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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 258 to 282 of 8406. Go back in thread:
Posted by selena on September 2, 2002, at 2:04:41
In reply to Ok, posted by pharmrep on September 1, 2002, at 18:55:07
pharmrep I think your information is very informative thank you for giving it. The more information the better, we can all look around the internet for a counterpoint if we want to, yours is just information like any other. thanks again
Posted by oracle on September 2, 2002, at 3:06:15
In reply to Re: Blocked for one week » LostBoyinNC1, posted by Dinah on September 1, 2002, at 19:03:28
> Sorry, Lost Boy. I asked you before to be civil, so I have had to block you from posting for one week.
This will be the 3-4th time he has been blocked, I think he is due for more than 1 week
Posted by oracle on September 2, 2002, at 4:01:17
In reply to Cheap, Generic Celexa, posted by moxy1000 on September 1, 2002, at 14:14:07
> So why is Lexapro being released here? It has been said that it is "basically the same as Celexa." Why would a company introduce a drug that is effectively the same as a drug they have three years left to make money off of?
Simple, more slices of the pie mean more money.
In general everyone rushes to the latest, so they will have 2 patents in force at the same time for the same chemical (an isomer). While it may seem that it would be better to release Lexapro when Celexa's patent runs out, I don't think it works this way. Having both patents in force means they see the profits sooner. It should take at least 2 years for the general population to indicate yea or nay on this one.
It is also a BIG leap to say they are doing this because Lexapro is better; this is about profit.
And, in truth, it should be ! Don't expect business to be run any way else, or they are doomed to fail.
Posted by pharmrep on September 2, 2002, at 9:49:55
In reply to Re: Cheap, Generic Celexa, posted by oracle on September 2, 2002, at 4:01:17
> Why would a company introduce a drug that is effectively the same as a drug they have three years left to make money off of?
>
> Simple, more slices of the pie mean more money.
> In general everyone rushes to the latest, so they will have 2 patents in force at the same time for the same chemical (an isomer). While it may seem that it would be better to release Lexapro when Celexa's patent runs out, I don't think it works this way. Having both patents in force means they see the profits sooner. It should take at least 2 years for the general population to indicate yea or nay on this one.
> It is also a BIG leap to say they are doing this because Lexapro is better; this is about profit.
> And, in truth, it should be ! Don't expect business to be run any way else, or they are doomed to fail.
>
>***Actually...it should take about about 6-12 months...not 2+ years for Lexapro to prove itself. And how does a Pharm Co. just go about "saying" (Product-X) is better without having any facts...that would fly real well with the competition and public right....Forest would get killed if it hung its hat on unfounded claims. I agree that this is a business...of course we make money and earn decent livings, but what's wrong with that? Don't you too? Just because this is in medicine doesnt make it impossible to make a good "business" decision and an ethical morally based move at the same time.
Posted by Geezer on September 2, 2002, at 11:48:31
In reply to Re: Cheap, Generic Celexa, posted by oracle on September 2, 2002, at 4:01:17
Good point Oracle. I wish there was more incentive for the drug companies to develope NEW and improved drugs. At present this is not possible due to the "jack-boot bureaucrats" at the FDA (the federal government is far less altruistic than the drug companies).
So what are the alternatives? We could turn the whole matter over to the liberal/socialists who would in turn burden us with national health care (more taxes, less health care and the loss of liberty). I can think of a few (not all) of the possible improvments. Establish a regulatory agency in the private sector (get rid of the FDA). Show us a 50% reduction in taxes so we could contract for our own health care. One thing the government could do is put a cap on judgements and some additional controls on tort lawyers.
Just some thoughts - thanks for the post.
Geezer
Posted by pharmrep on September 2, 2002, at 12:03:50
In reply to Re: Cheap, Generic Celexa, posted by Geezer on September 2, 2002, at 11:48:31
> Good point Oracle. I wish there was more incentive for the drug companies to develope NEW and improved drugs. At present this is not possible due to the "jack-boot bureaucrats" at the FDA (the federal government is far less altruistic than the drug companies).
>
> So what are the alternatives? We could turn the whole matter over to the liberal/socialists who would in turn burden us with national health care (more taxes, less health care and the loss of liberty). I can think of a few (not all) of the possible improvments. Establish a regulatory agency in the private sector (get rid of the FDA). Show us a 50% reduction in taxes so we could contract for our own health care. One thing the government could do is put a cap on judgements and some additional controls on tort lawyers.
>
> Just some thoughts - thanks for the post.
>
> Geezer** you two are funny...if you want to be in dreamland..why not just eliminate taxes altogether?
PS Lexapro is improved over Celexa...the incentive was that the FDA encourages the idea of isomer science and any possibility of a drug to be "cleaned up" and show data of improvement gets the FDA's attention...the Citalopram mixture was just lucky enough to be able to do this successfully...not all drugs lend themselves to be able to be "cleaner." For example, Paxil and Zoloft are already the isomers, Effexor cant,and Prozac tried twice but it didnt help (it actually hurt.)
Posted by JaneB on September 2, 2002, at 12:49:34
In reply to Re: alternatives » Geezer, posted by pharmrep on September 2, 2002, at 12:03:50
Why don't the study results indicate any positive conclusions about fewer ASE's or daytime sleepiness?
Appreciate your info.
JaneB
Posted by pharmrep on September 2, 2002, at 14:41:51
In reply to Lexapro study effectspharmrep, posted by JaneB on September 2, 2002, at 12:49:34
> Why don't the study results indicate any positive conclusions about fewer ASE's or daytime sleepiness?
> Appreciate your info.
> JaneB** Why do you think they dont? There are studies that show reduced s/e with Lexapro...here is a post from a couple days ago that has the FDA approved package insert info.
Re: Lexapro side-effects » dr dave
If you have any questions...I'd be glad to help if I can.
Posted by pharmrep on September 2, 2002, at 14:44:59
In reply to lexapro (P.I.) dose dependant adverse events, posted by pharmrep on September 1, 2002, at 0:00:38
> Some of the more common adverse events (as listed in the package insert) are as follows:
>
> adverse event......Placebo.(311 patients)/...10mg Lexapro.(310 patients)/...20mg Lexapro (125 patients)
> insomnia..............4%.................................7%..........................................14%
> diarrhea..............5%.................................6%..........................................14%
> dry mouth...........3%.................................4%...........................................9%
> somnolence.........1%.................................4%...........................................9%
> dizziness..............2%.................................4%...........................................7%
> sweating increased1%.................................3%...........................................8%
> constipation.........1%.................................3%...........................................6%
> fatigue.................2%.................................2%...........................................6%
> indigestion...........1%.................................2%...........................................6%
>
> The overall incidence rates of adverse events in 10mg Lexapro treated patients (66%) is similar to that of the placebo treated patients (61%), while the incidence rate in 20mg Lexapro treated patients was greater (86%).***oops...didnt attach, so I just posted again.
Posted by moxy1000 on September 2, 2002, at 15:21:57
In reply to Re: Cheap, Generic Celexa, posted by oracle on September 2, 2002, at 4:01:17
Seems to be a lot of people saying that "lexapro is half of Celexa." Okay...that's true, I guess. But that seems to be over simplifying things a bit.
Let's look at science.
Celexa is a racimic compound that contains the s and r enantiomers in equal proportion (50:50). These means essentially that they are stereoisomers.
There are many stereoisomers in nature - look for instance at carvone - s-carvone it is responsible for the taste and smell of caraway, while r-carvone is responsible for the taste and smell of spearmint.
Not really the same thing at all, is it?
Another example, both lemons and oranges contain a compound called limonene - however Lemons have the enantiomer s-limonene, while oranges have the enantiomer r-limonene. As a result, lemons smell and taste sour, while oranges smell and taste sweet.
Just because isomers are mirror images of eachother, does not mean they are the same thing at all. Science proves that.
In the case of Lexapro, the reason it is more potent comes down to receptor sites in the body.
Ready for more science? Receptor sites are very selective - the correct key is required for binding. However, they are not 100% selective. Similar molecules, or similar "keys" may be able to fit into or bind with the same receptor. The binding may be only partial, but it may be enough to keep another receptor binder from latching on.
This is the case with Celexa. The r-enantiomer was not a perfect fit for blocking the reuptake of serotonin. It fit "partially" with the cells. The s-enantiomer IS a perfect fit, but the presence of the r-enantiomer actually interfered with the ability of the s-enantiomer to increase serotonin levels in the brain.
I have tried to stay away from getting into isomer science, as I found it initially difficult to understand and I didn't want to bore anyone with the specifics, but this discussion seems to warrant a bit more depth in discussion regarding the science behind this isomer called Lexapro.
The point is, like caraway and spearmint, like oranges and lemons, Celexa and Lexapro are not the same. They act totally differently at the receptor sites - one is a perfect fit, and the other is not. The result is Lexapro being over 100 times (or in other words, 100%) more potent then the r-enantiomer in the inhibition of serotonin reuptake.
Do the math. Does logic tell you that one should work more efficiently then the other??
P.S. Dr. Dave, I'm not a scientist or a doctor, but I have done my homework, and contrary to your assumption, I do understand the pharmacodynamics.
Posted by moxy1000 on September 2, 2002, at 15:23:11
In reply to Re: Cheap, Generic Celexa, posted by oracle on September 2, 2002, at 4:01:17
Seems to be a lot of people saying that "lexapro is half of Celexa." Okay...that's true, I guess. But that seems to be over simplifying things a bit.
Let's look at science.
Celexa is a racimic compound that contains the s and r enantiomers in equal proportion (50:50). These means essentially that they are stereoisomers.
There are many stereoisomers in nature - look for instance at carvone - s-carvone it is responsible for the taste and smell of caraway, while r-carvone is responsible for the taste and smell of spearmint.
Not really the same thing at all, is it?
Another example, both lemons and oranges contain a compound called limonene - however Lemons have the enantiomer s-limonene, while oranges have the enantiomer r-limonene. As a result, lemons smell and taste sour, while oranges smell and taste sweet.
Just because isomers are mirror images of eachother, does not mean they are the same thing at all. Science proves that.
In the case of Lexapro, the reason it is more potent comes down to receptor sites in the body.
Ready for more science? Receptor sites are very selective - the correct key is required for binding. However, they are not 100% selective. Similar molecules, or similar "keys" may be able to fit into or bind with the same receptor. The binding may be only partial, but it may be enough to keep another receptor binder from latching on.
This is the case with Celexa. The r-enantiomer was not a perfect fit for blocking the reuptake of serotonin. It fit "partially" with the cells. The s-enantiomer IS a perfect fit, but the presence of the r-enantiomer actually interfered with the ability of the s-enantiomer to increase serotonin levels in the brain.
I have tried to stay away from getting into isomer science, as I found it initially difficult to understand and I didn't want to bore anyone with the specifics, but this discussion seems to warrant a bit more depth in discussion regarding the science behind this isomer called Lexapro.
The point is, like caraway and spearmint, like oranges and lemons, Celexa and Lexapro are not the same. They act totally differently at the receptor sites - one is a perfect fit, and the other is not. The result is Lexapro being over 100 times (or in other words, 100%) more potent then the r-enantiomer in the inhibition of serotonin reuptake.
Do the math. Does logic tell you that one should work more efficiently then the other??
P.S. Dr. Dave, I'm not a scientist or a doctor, but I have done my homework, and contrary to your assumption, I do understand the pharmacodynamics.
Posted by JaneB on September 2, 2002, at 15:24:11
In reply to Re: Lexapro study effects » JaneB, posted by pharmrep on September 2, 2002, at 14:41:51
> > Why don't the study results indicate any positive conclusions about fewer ASE's or daytime sleepiness?
> > Appreciate your info.
> > JaneB
>
> ** Why do you think they dont? There are studies that show reduced s/e with Lexapro...here is a post from a couple days ago that has the FDA approved package insert info.
> Re: Lexapro side-effects » dr dave
> If you have any questions...I'd be glad to help if I can.Pharmrep,
What about antidepressant induced sexual dysfunction? I saw the results you posted. Am I missing something or has this issue not been evaluated with Lexapro? What if 40 mg Celexa causes cycling and 20 mg is used. Can/should 10 mg Lexapro be cut in half to avoid this risk? I know package inserts don't cover these intricate side effects. Just wondered if you have inside information.
JaneB
Posted by winger on September 2, 2002, at 15:46:12
In reply to Re: Lexapro study effects, posted by JaneB on September 2, 2002, at 15:24:11
I missed out.. what is cycling??
> > > Why don't the study results indicate any positive conclusions about fewer ASE's or daytime sleepiness?
> > > Appreciate your info.
> > > JaneB
> >
> > ** Why do you think they dont? There are studies that show reduced s/e with Lexapro...here is a post from a couple days ago that has the FDA approved package insert info.
> > Re: Lexapro side-effects » dr dave
> > If you have any questions...I'd be glad to help if I can.
>
> Pharmrep,
>
> What about antidepressant induced sexual dysfunction? I saw the results you posted. Am I missing something or has this issue not been evaluated with Lexapro? What if 40 mg Celexa causes cycling and 20 mg is used. Can/should 10 mg Lexapro be cut in half to avoid this risk? I know package inserts don't cover these intricate side effects. Just wondered if you have inside information.
> JaneB
>
>
>
Posted by JaneB on September 2, 2002, at 16:22:34
In reply to Re: Lexapro study effects, posted by winger on September 2, 2002, at 15:46:12
You didn't miss out. After being on antidepressants for 5+ years with an unsure diagnosis my pdoc suggested cyclothymia. After research on cyclothymia I discovered and he confirmed that cy. is classified under bipolar2 and can be aggravated by antidepressants which are not stabilized with a mood stabilizer. Someone else could probably explain it better. But I have learned to stay on a low dose of antidepressants to avoid "cycling" which for me is feeling great one day and depressed the next. Hope this helps. I didn't mean to put a glitch in the discussion re. Lexapro. I take Klonopin with an AD to counteract any cycling. If Lexapro would necessitate more Klonopin (.5mg/day now) I won't switch.
JaneB
Posted by pharmrep on September 2, 2002, at 17:15:57
In reply to Re: Lexapro study effects, posted by JaneB on September 2, 2002, at 15:24:11
> > > Why don't the study results indicate any positive conclusions about fewer ASE's or daytime sleepiness?
> > > Appreciate your info.
> > > JaneB
> >
> > ** Why do you think they dont? There are studies that show reduced s/e with Lexapro...here is a post from a couple days ago that has the FDA approved package insert info.
> > Re: Lexapro side-effects » dr dave
> > If you have any questions...I'd be glad to help if I can.
>
> Pharmrep,
>
> What about antidepressant induced sexual dysfunction? I saw the results you posted. Am I missing something or has this issue not been evaluated with Lexapro? What if 40 mg Celexa causes cycling and 20 mg is used. Can/should 10 mg Lexapro be cut in half to avoid this risk? I know package inserts don't cover these intricate side effects. Just wondered if you have inside information.
> JaneB
>
> **good news and bad. As far as cycling...I cant help you there...as far as sex. s/e...here's the scoop...5+ years ago, when Celexa was coming out the sex. s/e was at 6%. Back then (pre Viagra era and others) people were not very willing to mention sexual disfunction (embarrassed?) Anyway, we know that 6% was low...it was more like high-teens, or low 20's (Paxil and others had same problem and are believed to be 30%+.) Since Lexapro study was done in last year, we are hoping for a more "believeable" number since todays responders are more "aware" of the sexual s/e topic, and are more willing to bring it up. Anyway, the Lexapro number is 9%...it is believed to be slightly lower than Celexa, due to its increased Serotonin selectivity (there seems to be a connection to the more selective, the less the sex. s/e.) Ultimately, any AD working with serotonin will affect sex s/e. It's just a question of how much.
PS...the only mg's are 10mg and 20mg (but they are scored...the idea is so you can use 15mg...but of course some people do respond differently and maybe 5mg is good for some, however it has not been tested...10mg is the "normal" starting and maintenance dose. (And this is all in the P.I...read up if you can find it.)
Posted by pharmrep on September 2, 2002, at 17:28:16
In reply to Re: Lexapro effects » JaneB, posted by pharmrep on September 2, 2002, at 17:15:57
Cycling or "poop-out" takes a long time to evaluate. You are right about being on higher mg's to be affected...I have heard that. So if you are on 80+mg of Celexa (after titrating up from 20-40-60 over time) then you might get poop-out eventually...but not necessarily. If you have been on the same mg of something for a long time (low or high mg) then cycling should be less likely to occur. It is not an exact science, so nobody is sure on how or why it happens. Some people have taken prozac for 15 years, no probs...others needed to titrate up 10mg every few years or so, and now take 100+mg of prozac...anyway, you see the picture...hope this helps.
Posted by JaneB on September 2, 2002, at 18:17:30
In reply to Re: poop-out, posted by pharmrep on September 2, 2002, at 17:28:16
> Cycling or "poop-out" takes a long time to evaluate. You are right about being on higher mg's to be affected...I have heard that. So if you are on 80+mg of Celexa (after titrating up from 20-40-60 over time) then you might get poop-out eventually...but not necessarily. If you have been on the same mg of something for a long time (low or high mg) then cycling should be less likely to occur. It is not an exact science, so nobody is sure on how or why it happens. Some people have taken prozac for 15 years, no probs...others needed to titrate up 10mg every few years or so, and now take 100+mg of prozac...anyway, you see the picture...hope this helps.
"Cycling" and "poop out" are not the same at all. If an AD prescribed for depression "poops out" there are no good days. Just old depression and a dr. will up the dosage as you say. However, if there is "cycling" it is a spectrum of bipolar illness and can be induced by AD's. "Cycling" in this sense means highs and lows. Therefore, physicians should not prescribe antidepressants without being aware and following up a patient to watch for and educate patient about potential cycling caused by AD's. I think that some people who see all the ads of people laughing and feeling great may end up asking for an AD and subsequently find themselves worse off because of this potential for cycling and ignorance of the need for a mood stabilizer. (IMO). But you are not a patient or physician and have probably never found it necessary to research something of this nature. If I am wrong I welcome correction re. definition of "cycling", etc.
You are right--"poop out" takes a long time to evaluate. But "cycling" can happen right away with introduction of AD's and increased dosage for someone with bipolar tendencies. That is why I would change to Lexapro cautiously because it seems that I would be receiving more of the active antidepressant. Does this make sense?
Thanks,
JaneB
Posted by Mr.Scott on September 2, 2002, at 20:34:11
In reply to Re: alternatives » Geezer, posted by pharmrep on September 2, 2002, at 12:03:50
I think it's time for a new board that address politics..
Posted by Patson on September 2, 2002, at 20:46:28
In reply to Re: Raines et al, posted by dr dave on September 1, 2002, at 8:23:59
I have to admit I'm a little confused. Maybe I don't understand english all that well....
The investigators observed continued improvement in subjects with further reductions in the MADRS and CGI-S scores. ****The incidence of adverse events declined during escitalopram treatment versus short-term treatment. ****There were no clinically significant mean changes in vital signs, electrocardiogram (ECG), or laboratory values observed during continued escitalopram treatment, regardless of previous treatment. Researchers observed no new clinically significant adverse events in patients switching from citalopram to escitalopram treatment.
"In patients switched from citalopram to escitalopram, there are no safety concerns, and depressive symptoms continue to improve." the researchers concluded.
Hardly sounds like a negative...
> You can find a report by going to http://www.docguide.com and searching for 'escitalopram'. There is a news report dated 08/29/02 on the switching study. If there were any difference between citalopram and escitalopram the side-effects would have decreased and this would have been a major finding. It is noticeable by its absence.
>
>
> > "Indeed new research presented this week (Raines et al) looking at people switching from citalopram to escitalopram did not show any significant reduction in side-effects."
> >
> > That sounds important. Got a link? Or, can you copy and post?
> >
>
>
Posted by Patson on September 2, 2002, at 20:46:32
In reply to Re: Raines et al, posted by dr dave on September 1, 2002, at 8:23:59
I have to admit I'm a little confused. Maybe I don't understand english all that well....
The investigators observed continued improvement in subjects with further reductions in the MADRS and CGI-S scores. ****The incidence of adverse events declined during escitalopram treatment versus short-term treatment. ****There were no clinically significant mean changes in vital signs, electrocardiogram (ECG), or laboratory values observed during continued escitalopram treatment, regardless of previous treatment. Researchers observed no new clinically significant adverse events in patients switching from citalopram to escitalopram treatment.
"In patients switched from citalopram to escitalopram, there are no safety concerns, and depressive symptoms continue to improve." the researchers concluded.
Hardly sounds like a negative...
> You can find a report by going to http://www.docguide.com and searching for 'escitalopram'. There is a news report dated 08/29/02 on the switching study. If there were any difference between citalopram and escitalopram the side-effects would have decreased and this would have been a major finding. It is noticeable by its absence.
>
>
> > "Indeed new research presented this week (Raines et al) looking at people switching from citalopram to escitalopram did not show any significant reduction in side-effects."
> >
> > That sounds important. Got a link? Or, can you copy and post?
> >
>
>
Posted by Patson on September 2, 2002, at 20:47:01
In reply to Re: Raines et al, posted by dr dave on September 1, 2002, at 8:23:59
I have to admit I'm a little confused. Maybe I don't understand english all that well....
The investigators observed continued improvement in subjects with further reductions in the MADRS and CGI-S scores. ****The incidence of adverse events declined during escitalopram treatment versus short-term treatment. ****There were no clinically significant mean changes in vital signs, electrocardiogram (ECG), or laboratory values observed during continued escitalopram treatment, regardless of previous treatment. Researchers observed no new clinically significant adverse events in patients switching from citalopram to escitalopram treatment.
"In patients switched from citalopram to escitalopram, there are no safety concerns, and depressive symptoms continue to improve." the researchers concluded.
Hardly sounds like a negative...
> You can find a report by going to http://www.docguide.com and searching for 'escitalopram'. There is a news report dated 08/29/02 on the switching study. If there were any difference between citalopram and escitalopram the side-effects would have decreased and this would have been a major finding. It is noticeable by its absence.
>
>
> > "Indeed new research presented this week (Raines et al) looking at people switching from citalopram to escitalopram did not show any significant reduction in side-effects."
> >
> > That sounds important. Got a link? Or, can you copy and post?
> >
>
>
Posted by Seamus2 on September 2, 2002, at 22:02:26
In reply to Psycho babble for politics, posted by Mr.Scott on September 2, 2002, at 20:34:11
>
> I think it's time for a new board that address politics..
>
>Amen! "Psycho-Quibblers"
Seamus
Posted by Ritch on September 2, 2002, at 22:20:21
In reply to Psycho babble for politics, posted by Mr.Scott on September 2, 2002, at 20:34:11
>
> I think it's time for a new board that address politics..
>
>Scott,
This discussion definitely brings up POLICY issues for sure. I was certain this was going to wind up being political (socio-politico-economics of psych medication) when I saw a beatup pickup driving through town with a bumper sticker that said "HAVE YOU TAKEN YOUR LAZY PILLS TODAY?".
Mitch
Posted by pharmrep on September 3, 2002, at 0:24:59
In reply to Re: poop-out=cycling. No » pharmrep, posted by JaneB on September 2, 2002, at 18:17:30
Thanks for your clarification...can you have poop-out with or without cycling...or cycling with or without poop-out...I only ask because youre right..I dont know 1st hand and have only gotten this info from some of my Dr's...I heard the terms intermingled, but may be mistaken. Thanks
Posted by pharmrep on September 3, 2002, at 0:58:11
In reply to Re: Raines et al, posted by Patson on September 2, 2002, at 20:47:01
> I have to admit I'm a little confused. Maybe I don't understand english all that well....
>
> The investigators observed continued improvement in subjects with further reductions in the MADRS and CGI-S scores. ****The incidence of adverse events declined during escitalopram treatment versus short-term treatment. ****There were no clinically significant mean changes in vital signs, electrocardiogram (ECG), or laboratory values observed during continued escitalopram treatment, regardless of previous treatment. Researchers observed no new clinically significant adverse events in patients switching from citalopram to escitalopram treatment.
>
> "In patients switched from citalopram to escitalopram, there are no safety concerns, and depressive symptoms continue to improve." the researchers concluded.
>
> Hardly sounds like a negative...
> > You can find a report by going to http://www.docguide.com and searching for 'escitalopram'. There is a news report dated 08/29/02 on the switching study. If there were any difference between citalopram and escitalopram the side-effects would have decreased and this would have been a major finding. It is noticeable by its absence.
> >
> >
> > > "Indeed new research presented this week (Raines et al) looking at people switching from citalopram to escitalopram did not show any significant reduction in side-effects."
> > >
> > > That sounds important. Got a link? Or, can you copy and post?
> > >
> >
************** I run into the same problems with Dr. Dave too, he always seems to reach a different conclusion than what the study finds.
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