Escitalopram: Difference between revisions

{{dablink|The Cipralex brand name should not be confused with the antibiotic drug [[ciprofloxacin]] or its various brand names such as Cipro.}}

{{drugbox

| image = Escitalopram Structural Formulae.png

| image2 = Escitalopram-from-xtal-3D-balls.png

| width = 200

| verifiedrevid = 416383789

| CASNo_Ref = {{cascite|correct|CAS}}

| ChEMBL_Ref = {{ebicite|correct|EBI}}

| ChEMBL = 1508

| StdInChI_Ref = {{stdinchicite|correct|chemspider}}

| StdInChI = 1S/C20H21FN2O/c1-23(2)11-3-10-20(17-5-7-18(21)8-6-17)19-9-4-15(13-22)12-16(19)14-24-20/h4-9,12H,3,10-11,14H2,1-2H3/t20-/m0/s1

| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}

| StdInChIKey = WSEQXVZVJXJVFP-FQEVSTJZSA-N

| CAS_number = 128196-01-0

| ChEBI = 36791

| PubChem = 146570

| InChI = 1/C20H21FN2O/c1-23(2)11-3-10-20(17-5-7-18(21)8-6-17)19-9-4-15(13-22)12-16(19)14-24-20/h4-9,12H,3,10-11,14H2,1-2H3/t20-/m0/s1

| smiles = Fc1ccc(cc1)[C@@]3(OCc2cc(C#N)ccc23)CCCN(C)C

| InChIKey = WSEQXVZVJXJVFP-FQEVSTJZBT

| IUPAC_name = (''S'')-1-[3-(dimethylamino)propyl]-1-(4-fluorophenyl)-1,3-dihydroisobenzofuran-5-carbonitrile

| DrugBank_Ref = {{drugbankcite|correct|drugbank}}

| DrugBank = APRD00683

| image=Escitalopram.png

| molecular_weight = 324.392 g/mol<br>(414.43 as oxalate)

| bioavailability = 80%

| protein_bound = ~56%

| metabolism = Liver, specifically the enzymes [[CYP3A4]] and [[CYP2C19]]

| elimination_half-life = 27–32 hours

| pregnancy_category = C

| legal_status = Rx Only <small>(U.S)</small> [[Prescription only medicine|POM]] <small>(U.K)</small>

| routes_of_administration = Oral

'''Escitalopram''' (trade names '''Anxiset E'''(India) '''Lexapro''', '''Cipralex''', '''Seroplex''', '''Lexamil''', '''Lexam''') is an [[antidepressant]] of the [[selective serotonin reuptake inhibitor]] (SSRI) class. It is approved by the [[Food and Drug Administration (United States)|U.S. Food and Drug Administration]] (FDA) for the treatment of adults with [[major depressive disorder]] and [[generalized anxiety disorder]]{{cite}}. Escitalopram is the ''S''-[[stereoisomer]] ([[enantiomer]]) of the earlier Lundbeck drug [[citalopram]], hence the name ''es''citalopram. Escitalopram is noted for its high selectivity with [[selective serotonin reuptake inhibitor| serotonin reuptake inhibition]]. Its [[side effects]] are typical for the SSRI class.

[[Image:Lexapro pills.jpg|thumb|Lexapro tablets]]

Escitalopram is primarily used for the treatment of [[major depressive disorder]] and [[general anxiety disorder]] in adults.<ref name=AHFS>{{cite web|title=Escitalopram Oxalate|url=http://www.drugs.com/monograph/escitalopram-oxalate.html|work=The American Society of Health-System Pharmacists|accessdate=3 April 2011}}</ref> Trial databases of drug-approving agencies show statistically significant differences favouring escitalopram over other antidepressive agents for the acute phase treatment of major depression. <ref>{{cite journal|last=Cipriani|first=A|coauthors=Santilli, C, Furukawa, TA, Signoretti, A, Nakagawa, A, McGuire, H, Churchill, R, Barbui, C|title=Escitalopram versus other antidepressant agents for depression.|journal=Cochrane database of systematic reviews (Online)|date=2009 Apr 15|issue=2|pages=CD006532|pmid=19370639|doi=10.1002/14651858.CD006532.pub2|editor1-last=Cipriani|editor1-first=Andrea}}</ref> An analysis published in ''The Lancet Medical Journal'' found that escitalopram and [[sertraline]] had the highest rate of efficacy and acceptability among adults receiving treatment for [[major depression]] with second-generation [[antidepressants]].<ref>{{cite journal|last=Cipriani|first=A|coauthors=Furukawa, TA, Salanti, G, Geddes, JR, Higgins, JP, Churchill, R, Watanabe, N, Nakagawa, A, Omori, IM, McGuire, H, Tansella, M, Barbui, C|title=Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis|journal=Lancet|date=2009 Feb 28|volume=373|issue=9665|pages=746–58|pmid=19185342|doi=10.1016/S0140-6736(09)60046-5}}</ref>

==Adverse effects==

The [[Adverse drug reaction|side effect]] profile of escitalopram is similar to that of other [[SSRI]]s. For example, according to the FDA analysis of depression trials common side effects for the highest approved dose of escitalopram are insomnia (14% vs. 4% for placebo), constricted pupils (15% vs. 5% for placebo), dry mouth (9% vs 3% for placebo), [[somnolence]] (9% vs 1% for placebo), dizziness (7% vs 2% for placebo), sweating (8% vs 1% for placebo), constipation (6% vs 1% for placebo), fatigue (6% vs 2% for placebo) and indigestion (6% vs. 1% for placebo).<ref name=FDA10>{{cite web | author = FDA Center for Drug Evaluation and Research| title =Review and evaluation of clinical data for application 21-323|year=2001|accessdate = 2009-12-03 | url = http://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/21-323.pdf_Lexapro_Medr_P1.pdf}}</ref> Escitalopram, like other SSRIs, has been shown to affect sexual functions causing side effects such as decreased [[libido]], [[delayed ejaculation]], genital anesthesia,<ref>{{cite journal |author=Bolton JM, Sareen J, Reiss JP |title=Genital anesthesia persisting six years after sertraline discontinuation |journal=J Sex Marital Ther |volume=32 |issue=4 |pages=327–30 |year=2006 |pmid=16709553 |doi=10.1080/00926230600666410 |url=http://www.informaworld.com/openurl?genre=article&doi=10.1080/00926230600666410&magic=pubmed |unused_data=1B69BA326FFE69C3F0A8F227DF8201D0}}</ref> and [[anorgasmia]].<ref name="pmid16430968">{{cite journal

|author=Clayton A, Keller A, McGarvey EL

|title=Burden of phase-specific sexual dysfunction with SSRIs

|journal=Journal of Affective Disorders

|volume=91

|issue=1

|pages=27–32

|year=2006

|pmid=16430968

|doi=10.1016/j.jad.2005.12.007

}}</ref><ref>[http://www.frx.com/pi/lexapro_pi.pdf Lexapro prescribing information]</ref> Although usually reversible upon discontinuation, these sexual side effects can last for months or years after the drug has been completely withdrawn.<ref>{{cite journal |author=Csoka AB, Bahrick AS, Mehtonen O-P |title=Persistent Sexual Dysfunction after Discontinuation of Selective Serotonin Reuptake Inhibitors (SSRIs) |journal=J Sex Med. |volume=5 |issue= 1|pages=227–33 |year=2008 |doi= 10.1111/j.1743-6109.2007.00630.x|url=http://www.blackwell-synergy.com/doi/abs/10.1111/j.1743-6109.2007.00630.x |pmid=18173768}}</ref> This is known as [[Post SSRI Sexual Dysfunction]]. SSRI can rarely cause [[extrapyramidal side effects]] including [[akathisia]] through the indirect inhibition of [[dopamine]].

Escitalopram is not associated with significant weight gain. For example, 0.6&nbsp;kg mean weight change after 6 months of treatment with escitalopram for depression was insignificant and similar to that with placebo (0.2&nbsp;kg).<ref name="pmid17848424">{{cite journal |author=Baldwin DS, Reines EH, Guiton C, Weiller E |title=Escitalopram therapy for major depression and anxiety disorders |journal=Ann Pharmacother |volume=41 |issue=10 |pages=1583–92 |year=2007 |pmid=17848424 |doi=10.1345/aph.1K089}}</ref> 1.4–1.8&nbsp;kg mean weight gain was reported in 8-month trials of escitalopram for depression,<ref name="pmid17559729">{{cite journal |author=Pigott TA, Prakash A, Arnold LM, Aaronson ST, Mallinckrodt CH, Wohlreich MM |title=Duloxetine versus escitalopram and placebo: an 8-month, double-blind trial in patients with major depressive disorder |journal=Curr Med Res Opin |volume= 23|issue= 6|pages=1303|year=2007 |pmid=17559729 |doi=10.1185/030079907X188107}}</ref> and [[generalized anxiety disorder]].<ref name="pmid16420082">{{cite journal |author=Davidson JR, Bose A, Wang Q |title=Safety and efficacy of escitalopram in the long-term treatment of generalized anxiety disorder |journal=J Clin Psychiatry |volume=66 |issue=11 |pages=1441–6 |year=2005 |pmid=16420082 |doi=10.4088/JCP.v66n1115}}</ref> A 52-week trial of escitalopram for the long-term treatment of depression in elderly also found insignificant 0.6&nbsp;kg mean weight gain.<ref name="pmid17230032">{{cite journal |author=Kasper S, Lemming OM, de Swart H |title=Escitalopram in the long-term treatment of major depressive disorder in elderly patients |journal=Neuropsychobiology |volume=54 |issue=3 |pages=152–9 |year=2006 |pmid=17230032 |doi=10.1159/000098650}}</ref> Escitalopram may help reduce weight in those treated for [[binge eating]] associated [[obesity]].<ref name="pmid18058852">{{cite journal

| last = Guerdjikova

| first = Anna I.

| coauthors = Susan L. McElroy, Renu Kotwal, Jeffrey A. Welge, Erik Nelson, Katie Lake, David D' Alessio, Paul E. Keck Jr, James I. Hudson

|title = High-dose escitalopram in the treatment of binge-eating disorder with obesity: a placebo-controlled monotherapy trial

|journal= Human Psychopharmacology: Clinical and Experimental

|volume=23

|issue=1

|pages=1–11

|year=2008

|pmid=18058852

|doi=10.1002/hup.899

}}</ref>

An analysis conducted by the FDA found a statistically insignificant 1.5 to 2.4-fold (depending on the statistical technique used) increase of [[suicidality]] among the adults treated with escitalopram for psychiatric indications.<ref name=FDA>{{cite web | author = Levenson M, Holland C| title =Antidepressants and Suicidality in Adults: Statistical Evaluation. (Presentation at Psychopharmacologic Drugs Advisory Committee; December 13, 2006)|accessdate = 2007-05-13 | url = http://www.fda.gov/ohrms/dockets/ac/06/slides/2006-4272s1-04-FDA.ppt}}</ref><ref name =FDA2>{{cite web | url = http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4272b1-01-FDA.pdf | title = Clinical Review: Relationship Between Antidepressant Drugs and Suicidality in Adults| accessdate = 2007-09-22 | author = Stone MB, Jones ML | authorlink = | coauthors = |date=2006-11-17| format =PDF | work = Overview for December 13 Meeting of Pharmacological Drugs Advisory Committee (PDAC) | publisher = FDA| pages = 11–74| language = | archiveurl = | archivedate = | quote = }}</ref><ref name =FDA3>{{cite web | url = http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4272b1-01-FDA.pdf | title = Statistical Evaluation of Suicidality in Adults Treated with Antidepressants | accessdate = 2007-09-22 | author = Levenson M, Holland C | authorlink = | coauthors = |date=2006-11-17| format =PDF | work =Overview for December 13 Meeting of Pharmacological Drugs Advisory Committee (PDAC) | publisher = FDA| pages = 75–140| language = | archiveurl = | archivedate = | quote = }}</ref> Similarly, the UK [[MHRA]] data indicate an 80% increase of suicide-related events, not reaching [[statistical significance]], in the escitalopram vs placebo patients.<ref name="pmid15718537">{{cite journal |author=Gunnell D, Saperia J, Ashby D |title=Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomized controlled trials submitted to the MHRA's safety review |journal=BMJ |volume=330 |issue=7488 |pages=385 |year=2005 |pmid=15718537 |doi=10.1136/bmj.330.7488.385|accessdate=2007-09-25 |pmc=549105}}</ref> The authors of a related study note the general problem with statistical approaches: due to the rarity of suicidal events in clinical trials, it is hard to draw firm conclusions with a sample smaller than two million patients.<ref name="pmid17453659">{{cite journal |author=Khan A, Schwartz K |title=Suicide risk and symptom reduction in patients assigned to placebo in duloxetine and escitalopram clinical trials: analysis of the FDA summary basis of approval reports |journal=Ann Clin Psychiatry |volume=19 |issue=1 |pages=31–6 |year=2007 |pmid=17453659 |doi=10.1080/10401230601163550}}</ref> A single [[case report]] described a patient developing [[suicidal ideations]] after beginning treatment with escitalopram, and suicidal ideation disappearing after stopping the treatment.<ref>{{Cite journal

| last = Budur

| first = Kumar

| coauthors = Jeffrey Hutzler

| title = Severe suicidal idealization with escitalopram (Lexapro): a case report

| journal = Primary Care Psychiatry

| volume = 9

| issue = 2

| month = June

| year= 2004

| pages = 67–68

| doi = 10.1185/135525704125004222

}}</ref>

Escitalopram should be taken with caution when using [[St John's wort]].<ref>{{cite book | title=2006 Lippincott's Nursing Drug Guide |last=Karch |first=Amy |year= 2006 |publisher=Lippincott Williams & Wilkins |location=Philadelphia, Baltimore, New York, London, Buenos Aires, Hong Kong, Sydney, Tokyo |isbn= 1-58255-436-6}}</ref> Exposure to escitalopram is increased moderately, by about 50%, when it is taken with [[omeprazole]]. The authors of this study, employed by Lundbeck, suggested that this increase is unlikely to be of clinical concern<ref name=pmid16120067>{{Cite pmid|16120067}}</ref> Caution should be used when taking cough medicine containing [[dextromethorphan]] (DXM) as [[serotonin syndrome]], liver damage, and other negative side effects have been reported.

Escitalopram discontinuation, particularly abruptly may cause certain [[Withdrawal#Withdrawal_from_prescription_medicine|withdrawal]] [[symptom]]s such as "electric shock" sensations (also known as "[[brain zaps|brain shivers]]" or "[[brain zaps]]"), [[dizziness]], acute depressions and [[irritability]], as well as heightened senses of [[akathisia]].<ref>{{cite web | title=Lexapro – Warnings | url=http://www.rxlist.com/cgi/generic/lexapro_wcp.htm |date=12/08/2004 | publisher=RxList | accessdate=2006-10-22}}</ref>

Excessive doses of escitalopram usually cause relatively minor untoward effects such as agitation and tachycardia. However, [[dyskinesia]], [[hypertonia]] and [[clonus]] may occur in some cases. Plasma escitalopram concentrations are usually in a range of 20-80 μg/L in therapeutic situations and may reach 80-200 μg/L in the elderly, patients with hepatic dysfunction, those who are poor CYP2C19 metabolizers or following acute overdose. Monitoring of the drug in plasma or serum is generally accomplished using chromatographic methods. Chiral techniques are available to distinguish escitalopram from its racemate, citalopram.<ref>van Gorp F, Whyte IM, Isbister GK. Clinical and ECG effects of escitalopram overdose. Ann. Emer. Med. 54: 404-408, 2009.</ref><ref>Haupt D. Determination of citalopram enantiomers in human plasma by liquid chromatographic separation on a Chiral-AGP column. J. Chrom. B 685: 299-305, 1996.</ref><ref>R. Baselt, ''Disposition of Toxic Drugs and Chemicals in Man'', 8th edition, Biomedical Publications, Foster City, CA, 2008, pp. 552-553.</ref>

[[Image:Cipralex.jpg|thumb|right|Cipralex brand escitalopram package and tablet sheet]]

Escitalopram increases intrasynaptic levels of the neurotransmitter [[serotonin]] by blocking the [[reuptake]] of the neurotransmitter into the presynaptic neuron. Of the SSRIs currently on the market escitalopram has the highest affinity for the human [[serotonin transporter]] (SERT). The enantiomer of escitalopram (''R''-citalopram) counteracts to a certain degree the serotonin-enhancing action of escitalopram. As a result, escitalopram is a more potent antidepressant than citalopram, which is a mixture of escitalopram and ''R''-citalopram.

In order to explain this phenomenon, researchers from Lundbeck proposed that escitalopram enhances its own binding via an additional interaction with another [[allosteric site]] on the transporter.<ref name="pmid15160261">For an overview of supporting data, see {{cite journal

|author=Sánchez C, Bøgesø KP, Ebert B, Reines EH, Braestrup C

|title=Escitalopram versus citalopram: the surprising role of the R-enantiomer

|journal=Psychopharmacology (Berl.)

|volume=174

|issue=2

|pages=163–76

|year=2004

|pmid=15160261

|doi=10.1007/s00213-004-1865-z

}}</ref>

Further research by the same group showed that ''R''-citalopram also enhances binding of escitalopram,<ref name="pmid15695064">{{cite journal

|author=Chen F, Larsen MB, Sánchez C, Wiborg O

|title=The S-enantiomer of R,S-citalopram, increases inhibitor binding to the human serotonin transporter by an allosteric mechanism. Comparison with other serotonin transporter inhibitors

|journal=European Neuropsychopharmacology

|volume=15

|issue=2

|pages=193–198

|year=2005

|pmid=15695064

|doi=10.1016/j.euroneuro.2004.08.008

}}</ref> and therefore the allosteric interaction cannot explain the observed counteracting effect. In the most recent paper, however, the same authors again reversed their findings and reported that ''R''-citalopram decreases binding of escitalopram to the transporter.<ref name="pmid16448580">{{cite journal

|author=Mansari ME, Wiborg O, Mnie-Filali O, Benturquia N, Sánchez C, Haddjeri N

|title=Allosteric modulation of the effect of escitalopram, paroxetine and fluoxetine: in-vitro and in-vivo studies

|journal= The International Journal of Neuropsychopharmacology

|volume=10

|issue=1

|pages=31–40

|year=2007

|pmid=16448580

|doi=10.1017/S1461145705006462

}}</ref> Although allosteric binding of escitalopram to the serotonin transporter is of unquestionable research interest, its clinical relevance is unclear since the binding of escitalopram to the allosteric site is at least 1000 times weaker than to the primary binding site.

''In vitro'' studies using human liver microsomes indicated that [[CYP3A4]] and [[CYP2C19]] are the primary isozymes involved in the N-demethylation of escitalopram. The resulting metabolites, [[desmethylescitalopram]] and [[didesmethylescitalopram]], are significantly less active and their contribution to the overall action of escitalopram is negligible.

Escitalopram was developed in a close cooperation between [[Lundbeck]] and [[Forest Laboratories]]. Its development was initiated in the summer of 1997, and the resulting new drug application was submitted to the U.S. FDA in March 2001. The short time (3.5 years) it took to develop escitalopram can be attributed to the previous extensive experience of Lundbeck and Forest with [[citalopram]], which has similar pharmacology.<ref>{{cite web | title=2000 Annual Report. p 28 and 33 | url=http://www.materials.lundbeck.com/lundbeck/82/fullpdf/1.pdf |format=PDF |year=2000 |publisher=Lundbeck | accessdate=2007-04-07}}</ref>

The FDA issued the approval of escitalopram for major depression in August 2002 and for generalized anxiety disorder in December 2003. Escitalopram can be considered an example of "[[evergreening]]"<ref>{{cite web | title=New drugs from old. Presented at the Medical Journal Club, Morriston Hospital by Scott Pegler, Pharmacist at the National Health Service (UK) on November 20, 2006| url=http://www.pharmedout.org/Pegler_New_Drugs_From_Old_Nov2006.ppt |format=PPT |accessdate=2007-04-07}}</ref> (also called "lifecycle management"<ref>{{cite journal|url=http://dtb.bmj.com/cgi/content/abstract/44/10/73?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=escitalopram&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT| title=New drugs from old |journal=Drug and Therapeutics Bulletin ;44:73-77; |doi=10.1136/dtb.2006.441073 |publisher=BMJ Publishing Group Ltd. |pages=73–77 |year=2006 |volume=44|issue=10}}</ref>)– the long-term strategy pharmaceutical companies use in order to extend the lifetime of a drug, in this case of the citalopram franchise. Escitalopram is an [[enantiomer|enantiopure compound]] of the [[racemic mixture]] [[citalopram]], used for the same indication, and for that reason it required less investment and less time to develop. Two years after escitalopram's launch, when the patent on citalopram expired, the escitalopram sales successfully made up for the loss. On May 23, 2006, the FDA approved a generic version of escitalopram by Teva.<ref>{{cite news |author=Miranda Hitti |title=FDA OKs Generic Depression Drug – Generic Version of Lexapro Gets Green Light |url=http://www.webmd.com/content/article/122/114778.htm |publisher=WebMD |accessdate=2007-10-10}}</ref> On July 14 of that year, however, the [[United States District Court for the District of Delaware|U.S. District Court of Delaware]] decided in favor of Lundbeck regarding the patent infringement dispute and ruled the patent on escitalopram valid.<ref>{{cite news |author=Marie-Eve Laforte |title= US court upholds Lexapro patent |date=2006-07-14 |url=http://www.firstwordplus.com/Fws.do?src=corp_site&articleid=7474B41ED0D14C20894E262219E24B62 |publisher=FirstWord |accessdate=2007-10-10}}</ref>

In 2006 Forest Laboratories was granted an 828 day (2 years and 3 months) extension on its US patent for escitalopram.<ref>{{cite press release

| title = Forest Laboratories Receives Patent Term Extension for Lexapro

| publisher = PRNewswire-FirstCall

| date = 2006-03-02

| url = http://www.frx.com/news/PressRelease.aspx?ID=824655

| accessdate = 2009-01-19

}}</ref> This pushed the patent expiry from December 7, 2009 to March 14, 2012.

==Controversy==

According to ''[[The New York Times]]'', aggressive [[pharmaceutical marketing]] of escitalopram by Forest Laboratories has been controversial: the generic alternatives to the drug are cheaper, but a substantial number of doctors continue to prescribe the more expensive proprietary drug. The [[United States Senate Special Committee on Aging]] has released [http://www.nytimes.com/packages/pdf/politics/20090831MEDICARE/20090831_MEDICARE.pdf portions of the "Lexapro Fiscal 2004 Marketing Plan"] which gives some of the details of the plans to promote use of the drug by doctors.<ref>Harris, "A Drug Maker’s Playbook Reveals a Marketing Strategy"</ref>

In 2004, two separate civil suits alleging illegal marketing of citalopram and escitalopram for use by children and teenagers by Forest were initiated by two whistleblowers, one by a non-practicing physician named Joseph Piacentile, and the other by a Forest salesman named Christopher Gobble who was disturbed by what he witnessed at Forest.<ref>[http://www.law.com/jsp/article.jsp?id=1202428657301 "Forest Laboratories: A Tale of Two Whistleblowers"] article by Alison Frankel in ''[[The American Lawyer]] February 27, 2009</ref>

In February 2009, these two suits received support from the US Attorney for Massachusetts and were combined into one. Eleven states and the District of Columbia have also filed notices of intention to intervene as plaintiffs in the action. At the time, these drugs were approved only for use by adults and the application for use of citalopram in children was specifically rejected by the FDA. Although it is not illegal for physicians to prescribe a medicine for an off-label use not approved by the Food and Drug Administration, it is illegal for a manufacturer to promote the drugs for such uses. The government alleged that a research study showing lack of effectiveness when taken by children was concealed from its own medical advisers and sales personnel, as well as from researchers who conducted a study financed by the company. From 2001 to 2004, Forest heavily promoted results from another clinical trial it had financed which showed the drug was effective. Federal prosecutors also allege that the company has paid kickbacks to doctors to induce them to prescribe the medicines to children. The kickbacks allegedly included baseball tickets, a $1000 certificate to one of the most expensive New York restaurants, and paid vacations. Further, the complaint alleges that in September 2004, a Forest executive testified before Congress: “I want to emphasize that, because the FDA has not approved pediatric labeling of our products, Forest has always been scrupulous about not promoting the pediatric use of our antidepressant drugs, Celexa and Lexapro. That is the law and we follow it.” It is also alleged that the company conducted so-called "seeding studies" that were, in reality, marketing efforts to promote the drug's use by doctors.<ref>[http://amlawdaily.typepad.com/forestfca.pdf United States of America v. Forest Laboratories] Full text of the federal complaint filed in the US District Court for the district of Massachusetts</ref><ref>[http://www.nytimes.com/2009/02/26/business/26drug.html "Drug Maker Is Accused of Fraud"] article by Barry Meier and Benedict Carey in ''[[The New York Times]] February 25, 2009</ref> Forest responded to these allegations that it "is committed to adhering to the highest ethical and legal standards, and off-label promotion and improper payments to medical providers have consistently been against Forest policy.<ref>[http://www.frx.com/news/PressRelease.aspx?ID=1260234 "Forest Laboratories, Inc. Provides Statement in Response to Complaint Filed by U.S. Government"] Forest press-release. February 26, 2009</ref>"

==References==

{{Reflist|2}}

* [http://www.nytimes.com/2009/09/02/business/02drug.html "A Drug Maker’s Playbook Reveals a Marketing Strategy"] article in ''[[The New York Times]]'' by Gardiner Harris, September 1, 2009

==Cited texts==

*{{cite book| title = [[British National Formulary]] (BNF 58) |author= Royal Pharmaceutical Society of Great Britain|month = September|year=2009 |publisher=BMJ Group and RPS Publishing |location= UK|isbn=9780853697787 |url=http://www.bnf.org/bnf/ }}

* [http://www.lexapro.com/ Lexapro (Forest Laboratories)] Official Lexapro Homepage

* [http://www.cipralex.com/ Cipralex (Lundbeck)] Official Cipralex Homepage

* [http://www.rxlist.com/cgi/generic/lexapro.htm Pharmacological information] Lexapro

* [http://www.cipla.co.za/ Cipla Medpro ] Official Cipla Medpro Homepage

* [http://www.nytimes.com/packages/pdf/politics/20090831MEDICARE/20090831_MEDICARE.pdf portions of the "Lexapro Fiscal 2004 Marketing Plan"] released by the United States Senate Special Committee on Aging

* [http://druginfo.nlm.nih.gov/drugportal/dpdirect.jsp?name=Escitalopram U.S. National Library of Medicine: Drug Information Portal - Escitalopram]

{{Serotonergics}}

[[Category:Organofluorides]]

[[Category:Isobenzofurans]]

[[ar:إسيتالوبرام]]

[[cs:Escitalopram]]

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[[he:אסציטלופרם]]

[[hu:Eszcitalopram]]

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[[ru:Эсциталопрам]]

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