So I’ve been taking lexapro for many years now before coming back to Taiwan. Now, the clinic in Taiwan just prescribed supposedly the same drug, but on the package it says “Lepax”. Can anyone confirm that this is exactly the same as Lexapro?
Thanks guys. The reason I’m asking is that I’d like to stick to the name brand, since some generics in the past have given me side effects. Does anyone know if Lepax is actually Lexapro just rebranded in TW, or a generic form of the drug?
It’s a generic. Some clinics do prescribe actual Lexapro, but the majority do not because the generic is cheaper. There’s quite a few different generics that they use. Even big hospitals mostly don’t stock Lexapro.
I can guarantee that these clinics run by MOHW have Lexapro. One in Tucheng, one in Bali and one in Luzhou.
Actually generics have to reach a standard which is 80%-115% of the maximum blood concentration for that particular drug. So you may not get the exact same amount. Plus, the binding agents used to make a pill can affect the time it takes to release.
With psychiatric drugs, generics can feel significantly different.
They shouldn’t in principle, pharmaceutically, but like @Parkemoon said it can be affected by the permitted range of drug/blood concentrations, plus formulation issues like excipients and polymorphs etc.
And some people are just superstitious about having the “official” brand. I’ve even heard doctors suggest that - not in any kind of rational, educated way, just “you can try the original if you want to pay for it, maybe it’ll be a little better, up to you.”
From what I read about lexapro it is essentially an isolated isomer of the drug that is used in a different brand, except that different brand had a mix of right or left hand variety so more of the drug was needed in order to have an effect, as one isomer works and the other does not. Lexapro manages to filter out the inactive isomer and therefore gives better therapeutic effect with less side effect since less of the drug is needed.
Yep. That other drug was Celexa. They are two different drugs, not just different brands. Lexapro quickly became far more commonly prescribed (for good reason, as you mention) and continues to be.
That’s not what this thread is about, though. We’re discussing the difference (or lack of) between name brand Lexapro and generic Lexapro (literally the same active ingredient) not the significant difference between Lexapro and Celexa
as Lexapro is simply Celexa that has its inactive isomer removed thereby reducing required dosage, the method of production may be similar and that the difference between the actual brand and the generic brand could be that generic brand has more of the inactive isomer that has not been removed… thus the slightly higher side effect?
Yeah, what you wrote is essentially correct – it’s the (S) enantiomer of citalopram (hence the “es” in the generic name), which is apparently 30–40 times more active than the (R) enantiomer and twice as active as the racemic 1:1 mixture (for obvious reasons). It seems that (R)-citalopram may also slightly inhibit the activity of the (S) enantiomer as well, meaning that the enantiopure version has an even greater effect than double the dose of the racemate.
The active ingredient/drug is the same though, as you say (i.e., they’re exactly the same chemical compound in everything except optical and biological activity – just mirror images). It seems there’s a genuine advantage here, but sometimes pharmaceutical companies do that to extend patent lifetimes because it counts as a new drug. (The other famous example of this is thalidomide, where one enantiomer is a sedative and the other is a teratogen, but the difference between enantiomers wasn’t really understood at the time).
I’m not sure how the synthetic routes used industrially vary. To manufacture an enantiopure form, they often need to completely revise the chemistry and processes to use chiral starting materials (often expensive). It does seem in this case though that they indeed use chiral chromatographic separation to remove the inactive (R)-citalopram or late-stage intermediates, which I believe is still pretty rare.
So it’s plausible that what you say is correct – that more of the inactive isomer could be present depending on the manufacturing process. That’s a trivial thing to measure analytically though. It might be that overall purity (chemical purity plus enantiopurity) is a bigger contributor, plus formulation differences (and psychology, as mentioned above). I guess it all depends on the standards of the generic manufacturer.
Only way to know for sure is to do a study on them, by putting generic drugs in the same package of the genuine one (which would cause a lot of problems with trademark) and compare this to people who take the real thing. To eliminate psychology as a contributor.
But in my experience I have not experienced any side effect except when I try to quit them cold turkey. But almost all SSRI has issues with this.