Posted by pharmrep on August 21, 2002, at 12:04:44
In reply to Re: Knowledge, posted by dr. dave on August 21, 2002, at 8:58:35
> This is a good point. I think my stance is that I shouldn't be changing my practice, particularly if it is an expensive change which will unavoidably reduce resources in some other area, until I have reasonable grounds for doing so, and I don't think that I have those grounds to change to Lexapro. If the drug company can't come up with reasonable evidence, with every incentive to do so, I can feel fairly sure there's not much to find.
> Having said that for a particular patient with a particular problem, where all other logical options have been tried, I would give the rather far-fetched claims for Lexapro a go, but I would prefer to make decisions based on strong evidence before satisfying curiosity about a new drug for which convincing support cannot be found.
> I don't think it is unreasonable to look to scientific evidence to inform my prescribing habits rather than just 'having a go' with something new in case it works. If we all did that prescribing would be even more chaotic than it already is. I think large-scale well designed studies actually do carry more weight than one doctor's anecdotal evidence.
> I haven't been able to find the data which indicate a lower incidence of sexual side-effects on Lexapro than Celexa - If pharmrep or anyone can point me in the right direction I would be very interested.
*** You keep mentioning expense...why? Lexapro although new, will cost less than Celexa for your patients. Even if you are not persuaded by the studies you've read that Lexapro has better efficacy...would you agree that the side effect profile and drug to drug interactions and lack of adverse events are even more favorable than Celexa? That alone should be enough. But I know that it will be slow going for some (you included) and thats fine...you can judge for yourself with the patients you do try it with. As for additional studies...the FDA wants specific ones first...efficacy, tolerablity, and others. I know that others are already in the works...(ie head to head Lexapro vs Effexor...etc.) Larger scale studies take more time and will out soon too. As for sexual side effects...the FDA relies on "volunteered" info...so Celexa at 6% over 5 years ago was really more like in the teens-20% (I hear Paxil and Prozac at 30% and above from my dr's) but the awareness then and candidness was not what it is today.
Lexapro at 9% is believed to be a more accurate number since data is less than 1 yr old and the study-patients might have been more apt to site the ejac/delay. But if the number crept up to the low teens...I wouldnt be surprised...Lexapro is still an SSRI, so it will be there...it seems the more selective though, the less the side effects. Only real life practices and experience will be able to reveal a clearer picture.