Celexa but re-branded and re-patented. There is no evidence of the R-citalopram component they have removed doing anything of significance pharmacologically. To understand this 'new' drug you have to understand that the patent on Celexa just ran out, but the manufacturers can effectively renew the patent by isolating the active component and re-branding it.
>
> See more at http://www.guardian.co.uk/Archive/Article/0,4273,4434943,00.html
>
> The critical comments in the article are mine.
Hi,Thanks for the article. It wouldn't surprise me a whole lot if the only advantage it winds up having is less medicine for your liver to clear out! I have always wondered about the "mechanism" versus "medicine" distinction between antidepressants when it comes to how they work and side-effects. SSRI's all tend to cause many similar wanted and unwanted effects. If they isolated the *active* isomer, then they probably isolated something that is *more* likely to cause typical SSRI wanted and *unwanted* effeects. It will be interesting to see the comments made here when people start "reporting" in about it.
Mitch
Posted by Anyuser on June 19, 2002, at 10:29:43
In reply to Re: Lexapro side-effects » dr. dave, posted by Ritch on June 19, 2002, at 9:11:56
http://www.micromedex.com/products/drugdex/updates/escit.htm
Posted by Ritch on June 19, 2002, at 12:41:45
In reply to A link to MicroMedex, posted by Anyuser on June 19, 2002, at 10:29:43
> http://www.micromedex.com/products/drugdex/updates/escit.htm
Cool site, thanks!! What I found interesting is that the monograph for Celexa lists its elimination half-life of 35 hrs, whereas on MicroMedex they break it down into the mostly active parent drug, and then the relatively inactive metabolite (22-27hrs, 40 hrs respectively), and note that the elimination rates are similar to citalopram. That probably explains why citalopram doesn't upset my sleep as much (neither did Paxil), due to the shorter half-life of the active parent.Mitch
Posted by mopey on June 19, 2002, at 15:40:30
In reply to Re: A link to MicroMedex » Anyuser, posted by Ritch on June 19, 2002, at 12:41:45
I'm disappointed to hear that side effects on Lexapro might be the same as with Celexa. I was fine for four weeks on Celexa then got slammed with severe sleepiness, so had to stop taking it.
Might still give Lexapro a try. When is its "due date"?
Posted by Ritch on June 19, 2002, at 23:01:41
In reply to when will lexapro be available?, posted by mopey on June 19, 2002, at 15:40:30
> I'm disappointed to hear that side effects on Lexapro might be the same as with Celexa. I was fine for four weeks on Celexa then got slammed with severe sleepiness, so had to stop taking it.
>
> Might still give Lexapro a try. When is its "due date"?Supposedly, this month. If not, then maybe sometime before the end of next month.
Mitch
Posted by pharmrep on July 31, 2002, at 2:04:24
In reply to Re: Lexapro side-effects, posted by dr. dave on June 19, 2002, at 4:41:27
I am a Celexa rep, and will be marketing Lexapro once the FDA gives final approval (sometime in August is what we've been told). I have gone to extra training to know the differences between Celexa and Lexapro, and when the samples go to the Dr's, so will the studies (very impressive.)
As far as efficacy...yes it will be more effective than Celexa or any antidepressant available...it will also be more tolerable with "side-effects and discontinuation due to adverse events comparable to placebo." That last quote is being allowed by the FDA...awesome. And most importantly...Lexapro is replacing Celexa because the technology to separate the isomers is just now available...so Ritch, you are partially right, but re-patent? Wrong...Celexa will still be available for 3 years before going generic. Dont lump Forest in with some other unethical pharm companies who get FDA approval years in advance, and then don't offer the new drug til the old one goes generic. Forest is moving to Lexapro because studies show Lexapro is better, and all our efforts will be in promoting the better drug. Hard to believe a company is giving up over $5 billion over the next 3 years...I guess the message Forest is sending is that it that sure Lexapro is that good.
Posted by Anyuser on July 31, 2002, at 9:11:22
In reply to Re: Lexapro update, posted by pharmrep on July 31, 2002, at 2:04:24
What's the clinical experience in Europe?
Posted by pharmrep on July 31, 2002, at 10:00:08
In reply to Re: Lexapro update » pharmrep, posted by Anyuser on July 31, 2002, at 9:11:22
It also just launched this year in Europe.
There are no stats yet...too early,
But Celexa has been number 1 in 14+ countries and
was available for over 13 years there...Forest expects
the same in US, even though Celexa only here since 1998
Posted by katekite on July 31, 2002, at 10:13:30
In reply to Re: Lexapro update, posted by pharmrep on July 31, 2002, at 2:04:24
Hey pharmrep, since people need approximately half the dose of Lexapro if they switch from their current dose of Celexa, will they pay half as much?Is the price per milligram half of that of Celexa?
Kate
Posted by pharmrep on July 31, 2002, at 10:42:52
In reply to Re: Lexapro update, posted by katekite on July 31, 2002, at 10:13:30
NO...only 10-15% less...since it is a rather new
technology, it does cost some money, however it is
less than Celexa. In California, you can get 20mg of
Celexa for about $55/month, and 40mg is about $60 (notice
you are not charged double...no penalty for needing a higher
therapeutic dose. Celexa is the least expensive of the
branded antidepressants out there)..Lexapro is even less.
Posted by Anyuser on July 31, 2002, at 10:43:29
In reply to Re: Lexapro in Europe, posted by pharmrep on July 31, 2002, at 10:00:08
What are the sexual SE of lexapro, and how do they differ from celexa? Celexa.com says the incidence of ejaculation disorder with celexa is only 6%. Does that sound right to you?
Posted by katekite on July 31, 2002, at 11:48:47
In reply to Re: Lexapro update, posted by pharmrep on July 31, 2002, at 10:42:52
I'm sorry for not understanding yet. You said 10-15% but I'm not clear on what dose equivalency that would be for.
So two questions:
If someone normally takes 40 mg of Celexa and they really wanted to try Lexapro would they usually take around 20 mg of Lexapro? I'm guessing maybe even a little less than that if it does turn out to be more potent?
Can you tell me what a 20 mg pill of Lexapro will cost compared to a 40 mg pill of Celexa? (Nationwide that is rather than any state that might have programs like California.)
Thank you.
Kate
Posted by LLL on July 31, 2002, at 13:10:23
In reply to Re: Lexapro update, posted by pharmrep on July 31, 2002, at 2:04:24
Does it show any usefulness for panic disorder/agoraphobia?
Posted by Ritch on July 31, 2002, at 13:11:24
In reply to Re: Lexapro update, posted by pharmrep on July 31, 2002, at 2:04:24
> I am a Celexa rep, and will be marketing Lexapro once the FDA gives final approval (sometime in August is what we've been told). I have gone to extra training to know the differences between Celexa and Lexapro, and when the samples go to the Dr's, so will the studies (very impressive.)
> As far as efficacy...yes it will be more effective than Celexa or any antidepressant available...it will also be more tolerable with "side-effects and discontinuation due to adverse events comparable to placebo." That last quote is being allowed by the FDA...awesome. And most importantly...Lexapro is replacing Celexa because the technology to separate the isomers is just now available...so Ritch, you are partially right, but re-patent? Wrong...Celexa will still be available for 3 years before going generic. Dont lump Forest in with some other unethical pharm companies who get FDA approval years in advance, and then don't offer the new drug til the old one goes generic. Forest is moving to Lexapro because studies show Lexapro is better, and all our efforts will be in promoting the better drug. Hard to believe a company is giving up over $5 billion over the next 3 years...I guess the message Forest is sending is that it that sure Lexapro is that good.Hi,
Thanks for the information. I am a little concerned however that you could be in trouble with your employer (Forest) if you were discussing the product on the internet as you are now. I am assuming that your employer isn't encouraging you to do so... if they *are* encouraging you (and others) to do this I think it could look badly for Forest.
Mitch
Posted by Anyuser on July 31, 2002, at 13:52:06
In reply to Re: Lexapro update » pharmrep, posted by Ritch on July 31, 2002, at 13:11:24
Good point. Maybe he's an FNG. Businessweek had a cover story on Forest Laboratories, and apparently they are hiring zillions of marketing reps for Lexapro. The BW article is not online, but if you come across it, it offers a very interesting (albeit capitalist tool, of course) perspective on Forest Labs. Apparently the founder's son had devastating depression, so the founder and the company at large are true believers in antidepressants.
Posted by Anyuser on July 31, 2002, at 13:53:58
In reply to Re: Lexapro update, posted by Anyuser on July 31, 2002, at 13:52:06
Posted by pharmrep on July 31, 2002, at 20:46:51
In reply to Re: Lexapro update » pharmrep, posted by Ritch on July 31, 2002, at 13:11:24
Yet another "watch out" note....I just got home and am going to try to comment to about 30-something hits on the topic.
If I knew this would be such a hot topic, I don't think I would have participated. Anyway...here goes (and I will only
be using this thread from now on..hope that is ok) Forest has no idea what I do online, I am not a rogue-rep, and this
is not a sinister marketing plan to promote Lexapro....although I could really be Kate just trying to fool you.(sorry Kate
I had to get a chuckle.) However...Mitch, you do have a point, I don't want to do the wrong thing here, so I might not be
as specific as I have been in the past to protect myself from getting in trouble. So if you have more questions please fire
away, but I am not DR Bob, and it may take time to respond.
PS...Dr Bob, if you see this, can you and I have a private chat before I continue? please email me, you have my address.
Posted by pharmrep on July 31, 2002, at 21:30:49
In reply to Re: Captain Mitch and the downers, posted by pharmrep on July 31, 2002, at 20:46:51
I need to be brief, so I hope this helps several of the last threads.
Poop out? if this means patent..Celexa is not going to have a generic
available for 3 years. Sex side effects..anorgasmia, ejaculatory delay,
impotence, ED, decreased libido, etc. Celexa showed 6%, (ejac delay only) but was more like
20%. This is a tricky one...the doctors dont ask the patients the question,
it is volunteered (5+ yrs ago (pre-viagra..etc) nobody wanted to admit it, now
it is much more open. All ssri's deal with seratonin, so it cant me avoided, but the
more selective, the less the effects...ie, Celexa only needed to list ejac delay since
greater than 5%, the other side efx are less that that. early Lex studies show good
promise in this arena. 9%, and this is a more accurate read since people are more willing
to talk about it, but maybe teens will be reality, only time will tell.
Celexa is indicated 20/40/60 mg. 20 is used 62%, then 40 is the next 30%...60 and higher is usually
for major dp or ocd component. Lex will be 10/20 mg 10 is starting and maintenance dose, and will
be for most. Early studies show 10/mg Lex is slightly more efficacious than 40mg/Celexa, as early of
an onset as 1-2 wks for most. (Journal of Clin Psych 2002; 63:331-336 by William Burke.
Sorry, I cant give cost analysis for everywhere other than Lex will be slightly less than Celexa.
LLL, are you 5'2" or so and in So. Cal? Anyway, the initial studies are showing efficacy, head to head vs.Celexa and placebo, and anxiety..I'm sure other head to head and others will come. I know that other indications have
already been filed too. Another good study by Burke is more about stereoisomers (journ. Clin Psych 2002;4(1)
Posted by pharmrep on July 31, 2002, at 21:49:05
In reply to Re: Captain Mitch and the downers, posted by pharmrep on July 31, 2002, at 21:30:49
oops..forgot to retitle the last one..sorry. Kate, I like your trust note, I will continue to earn yours.
You said you like Meta-regression analysis, well try this. Nick Freemantle British Journal of Psych. 2000, 177, 292-302
(It is sponsored by Wyeth Labs but backfired) ultimately it is a compilation of 105 studies/11000+ patients to see if hitting
other receptor sites other than serotonin is better (ie Effexor hitting Norepinephrine at above 150mg)...it says "This analysis does not provide evidence that anti-
depressants acting at more than one pharmacological site differ in efficacy from drugs selective for serotonin reuptake in the
treatment for major depression". Even though Wyeth sponsored, he goes on to say that "dual action" has "become a marketing concept
for a number of antidepressants, and this study raises the question as to whether it has a legitimate scientific basis, in considering
mechanisms behind antidepressant efficacy." Again...wow. Anyway, I wanted to show this study to you so you can see that Dr's dont care
who is paying them...they just run the tests, they wont destroy their credibility for a paycheck.
Posted by johnj on July 31, 2002, at 22:27:51
In reply to Re: Captain Mitch and the downers, posted by pharmrep on July 31, 2002, at 20:46:51
chance to stop workin after a period of time. Basically, they lose their effectivness. What are the poop out rates for Celexa? Or hasn't this been a problem? Thanks
Posted by pharmrep on July 31, 2002, at 22:37:46
In reply to Poop out refers to ssri's having the high » pharmrep, posted by johnj on July 31, 2002, at 22:27:51
I get it...I havent been taught it in training, nor have I heard it from my Dr's. There is nothing worse than misleading Dr's, and if Forest has info (even if not positive) it will share it with us or others ...ie 6% ejac delay is not really accurate...it's more like teens or 20%...the 6% is based on voluntary input from patients, and over 5 yrs ago, people didnt really want to share that kind of stuff.
Posted by Ritch on July 31, 2002, at 23:10:57
In reply to continued info, posted by pharmrep on July 31, 2002, at 21:49:05
> oops..forgot to retitle the last one..sorry. Kate, I like your trust note, I will continue to earn yours.
> You said you like Meta-regression analysis, well try this. Nick Freemantle British Journal of Psych. 2000, 177, 292-302
> (It is sponsored by Wyeth Labs but backfired) ultimately it is a compilation of 105 studies/11000+ patients to see if hitting
> other receptor sites other than serotonin is better (ie Effexor hitting Norepinephrine at above 150mg)...it says "This analysis does not provide evidence that anti-
> depressants acting at more than one pharmacological site differ in efficacy from drugs selective for serotonin reuptake in the
> treatment for major depression". Even though Wyeth sponsored, he goes on to say that "dual action" has "become a marketing concept
> for a number of antidepressants, and this study raises the question as to whether it has a legitimate scientific basis, in considering
> mechanisms behind antidepressant efficacy." Again...wow. Anyway, I wanted to show this study to you so you can see that Dr's dont care
> who is paying them...they just run the tests, they wont destroy their credibility for a paycheck.
PharmRep,Thanks for the added information! Well, well, it looks like we are headed for a slugfest between Lexapro and Cymbalta, eh? :) Cymbalta (duloxetine-Lilly) is supposed to be out on the market just after the first of the year from what I understand. Serotonin reuptake inhibition (selective or not), does tend to cause similar side effects and that is really no big revelation. Just a hunch, but the *differing* side effect profiles among SSRI's must be accounted for by something other than just their relative lack of "selectivity", no?
Mitch
Posted by pharmrep on July 31, 2002, at 23:35:51
In reply to Re: continued info » pharmrep, posted by Ritch on July 31, 2002, at 23:10:57
Maybe...if Lilly can get their manufacturing out of the toilet. They are in trouble right now. read up on them on your favorite news site...yahoo, hoovers, etc..their stock is in the dumps and rumors of a buyout are all over. they have a decent pipeline of products on the way, but if they cant get out the QA/manufacturing disaster they are in...who knows how long it will be. My Lilly rep friend says it was suppossed to be out in spring, and now...maybe 1+ years away. Anyway, with the Freemantle study about other sites not being better, it will be interesting to see how this new drug can perform. It's a shame that the company who introduced ssri's and got us out of tricyclics is having trouble. They need to get it together fast, or all credibility will be lost. As far as side effects...naseua is common with nearly any new med, but the activating and gastrointestinal side effects for all the ssri's (and other classes) do vary greatly from each other. Only a few s/e are common between them.
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