Category Archives: Antipsychotics

Second generation antipsychotics for schizophrenia: ECONOMIC EVALUATIONS OF THE SECOND GENERATION ANTIPSYCHOTICS(3)

Economic evaluation of other second generation agents is forthcoming. At this time, preliminary data comparing olanzapine with haloperidol treatment indicate greater cost savings with olanzapine primarily based on reduced hospitalization rates and durations. No data are available regarding the other second generation agents.

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Second generation antipsychotics for schizophrenia: ECONOMIC EVALUATIONS OF THE SECOND GENERATION ANTIPSYCHOTICS(1)

ECONOMIC EVALUATIONS OF THE SECOND GENERATION ANTIPSYCHOTICS(1)

Antipsychotic drug therapy accounts for 1% to 4% of the total costs involved in managing patients with schizophrenia. The greatest direct and indirect costs associated include hospitalization, rehabilitation, visits to physicians, outpatient and community support programs, lost work productivity of the individual and family members, and suicide. Successful drug therapy can significantly alter the use of direct cost services and limit the impact on indirect costs. Thus, to evaluate properly from a societal perspective, economic evaluation studies determining the cost of antipsychotics (eg, cost effectiveness analysis) are required. birth control pills

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Second generation antipsychotics for schizophrenia: SWITCHING THERAPY(2)

There is little documented experience with switching patients from conventional antipsychotics to the second generation agents; however, these treatment conversions are becoming increasingly common, and some general principles should be applied. It should be decided whether the current drug requires immediate discontinuation (ie, serious adverse drug reaction) or whether overlapping the two therapies is possible (ie, to minimize risk of relapse). With overlaps, the specific increments and timing of dosage changes should be on a flexible schedule and patients require close monitoring (eg, every day or two for inpatients and once or twice weekly for the more gradual overlaps completed for outpatients). buy antibiotics online

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Second generation antipsychotics for schizophrenia: SWITCHING THERAPY(1)

SWITCHING THERAPY(1)

Switching patients from one antipsychotic to another can be challenging and requires an awareness of the differences and similarities of the two agents’ pharmacological profiles. With each antipsychotic substitution, there is risk of relapse, toxicity and withdrawal symptoms (such as anticholinergic withdrawal and rebound dyskinesias). Unfortunately, attempts to limit one risk may increase another. Overlapping therapies can decrease the risk of relapse, but this increases the risk of toxicity and may not prevent withdrawal symptoms . For example, patients switching from clozapine to risperidone are at risk for early relapse, which risperidone may limit by overlapping the therapies. buy ortho tri-cyclen

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Second generation antipsychotics for schizophrenia: SECOND GENERATION ANTIPSYCHOTICS(12)

Ziprasidone

Ziprasidone has been submitted to the Health Protection Branch in Canada and the United States Food and Drug Administration, and is currently undergoing review for approval. It has been shown to be more effective than placebo for positive and negative symptoms of schizophrenia in four-and six-week, double-blind, randomized, fixed-dose trials using 80 to 160 mg/day. It has also been shown to be comparable to haloperidol in a four-week study (160 mg/day versus 15 mg/day). Its long term efficacy and safety have been evaluated during a one-year double-blind, randomized, placebo-controlled, parallel-group study that revealed a reduction in the risk of relapse and an improvement in negative symptoms over placebo. Studies remain in the preliminary phase, and data comparing ziprasidone with other second generation compounds are needed.

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Second generation antipsychotics for schizophrenia: SECOND GENERATION ANTIPSYCHOTICS(11)

Weight gain, a side effect common among atypical agents, appears to be dose-related with quetiapine use and is similar to chlorpromazine. After an average of one year, weight gain averages 12 kg with quetiapine treatment.

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Second generation antipsychotics for schizophrenia: SECOND GENERATION ANTIPSYCHOTICS(10)

SECOND GENERATION ANTIPSYCHOTICS(10)

Relapse at one year for stabilized patients maintained on conventional antipsy-chotics is approximately 30%, and less with depot antipsychotic use (24%) . Quetiapine has not been studied in treatment-refractory patients, and trials are underway evaluating its use in first-episode psychosis and its use compared with other novel antipsychotics.

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Second generation antipsychotics for schizophrenia: SECOND GENERATION ANTIPSYCHOTICS(9)

Olanzapine is a broad-spectrum antipsychotic. Considering its low risk for EPS and TD and its advantages over ha-loperidol, as shown in the only published randomized, controlled trial of the novel agents in first-episode patients, olanzapine should be considered as first line therapy for recently diagnosed patients. However, olanzapine should be reserved as an alternative agent for overweight patients due to the risk of significant weight gain. Further research is required to determine its role in the management of treatment-resistant patients. Olanzapine has some anticholinergic effects that could limit its use in the elderly. birth control pills

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Second generation antipsychotics for schizophrenia: SECOND GENERATION ANTIPSYCHOTICS(8)

Overall, olanzapine is well tolerated and free from hematological side effects. Dose-related side effects include somnolence, orthostatic hypotension, dry mouth, constipation, tremor, akathisia and weight gain. Weight gain is one of the most problematic adverse effects, especially in younger patients who tend to be more image conscious. Weight gain after 28 weeks of treatment was 4.1 kg with olanzapine compared with 2.3 kg with risperidone. Managing weight gain with long term treatment can be challenging. As early as possible, diet and exercise counselling should be stressed, with emphasis on establishing a health-promoting routine. buy diabetes drugs

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Second generation antipsychotics for schizophrenia: SECOND GENERATION ANTIPSYCHOTICS(7)

SECOND GENERATION ANTIPSYCHOTICS(7)

One of olanzapine’s main advantages, similar to clozapine, is its reduced incidence of EPS/TD . Doses less than 20mg/day are associated with minimal EPS, although clinical experience indicates that this benefit may be lost with doses exceeding 20mg/day. The occurrence of TD is less with olanzapine than with haloperidol. After an average period of use of approximately two-thirds of a year, the incidences of TD in the olanzapine and haloperidol groups were 1.0% and 4.6%, respectively. flovent inhaler

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