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Department of Pharmaceutical Services

Lexapro (escitalopram)

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Dear Physician,

Escitalopram (Lexapro) is the active isomer of the antideperessant citalopram (Celexa) which is generic. The manufacturer claims that escitalopram has more efficacy and a faster onset of offect thatn citalopram. These claims are not justified because they are based upon secondary outcomes, non-intention-to-treat analyses and arbitrarily defined subgroups. Generic citalopram (Celexa) is 6 cents for the 20 or 40 mg tablet while branded Lexapro costs over $2 for the 5,10, and 20 mg tablet.

Annals of Internal Medicine 2005;143:415-426 reviewd 46 head-head randomized, controlled trials comparing one second generation antidepressant (citalopram, escitalopram, sertraline, fluoxetine, paroxetine) with another. Overall, second generation antidepressants did not differ substantially for treating patients with major depressive disorder. In the absence of individual patient preference in terms of expected side effects or a product-specific dosing schedule, selection of initial treatment might be based on cost.

In five large studies of escitalopram versus citalopram in major depressive disorder (MDD), the overall type and incidence of adverse events was generally similar between treatments (Drugs 2005;65 (16) 2379-2404).

Summary: Generic citalopram provides safety and efficacy when compared to escitalopram but at a fraction of the cost.

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