[e-drug] escitalopram vs citalopram ads - new article (3)

e-drug
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E-DRUG: escitalopram vs citalopram ads - new article (3)
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In response to Stevan Gressitt's thoughts:

It's obviously a good idea to take away the "inert constituent" of a chiral
drug when this causes side-effects or opposes the desired effect. Even when
this constituent is truly inert, I agree that it would in principle be
better to avoid the chiral ballast. The question is how much one should be
prepared to pay for this prinicipal benefit.

You can now get 98 20mg-tablets of generic citalopram for 188,50 SEK in
Sweden: the corresponding price for 98 10mg-tablets of escitalopram is
777,00 SEK. Both preparations contain 10 mgs of escitalopram and citalopram
also contains 10 mgs of R-citalopram. Should we pay 4,1 times more to avoid
having R-citalopram cruising around in the blood and being excreted into the
environment? Or, if our goal is to reduce the "R-citalopram pollution",
would we be better off spending our money on efforts to reduce unnecessary
prescriptions of citalopram?

Staffan Svensson
Dept of Clinical Pharmacology
Sahlgren's University Hospital
Sweden
staffan.svensson@pharm.gu.se

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E-DRUG: escitalopram vs citalopram ads - new article (4)
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dear E-druggers,

I wonder if there are any other isomer comparisons that can be made? On
economics it would be interesting to see if the comparative valuation holds
up. Strictly from a position of prescribing the most appropriate agent, the
fewer variables with metabolic influence the better, but I am unaware of how
significant that is. The waste element seems somewhat more compelling. When
specific brand-named pharmaceuticals show up in whatever the next
environmental survey there will likely be increasingly large a public
concern. It was recently brought to my attention that "Prozac Fish" are
being sold as bumper sticker emblems.
Is it a truism that racemic mixtures are always cheaper to produce than
isomeric?

regards

Stevan Gressitt, M.D.
gressitt@uninets.net

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