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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 158 to 182 of 8406. Go back in thread:
Posted by Ritch on August 23, 2002, at 8:34:52
In reply to Re: scoring » Ritch, posted by pharmrep on August 23, 2002, at 0:05:14
> > PharmRep,
> >
> > Why can't most SSRI manufacturer's go for the very low-dose maintenace dosages with scored tablets instead of liquids? I realize that it probably is far cheaper to "tool" for a liquid version, than to create dies and whatnot for low-dose tablets (and add scoring to the costs). However, given that you mention that about 2/3 of the prescribers are on the low-dose end, why not market very low-dose tablet alternatives? With Celexa, the max. I can tolerate every day is nowhere near 10mg. A 5mg tablet of Lexapro that is scored FOUR-WAYS to enable one to take a quarter-tablet would be a fine marketing idea, HINT-HINT
> >
> > Mitch
> >
> ** I think it boils down to this...efficacy just isnt seen at lower doses, and the "majority" of patients see the right amount of effectiveness at the starting doses. In your case, you just happen to be more sensitive and only lower doses are tolerable...unfortunately...you are in the minority. One other thought...have you considered that when you "cut" your own tabs, that since the active ingredients are so trace that you may not be getting a "therapeutic" dose? I know that the scored tablets are ok, but any further splitting might be giving you a placebo sometimes. (I dont know this for fact with Celexa...I am just theorizing with you since all manufacturing is done differently.)
I take a low-dose SSRI primarily to help prevent panic attacks and several of them (including Celexa) work rather well for that. It seems that with SSRI's I only need that small amount to make a big difference. Also, at higher doses they (all of them) tend to precipitate hypomania (I am bipolar). That is primarily the "sensitivity" issue. I had a general practictioner who disbelieved strongly that it wasn't doing me any good to take such a small amount, so "why take any at all". That was before a study was done that showed people could take as little as 15mg of Prozac every week as a *maintenance* to prevent panic. Then Prozac weekly came out after that (but not specifically for that condition). I wonder how many people out there on *maintenance* regimes for panic would find the four-way scored 5mg Lexapro tabs very convenient. The data you provide about dosages probably relate to "acute" treatment for depression only (which is the only formal indication for Celexa and Lexapro thus far-here in the US anyhow). There are many people who are being treated for anxiety disorders with SSRI's as well.thanks,
Mitch
Posted by Anyuser on August 23, 2002, at 8:53:10
In reply to Re: Lexapro clinical data, posted by dr. dave on August 23, 2002, at 8:21:18
Your comments are reasonable and interesting and apparently bona fide, but I have to ask. Do you have any biases or conflicts we should know about? What animates you to build a case against escitalopram?
Posted by pharmrep on August 23, 2002, at 9:39:16
In reply to Re: scoring » pharmrep, posted by Ritch on August 23, 2002, at 8:34:52
> > > PharmRep,
> > >
> > > Why can't most SSRI manufacturer's go for the very low-dose maintenace dosages with scored tablets instead of liquids? I realize that it probably is far cheaper to "tool" for a liquid version, than to create dies and whatnot for low-dose tablets (and add scoring to the costs). However, given that you mention that about 2/3 of the prescribers are on the low-dose end, why not market very low-dose tablet alternatives? With Celexa, the max. I can tolerate every day is nowhere near 10mg. A 5mg tablet of Lexapro that is scored FOUR-WAYS to enable one to take a quarter-tablet would be a fine marketing idea, HINT-HINT
> > >
> > > Mitch
> > >
> > ** I think it boils down to this...efficacy just isnt seen at lower doses, and the "majority" of patients see the right amount of effectiveness at the starting doses. In your case, you just happen to be more sensitive and only lower doses are tolerable...unfortunately...you are in the minority. One other thought...have you considered that when you "cut" your own tabs, that since the active ingredients are so trace that you may not be getting a "therapeutic" dose? I know that the scored tablets are ok, but any further splitting might be giving you a placebo sometimes. (I dont know this for fact with Celexa...I am just theorizing with you since all manufacturing is done differently.)
>
>
> I take a low-dose SSRI primarily to help prevent panic attacks and several of them (including Celexa) work rather well for that. It seems that with SSRI's I only need that small amount to make a big difference. Also, at higher doses they (all of them) tend to precipitate hypomania (I am bipolar). That is primarily the "sensitivity" issue. I had a general practictioner who disbelieved strongly that it wasn't doing me any good to take such a small amount, so "why take any at all". That was before a study was done that showed people could take as little as 15mg of Prozac every week as a *maintenance* to prevent panic. Then Prozac weekly came out after that (but not specifically for that condition). I wonder how many people out there on *maintenance* regimes for panic would find the four-way scored 5mg Lexapro tabs very convenient. The data you provide about dosages probably relate to "acute" treatment for depression only (which is the only formal indication for Celexa and Lexapro thus far-here in the US anyhow). There are many people who are being treated for anxiety disorders with SSRI's as well.
>
> thanks,
>
> Mitch
>
>** I am fascinated to hear that such a low dose (of any med) can still work for somebody in an off label application. I know that panic attack studies (for the indication) are being done. It will be interesting to see what mg is recommended.
PS You didnt comment on the "scoring" theory.
Posted by moxy1000 on August 23, 2002, at 11:09:37
In reply to Re: Lexapro clinical data » moxy1000, posted by pharmrep on August 22, 2002, at 20:25:46
Dr. Dave - I totally agree and understand that there seems to be some kind of "bias" on behalf of drug company data. However, there wouldn't be much data at all if not for the funds made available by drug companies in way of unrestricted educational grants. My suggestion to you would be this - if you don't "trust" the drug companies, do your own "clinical study" on Lexapro. Your experience with the drug, after all, will be the only experience that matters.
Just my two cents.
Posted by moxy1000 on August 23, 2002, at 11:17:03
In reply to Bias » dr. dave, posted by Anyuser on August 23, 2002, at 8:53:10
Never thought of it that way, but that is a good question. I will anxiously await Dr. Dave's response. Perhaps he is paid by other drug companies as a lecturer or research clinician? Maybe a lot of stock in a competitors company? It does seem he has a vested interest in tarnishing this drugs reputation, and since I'll presume Dr. Dave hasn't had wide clinical experience with Lexapro, I'm curious as to why he already has disdain for it.
Posted by moxy1000 on August 23, 2002, at 11:19:54
In reply to Re: Sanchez study » IsoM, posted by pharmrep on August 21, 2002, at 22:57:22
I heard about the sanchez study but it was my understanding that it wasn't finished yet (at least it wasn't back in June.) Maybe they're still getting the data ready for submission?
Posted by moxy1000 on August 23, 2002, at 11:21:40
In reply to Re: Lexapro clinical data » moxy1000, posted by pharmrep on August 22, 2002, at 20:25:46
I haven't found the studies on line, either, but they will be widely available in hard copy form sometime in september.
Posted by Dinah on August 23, 2002, at 11:39:09
In reply to Re: Bias, posted by moxy1000 on August 23, 2002, at 11:17:03
> It does seem he has a vested interest in tarnishing this drugs reputation, and since I'll presume Dr. Dave hasn't had wide clinical experience with Lexapro, I'm curious as to why he already has disdain for it.
Hi, Dinah here. I'm filling in for Dr. Bob for a couble of weeks. (See notice above.)
Please don't make assumptions about the motives of other posters, or post statements that may make other posters feel accused or put down. Here is a link to the civility guidelines of this site:
http://www.dr-bob.org/babble/faq.html#civil
Let's please keep this potentially volatile discussion based on ideas and facts?
Thanks,
Dinah
P.S. If wish to discuss this post or any other administrative issues, that's fine, but it should be done on the administrative board rather than on the medication board. Follow the link at the top of the page.
Posted by moxy1000 on August 23, 2002, at 11:40:07
In reply to Re: Wish I could » JaneB, posted by Ritch on June 11, 2002, at 23:04:41
September 5th the pharmacies will be stocked, according to the Forest Press Release.
Posted by moxy1000 on August 23, 2002, at 11:58:34
In reply to Re: Lexapro side-effects, posted by dr. dave on June 19, 2002, at 4:41:27
Dr. Dave, I have spent a few hours this morning reading your recent posts, and the more I read, the more I am convinced that you have some sort of hidden agenda against Lexapro.
I'm surprised I didn't notice it sooner. I am taking a "wait and see" attitude with Lexapro. I know you're in Europe, But I would like to ask what your opinion is of Lexapro's release in the U.S. I ask because Forest has a U.S. patent on Celexa until at least 2005. Why would they stop marketing a billion dollar drug and start marketing Lexapro if it had, as you say repeatedly, no advantages over Celexa?
Also, I think it's worth pointing out that this company (Forest) has a vested interest in Depression. Did you know Howard Soloman, the CEO of Forest, has a son who has battled depression his entire life? Andrew wrote a book about his battle, called the "Noonday Demon." (Andrew, by the way, mentions nothing of Celexa or any Forest product in his book.) Also, did you know Howard's wife committed suicide? This is common knowledge in the U.S. Business Week did a cover story about this a few months ago.
My point is that I believe this company has been touched to the core by this disease called depression. I also believe that they are releasing Lexapro in the U.S. because it would be unethical to delay the release of a superior treatment like Lexapro, simply because Celexa still had life left in it's patent.
I would be interested to hear your response.
Posted by Dinah on August 23, 2002, at 13:02:01
In reply to Dr. Dave - why do you hate this drug?, posted by moxy1000 on August 23, 2002, at 11:58:46
I'm terribly sorry, Moxy1000, but I've asked you before to follow the civility guidelines of this site. Those guidelines include not making assumptions about the motives of another poster and not posting anything that could be another poster could take as accusatory.
Therefore I have to block you from posting for one week.
Follow ups to this administrative matter may be discussed on the administrative board.
Posted by IsoM on August 23, 2002, at 15:36:29
In reply to Re: Wish I could, posted by moxy1000 on August 23, 2002, at 11:40:07
I don't believe either of you are out for ulertior motives like some believe. I do believe that two people can have conflicting ideas with perfectly good, altrusitic motives. I mean we're not talking "absolute truths" here but effects of a certain medication that may or may not prove what it is hoped to do.
Both of you aren't masquerading under misleading usernames as what you do - pharmrep says it & so does dr.dave. But due to opposite viewpoints, this sounds too much like an argument to me.
Please, I'm only interested in facts & some conjecturing based on solid information. I very much appreciate any links given & read them over as objectively as I can. Please continue with any relevant info you find.
Pharmarep, you say you only have hard copy studies (nothing online available). Could you not scan the papers in a word document form & then copy & paste the results directly here for us to read? My computer skills aren't fantastic but I can scan printed papers & change them easily into word documents for sending to others if needed.
And dr. dave, if you can find any further info on Lexapro from your practice or that of collegues, could you please let us know about them, both pro & con?
You see, I use Celexa & of all the various SSRIs & ADs I've used before (Prozac, Luvox, Zoloft, Effexor, moclobemide [Manerix], amoxepine, imipramine, & desipramine), Celexa is by far the best. If Lexapro may be even lightly better for me, I'd be interested in giving it a try. But I want my decision to be a sound one based on facts.
Posted by johnj on August 23, 2002, at 19:28:35
In reply to Question for pharmrep and dr.dave both, posted by IsoM on August 23, 2002, at 15:36:29
Hi again,
I just read your reply to my Celexa queston from a week or so back and thank you. I too have the dry mouth and constipation from TCA's, nortryptline and imipramine. The doc has pushed a ssri for quite some time, but after a sponge head binge on remeron I am a little leary of something new. However, I am going to try lexapro later in the year sometime around thanksgiving most likely. I have an exam to study for and I can't afford a setback at this moment. I can see the TCA/lithium wait gain due in part to age starting to emerge and want to try a new med that will not keep me from working out.
I don't remember but is your son in Japan or planning to go? Take care.
johnj
Posted by IsoM on August 23, 2002, at 20:17:16
In reply to Re: Question for pharmrep and dr.dave both » IsoM, posted by johnj on August 23, 2002, at 19:28:35
I'm at the computer fairly frequently, so saw your post right away. When it's hot in summer, I do some work, then come to the computer where there's an overhead fan & cool off for a few minutes, then back to work.
I hope Celexa (or Lexapro) works for you as well as it does for me. I honestly have noticed no side effects from Celexa but then I've always been a very sleepy & yet strangely, a wired sort of person. Maybe the Celexa's made it worse but I can't honestly judge it.
John, I don't remember what your diagnosis is - want to refresh my memory? Have you considered Provigil at all? It really serves to sharpen one's mind when there's cognitive difficulties from depression and/or medications. I joke that I could do so much but my working RAM is small even though my (brain's) HD is huge. That & being able to access what's in my memory somewhere but I can't pull it up when I want to. Provigil has helped somewhat for that but it'll always be my Achilles heel.
My son has never been to Japan but would dearly love to go. He has Asperger which involves dislike of too much social contact. I wonder if the sheer number of people packed into such a small island wouldn't overwhelm him. Not too many places are as beautiful & uncrowded as the gardens of the Imperial palace. It may be a degree of idealization but I wouldn't ruin his dreams for anything. Besides, the reserve that Japanese people must erect in such crowded conditions would be easier for him to take than the 'all-over-you' attitude found in our society here.
So what exam are you studying for? Personally, I'm happy that I don't have the stresses of cramming for exams, trying to remember under pressure. I don't do well with that. Things that I know fairly well will literally vanish when I write exams. It's only when a memory is so deeply engrained that I can call it up no matter what. And even then, not always (like someone's name I've known for many, many years!).
My biology professor would let students take cheat sheets into exams. We were allowed as much as we could hand-write on a standard 8x11 sheet of paper, one side & take that it with us. She said she remembered from her student days, the pressure & blank mind. By being allowed a cheat sheet, students would visibly relax & remember better. She also thought that the effort of writing down what we were less sure of was a great way to instill the info into our memory better. She was a fantastic instructor & we got along great, she was only about 5 years older than me. We were both plant nuts into growing exotic plants.
Posted by pharmrep on August 23, 2002, at 22:28:57
In reply to Question for pharmrep and dr.dave both, posted by IsoM on August 23, 2002, at 15:36:29
> I don't believe either of you are out for ulertior motives like some believe. I do believe that two people can have conflicting ideas with perfectly good, altrusitic motives. I mean we're not talking "absolute truths" here but effects of a certain medication that may or may not prove what it is hoped to do.
>
> Both of you aren't masquerading under misleading usernames as what you do - pharmrep says it & so does dr.dave. But due to opposite viewpoints, this sounds too much like an argument to me.
>
> Please, I'm only interested in facts & some conjecturing based on solid information. I very much appreciate any links given & read them over as objectively as I can. Please continue with any relevant info you find.
>
> Pharmarep, you say you only have hard copy studies (nothing online available). Could you not scan the papers in a word document form & then copy & paste the results directly here for us to read? My computer skills aren't fantastic but I can scan printed papers & change them easily into word documents for sending to others if needed.
>
> And dr. dave, if you can find any further info on Lexapro from your practice or that of collegues, could you please let us know about them, both pro & con?
>
> You see, I use Celexa & of all the various SSRIs & ADs I've used before (Prozac, Luvox, Zoloft, Effexor, moclobemide [Manerix], amoxepine, imipramine, & desipramine), Celexa is by far the best. If Lexapro may be even lightly better for me, I'd be interested in giving it a try. But I want my decision to be a sound one based on facts.
** I am tring to be objective...if you feel otherwise..let me know. Would you believe I dont have a scanner...sorry. I'm still looking online...they will show up soon.
Posted by pharmrep on August 23, 2002, at 23:20:37
In reply to Re: Lexapro clinical data, posted by dr. dave on August 23, 2002, at 8:21:18
Interesting article...I would like to see a test done In US to see if similar data seen. Anyway...point taken. I have a question for you. How do you feel about "dual action" or "dual mechanism" for an AD? Do you believe there is any "advantage?"
PS Sorry you've been taking a beating recently...I used to get it when I started too....dont give up..."chin up" ol'chap.
Posted by pharmrep on August 23, 2002, at 23:35:29
In reply to Re: Sanchez study, posted by moxy1000 on August 23, 2002, at 11:19:54
> I heard about the sanchez study but it was my understanding that it wasn't finished yet (at least it wasn't back in June.) Maybe they're still getting the data ready for submission?
>
*** It's done...as are 8 others....it's just a matter of finding them online...or hitting up your psych after 9/5, they can make a copy of their studies for you (and they will be getting plenty of them and samples starting 9/5...within 1 week...85+% of doctors should have been seen by at least 1 rep)
Posted by Patson on August 24, 2002, at 0:42:54
In reply to Re: Lexapro clinical data, posted by moxy1000 on August 23, 2002, at 11:21:40
Simply call Forest Professional Affairs Dept. at 1-800-678-1605. They can send you the studies, or provide the information you need to find them on your own. The studies are all published and public information.
Posted by pharmrep on August 24, 2002, at 0:47:47
In reply to Re: Lexapro clinical data, posted by Patson on August 24, 2002, at 0:42:54
> Simply call Forest Professional Affairs Dept. at 1-800-678-1605. They can send you the studies, or provide the information you need to find them on your own. The studies are all published and public information.
** did you get them? I asked my buddy Derek over there...he said not out til later. (like around 9/5). If you can get them...more power to you.
Posted by IsoM on August 24, 2002, at 0:58:14
In reply to Re: Question » IsoM, posted by pharmrep on August 23, 2002, at 22:28:57
Do you know anyone with a scanner or any way you could get access to a scanner? They're remarkably cheap unless you want the absolute best. Surely, in your line of work, there must be some place to use a scanner?
Posted by Ritch on August 24, 2002, at 1:15:52
In reply to Re: scoring » Ritch, posted by pharmrep on August 23, 2002, at 9:39:16
> > > > PharmRep,
> > > >
> > > > Why can't most SSRI manufacturer's go for the very low-dose maintenace dosages with scored tablets instead of liquids? I realize that it probably is far cheaper to "tool" for a liquid version, than to create dies and whatnot for low-dose tablets (and add scoring to the costs). However, given that you mention that about 2/3 of the prescribers are on the low-dose end, why not market very low-dose tablet alternatives? With Celexa, the max. I can tolerate every day is nowhere near 10mg. A 5mg tablet of Lexapro that is scored FOUR-WAYS to enable one to take a quarter-tablet would be a fine marketing idea, HINT-HINT
> > > >
> > > > Mitch
> > > >
> > > ** I think it boils down to this...efficacy just isnt seen at lower doses, and the "majority" of patients see the right amount of effectiveness at the starting doses. In your case, you just happen to be more sensitive and only lower doses are tolerable...unfortunately...you are in the minority. One other thought...have you considered that when you "cut" your own tabs, that since the active ingredients are so trace that you may not be getting a "therapeutic" dose? I know that the scored tablets are ok, but any further splitting might be giving you a placebo sometimes. (I dont know this for fact with Celexa...I am just theorizing with you since all manufacturing is done differently.)
> >
> >
> > I take a low-dose SSRI primarily to help prevent panic attacks and several of them (including Celexa) work rather well for that. It seems that with SSRI's I only need that small amount to make a big difference. Also, at higher doses they (all of them) tend to precipitate hypomania (I am bipolar). That is primarily the "sensitivity" issue. I had a general practictioner who disbelieved strongly that it wasn't doing me any good to take such a small amount, so "why take any at all". That was before a study was done that showed people could take as little as 15mg of Prozac every week as a *maintenance* to prevent panic. Then Prozac weekly came out after that (but not specifically for that condition). I wonder how many people out there on *maintenance* regimes for panic would find the four-way scored 5mg Lexapro tabs very convenient. The data you provide about dosages probably relate to "acute" treatment for depression only (which is the only formal indication for Celexa and Lexapro thus far-here in the US anyhow). There are many people who are being treated for anxiety disorders with SSRI's as well.
> >
> > thanks,
> >
> > Mitch
> >
> >** I am fascinated to hear that such a low dose (of any med) can still work for somebody in an off label application. I know that panic attack studies (for the indication) are being done. It will be interesting to see what mg is recommended.
> PS You didnt comment on the "scoring" theory.
PharmRep,I have been pill chopping with SSRI's and bupropion for quite some time now with good results. I made my own liquid Prozac for several years. Scoring, just makes it easier to break a tablet cleanly, that's all. It provides a stress relief that makes the resultant dose easy to break with your fingers and more evenly halved or quartered, that's all.
Mitch
Posted by pharmrep on August 24, 2002, at 1:18:21
In reply to Re: Question about Scanner and Studies » pharmrep, posted by IsoM on August 24, 2002, at 0:58:14
> Do you know anyone with a scanner or any way you could get access to a scanner? They're remarkably cheap unless you want the absolute best. Surely, in your line of work, there must be some place to use a scanner?
** Its all about personal delivery and conversation...not faxes and scanners. (You can answer questions and add comments through machines) Anyway...I will figure a way out to get them and post them...just need a little more time.
Posted by pharmrep on August 24, 2002, at 1:24:00
In reply to Re: scoring » pharmrep, posted by Ritch on August 24, 2002, at 1:15:52
> > > > > PharmRep,
> > > > >
> > > > > Why can't most SSRI manufacturer's go for the very low-dose maintenace dosages with scored tablets instead of liquids? I realize that it probably is far cheaper to "tool" for a liquid version, than to create dies and whatnot for low-dose tablets (and add scoring to the costs). However, given that you mention that about 2/3 of the prescribers are on the low-dose end, why not market very low-dose tablet alternatives? With Celexa, the max. I can tolerate every day is nowhere near 10mg. A 5mg tablet of Lexapro that is scored FOUR-WAYS to enable one to take a quarter-tablet would be a fine marketing idea, HINT-HINT
> > > > >
> > > > > Mitch
> > > > >
> > > > ** I think it boils down to this...efficacy just isnt seen at lower doses, and the "majority" of patients see the right amount of effectiveness at the starting doses. In your case, you just happen to be more sensitive and only lower doses are tolerable...unfortunately...you are in the minority. One other thought...have you considered that when you "cut" your own tabs, that since the active ingredients are so trace that you may not be getting a "therapeutic" dose? I know that the scored tablets are ok, but any further splitting might be giving you a placebo sometimes. (I dont know this for fact with Celexa...I am just theorizing with you since all manufacturing is done differently.)
> > >
> > >
> > > I take a low-dose SSRI primarily to help prevent panic attacks and several of them (including Celexa) work rather well for that. It seems that with SSRI's I only need that small amount to make a big difference. Also, at higher doses they (all of them) tend to precipitate hypomania (I am bipolar). That is primarily the "sensitivity" issue. I had a general practictioner who disbelieved strongly that it wasn't doing me any good to take such a small amount, so "why take any at all". That was before a study was done that showed people could take as little as 15mg of Prozac every week as a *maintenance* to prevent panic. Then Prozac weekly came out after that (but not specifically for that condition). I wonder how many people out there on *maintenance* regimes for panic would find the four-way scored 5mg Lexapro tabs very convenient. The data you provide about dosages probably relate to "acute" treatment for depression only (which is the only formal indication for Celexa and Lexapro thus far-here in the US anyhow). There are many people who are being treated for anxiety disorders with SSRI's as well.
> > >
> > > thanks,
> > >
> > > Mitch
> > >
> > >** I am fascinated to hear that such a low dose (of any med) can still work for somebody in an off label application. I know that panic attack studies (for the indication) are being done. It will be interesting to see what mg is recommended.
> > PS You didnt comment on the "scoring" theory.
>
>
> PharmRep,
>
> I have been pill chopping with SSRI's and bupropion for quite some time now with good results. I made my own liquid Prozac for several years. Scoring, just makes it easier to break a tablet cleanly, that's all. It provides a stress relief that makes the resultant dose easy to break with your fingers and more evenly halved or quartered, that's all.
>
> Mitch
>
> *** Maybe I wasnt clear...here is the thought...let's say that the active materials in the tablet comprise 10%, the other 90% is filler. If you make your own additional cuts besides the scored one on the pill, how do you know you are actually getting any therapeutic dose, and not just filler? (you are assuming univeral/even distribution.)
Posted by Ritch on August 24, 2002, at 9:46:28
In reply to last try for scoring » Ritch, posted by pharmrep on August 24, 2002, at 1:24:00
Posted by oracle on August 25, 2002, at 3:02:28
In reply to I am assuming universal distribution (nm) » pharmrep, posted by Ritch on August 24, 2002, at 9:46:28
Why do you assume this ? It is not going to happen in a pill that not ~100 % active.
You need to compound to make sure you are getting active meds in your micro dose.
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