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FRX Message Board

  • wallcheat wallcheat Jun 19, 2003 11:04 AM Flag

    lexapro and pharmacology shcl

    just talked to a newly graduated pharmacist

    he was taught in his classes about follow on drugs to patent expiring drugs

    his professor highlighted 2 specific drugs where they were told no real advantage exists with the new drug

    they were lexapro and nexium

    I think it is interesting that all these shrinks think there is a clear difference and advantage, meanwhile pharmacology schools are teaching their students otherwise

    I wonder what the truth realaly is and can it really be ascertained?

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    • I remember reading somewhere that Lexapro offers real advantages for negroes but not so in regular white people.

    • Facts are facts drugstockdude....perhaps if you had ever worked in a pharmacy to see trends that go through there I'd take your opinion a little more seriously. And when did I ever make the statement "all enantiomers are the same"....and what are you credentials to call some distinguished professors "jaded". Go take your Lexapro.

      • 1 Reply to Rastaman17_99
      • How do you know I do not work in a pharmacy? How can you call my credentials into account without even asking what they are? You are the one who identified yourself as a student, and by defination, as a student you are still learning and lack practical experience.

        As most people over the age of 25 with college educations will tell you, it takes time and experience to realize that not everything one learns in college is true. That's not a bust...just a common expereince most people share.

        And one last note - get off beleiveing the world is ruled by pharmacokenitics. There is also something called pharmacodynamics. To be honest, most docs are more concerned with the latter, becasue nobody treats plasma levels, buddy...doctors treat real real life people with real life problems. While PK info is useful, it is not everything.

        And if there was no difference between the drugs, why does the 10 mg dose of escitalopram give the same pharmacodynamic reults as the 40 mg dose of Celexa, which contains 20 mg of the s-enantiomer? It should be only half as effective if your professor was right and there was no difference. Could it possibly be that the r-enantiomer inhibits the s-enantiomer? Did your professor show you any of the studies that look at the two diffent enantiomers and their effects? If so, which ones? If he did, you would see (as millions of patients and thousands of doctors have) that there is a diffence.

    • To the question regarding whether his doctor knows what he is doing when he only prescribes Celexa for anxiety....Celexa is occasionally used for anxiety, but not commonly. It's main indication is for depression. As for your doctor giving Celexa for anxiety, there are drugs that have been a mainstay as anti-anxiety drugs (Xanax) for years upon years now that have generics that are a fraction of the price. So that is what I would get if I had anxiety problems. Don't get me wrong, I respect doctors to the utmost degree, but they only have one semester of pharmacology in med school and often simpily don't prescibe the best drug for a given situation because of lack of knowledge of more appropriate drugs and because of lack of knowledge of what the patient will be shelling out at the pharmacy.

    • The reason drug companies market one enantiomer at some point (Lexapro) over the racemic mixture of both enantiomers is because patents are running out soon and they want to keep their market share with a "newer, better" drug. There is a claim that the single enatiomer drug would have less side effects, but you see in practice that there is essentially no difference in patients side effects. The reason companies don't originally market the active enantiomer is two reasons: 1) so they can pull this switch when patent is running out 2)it is more cheaper in terms of production to make the racemic mixture(of both enantiomers) rather than chemically separating one from the other. With all this said, the average person knows none of the market place is still greatly affected by the enantiomeric switch. A couple other well known examples other than Lexapro/Celexa is Nexium/Prilosec and Clarinex/Claritin.

      • 2 Replies to Rastaman17_99
      • As a treatment resistent depression patient that has probably been on 30 or more drugs, I can assure you that for me Lexapro is a superior drug to Celexa. First, I have no inorgasmia with Lexapro. I had significan sexual side effects with Celexa, Paxil, mood stabilizers, etc. Also, on Lexapro you feel more normal. You mood is improved with both but on Celexa you feel "flatter." Good job FRX. Keep on developing!!!

      • Rasta:

        I have no doubt you are telling us what you really beleive. I also have no doubt that your sources of information are limited to a few professors, who are citing a few selected sources and who probably have not seen anything outside the acedemic setting for a very long time.

        Some of what you say is true...other parts are not...and not all isomers are the same. To say all enantimers are nothing more than patent-beating ploys is very naive, and shows a lack of balance in your training.

        Beleive it or not, you do not know it all as a 21 year old pharm student. And you will learn (as all of us who have gone through school) that profs are not always right, and sometimes are down-right jaded.

    • The pharmacist you talked to was telling you the truth...I'm a 3rd year pharmacy student and we were taught the same. And we're positive it's true because we learned it down to the pharmacology. For example, the anti-depresant Lexapro is a take off of the drug Celexa. Drugs have two enantiomers or chemical configurations they take in the body, one being active and the other inactive. Lexapro is the active enantiomer of Celexa. It is NO MORE EFFECTIVE....
      so 10mg Lexapro=20mg Celexa. Of course, the common person doesn't know that and always wantsthe "newer" drug because it must be "better" they think. So it is no more effective, but that doesn't mean that it won't make lots of money.

      • 2 Replies to Rastaman17_99
      • Your pharmacology training was incomplete if it taught you that Lexapro is equivalent to Celexa, just at half the dose. Being a pure enantiomer rather than a mixture of two, Lexapro not only differs from Celexa in dosing, but also its pharmacokinetics, biodistribution, and side effect liability will differ. This is supported by clinical data demonstrating equivalent antidepressant efficacy with 10 mg Lexapro and 40 mg Celexa, but with reduced side-effect liability. Finally, the marketplace is sensitive to differences between Lexapro and Celexa (and other antidepressants), accounting for the impressive product launch and takeover of market share from more entrenched products.

      • rastaman - thata sounds interesting

        is this the same concept as a reversed molecule

        also, why do think that the active form, or lexapro, was not the one originally brought to market

        also, when is it or is it not an advantage to take a lower dose form?

        for instance, that same pharma grad. said that he was taught that lipiptor is a superior statin, precisely because it takes less of the compound to acheieve the same effect as others, and is therefore less a negative burden on the body

        would there be any lower dose advantage in the lexapro case?