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Citalopram pharmacology

Posted by dr. dave on August 20, 2002, at 15:22:46

In reply to Re: Question re dose pharmrep, posted by Anyuser on August 20, 2002, at 14:57:57

The statement '10mg Lex is 40mg Celexa' doesn't make any sense. Let's get down to the science here - '10mg lex' is 10mg of s-citalopram. '40mg Celexa' is 20mg s-citalopram plus 20mg r-citalopram. That's different. A study has been presented claiming 10mg Lexapro is as effective as 40mg Celexa - but Jack Gorman in his meta-analysis of the research states that this study was too small to demonstrate differences in efficacy. The result of one small trial is not necessarily the complete and absolute truth.

Is the separation expensive? A slow-moving bed plant required to separate stereoisomers costs upward of $5 million. To me, that's expensive.

Where do I get my info? From the published studies, which I have looked through thoroughly, and from a knowledge of pharmacology from studying at Cambridge University.

The studies SUGGEST certain things, but are very very far from demonstrating them conclusively. Statistical significance of difference is inconsistent across the studies. Lexapro will certainly not be cheaper than generic citalopram which is available in Europe to the best of my knowledge.

Although r-citalopram has some affinity to histamine (not 'histomine') receptors this does not mean it is 'inhibiting s-citalopram'. You cannot inhibit a molecule, you can only inhibit a process - which process involving s-citalopram is the r-citalopram/histamine receptor interaction inhibiting?

The whole marketing of this drug seems to be based on sloppy science. I have no problem with Celexa, I prescribe it all over the place, but raising desparate people's hopes with woolly and wishful thinking I object to.

I would be happy to discuss the shortcomings of any particular study on escitalopram that is publically available if we want to get into the science of it.




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