Are there any advantages in using fluoxetine (Fontex, under special license) instead of citalopram

Fråga: Are there any advantages in using fluoxetine (Fontex, under special license) instead of citalopram (Cipramil) for obsessive compulsive disorder?

Sammanfattning: Preliminary data indicate that selective SRIs are effective in the treatment of obsessive compulsive disorder. Major efficacy differences between fluoxetine and citalopram are unlikely.

Svar: Serotonin reuptake inhibitors (SRIs) are considered as the pharmacological treatment of choice for obsessive compulsive disorder. Clomipramine, the tricyclic antidepressant, has been widely used, but also the new, selective SRIs like fluoxetine and fluvoxamine appear to be effective (1). Although sufficiently large comparative studies have not been performed, the latter are not considered quite as effective but they induce less adverse drug reactions (1,2,3).

In a recent article summarizing two large (n=572) double-blind randomized studies fluoxetine was found more effective than placebo (4). The therapeutic response emerged, however, slowly and increased gradually. Twenty mg daily was effective in many patients but in some patients, an optimal response was achieved with higher (up to 80 mg daily) doses (4).

We could not find any published references assessing the efficacy of citalopram in this indication. Although there may be subtle differences in the effects on other neurotransmitter systems between citalopram and fluoxetine, major efficacy differences are unlikely. 1 Rasmussen SA, Eisen JL, Pato MT: Current issues in the pharmacologic management of obsessive compulsive disorder. J Clin Psychiatry 1993; 54(suppl): 4-9 (enclosed) 2 Obsessive compulsive disorder and its treatment. Information news from North Thames - West Region Drug Information Service 3 Pigott TA, Pato MT, Bernstein SE: Controlled fcomparisons of clomipramine and fluoxetine in the treatment of obsessive-compulsive disorder. Arch Gen Psychiatry 1990; 47: 926-932 4 Wood A, Tollefson GD, Birkett M: Pharmacotherapy of obsessive compulsive disorder - experience with fluoxetine. Int Clin Psychopharmacol 1993; 8: 301-306