DOCSLIB.ORG

SEROQUEL XR (Quetiapine Fumarate) Is an Atypical Antipsychotic Belonging to a Chemical Class, the Dibenzothiazepine Derivatives

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
SEROQUEL XR (Quetiapine Fumarate) Is an Atypical Antipsychotic Belonging to a Chemical Class, the Dibenzothiazepine Derivatives HIGHLIGHTS OF PRESCRIBING INFORMATION Major Depressive 50 mg/day 150-300 mg/day 300 mg/day These highlights do not include all the information needed to use Disorder, Adjunctive SEROQUEL XR safely and effectively. See full prescribing information Therapy with for SEROQUEL XR. Antidepressants - SEROQUEL XR® (quetiapine fumarate) extended-release tablets, for Adults (2.2) oral use Initial U.S. Approval: 1997 --------------------- DOSAGE FORMS AND STRENGTHS -------------------- Extended-Release Tablets: 50 mg, 150 mg, 200 mg, 300 mg, and 400 mg (3) WARNING: INCREASED MORTALITY IN ELDERLY ------------------------------ CONTRAINDICATIONS ----------------------------- PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS; and Known hypersensitivity to SEROQUEL XR or any components in the SUICIDAL THOUGHTS AND BEHAVIORS formulation. (4) See full prescribing information for complete boxed warning. Increased Mortality in Elderly Patients with Dementia-Related ----------------------- WARNINGS AND PRECAUTIONS ---------------------- Psychosis Cerebrovascular Adverse Reactions: Increased incidence of Elderly patients with dementia-related psychosis treated with cerebrovascular adverse reactions (e.g., stroke, transient ischemic attack) antipsychotic drugs are at an increased risk of death. has been seen in elderly patients with dementia-related psychoses treated SEROQUEL XR is not approved for elderly patients with with atypical antipsychotic drugs (5.3) dementia-related psychosis. (5.1) Neuroleptic Malignant Syndrome (NMS): Manage with immediate Suicidal Thoughts and Behaviors discontinuation and close monitoring (5.4) Increased risk of suicidal thoughts and behavior in children, Metabolic Changes: Atypical antipsychotics have been associated with adolescents and young adults taking antidepressants. (5.2) metabolic changes. These metabolic changes include hyperglycemia, Monitor for worsening and emergence of suicidal thoughts and dyslipidemia, and weight gain (5.5) behaviors. (5.2) Hyperglycemia and Diabetes Mellitus: Monitor patients for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Monitor glucose regularly in -------------------------- RECENT MAJOR CHANGES -------------------------- patients with diabetes or at risk for diabetes Warnings and Precautions, Leukopenia, Neutropenia and Dyslipidemia: Undesirable alterations have been observed in Agranulocytosis (5.10) 11/2018 patients treated with atypical antipsychotics. Appropriate clinical monitoring is recommended, including fasting blood Warnings and Precautions, Anticholinergic lipid testing at the beginning of, and periodically, during (antimuscarinic) Effects (5.20) 11/2018 treatment Weight Gain: Gain in body weight has been observed; --------------------------- INDICATIONS AND USAGE -------------------------- clinical monitoring of weight is recommended SEROQUEL XR is an atypical antipsychotic indicated for the treatment of: Tardive Dyskinesia: Discontinue if clinically appropriate (5.6) Schizophrenia (1.1) Hypotension: Use with caution in patients with known cardiovascular or Bipolar I disorder, manic or mixed episodes (1.2) cerebrovascular disease (5.7) Bipolar disorder, depressive episodes (1.2) Increased Blood Pressure in Children and Adolescents: Monitor blood Major depressive disorder, adjunctive therapy with antidepressants pressure at the beginning of, and periodically during treatment in (1.3) children and adolescents (5.9) Leukopenia, Neutropenia and Agranulocytosis: Monitor complete blood ---------------------- DOSAGE AND ADMINISTRATION ---------------------- count frequently during the first few months of treatment in patients with Swallow tablets whole and do not split, chew or crush (2.1) a pre-existing low white cell count or a history of Take without food or with a light meal (approx. 300 calories) (2.1) leukopenia/neutropenia and discontinue SEROQUEL XR at the first Administer once daily, preferably in the evening (2.1) sign of a decline in WBC in absence of other causative factors (5.10) Cataracts: Lens changes have been observed in patients during long­ Geriatric Use: Consider a lower starting dose (50 mg/day), slower term quetiapine treatment. Lens examination is recommended when titration, and careful monitoring during the initial dosing period in the elderly. (2.3, 8.5) starting treatment and at 6-month intervals during chronic treatment (5.11) Hepatic Impairment: Lower starting dose (50 mg/day) and slower Anticholinergic(antimuscarinic) Effects: Use with caution with other titration may be needed (2.4, 8.7, 12.3) anticholinergic drugs and in patients with urinary retention, prostatic Indication Initial Recommended Maximum hypertrophy, constipation, or increased intraocular pressure (5.20). Dose Dose Dose Schizophrenia ­ 300 400-800 mg/day 800 mg/day ------------------------------ ADVERSE REACTIONS ----------------------------- Adults (2.2) mg/day Most common adverse reactions (incidence ≥5% and twice placebo): Schizophrenia ­ 50 mg/day 400-800 mg/day 800 mg/day Adults: somnolence, dry mouth, constipation, dizziness, increased appetite, Adolescents (13 to dyspepsia, weight gain, fatigue, dysarthria, and nasal congestion (6.1) 17 years) (2.2) Children and Adolescents: somnolence, dizziness, fatigue, increased appetite, Bipolar I Disorder 300 400-800 mg/day 800 mg/day nausea, vomiting, dry mouth, tachycardia, weight increased (6.1) manic or mixed ­ mg/day To report SUSPECTED ADVERSE REACTIONS, contact AstraZeneca Acute monotherapy at 1-800-236-9933 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. or adjunct to lithium or divalproex ­ ------------------------------ DRUG INTERACTIONS ----------------------------- Adults (2.2) Concomitant use of strong CYP3A4 inhibitors: Reduce quetiapine dose Bipolar I Disorder, 50 mg/day 400-600 mg/day 600 mg/day to one sixth when coadministered with strong CYP3A4 inhibitors (e.g., manic Acute ketoconazole, ritonavir) (2.5, 7.1, 12.3) monotherapy ­ Concomitant use of strong CYP3A4 inducers: Increase quetiapine dose Children and up to 5 fold when used in combination with a chronic treatment (more Adolescents (10 to than 7-14 days) of potent CYP3A4 inducers (e.g., phenytoin, rifampin, 17 years) (2.2) St. John’s wort) (2.6, 7.1, 12.3) Bipolar Disorder, 50 mg/day 300 mg/day 300 mg/day Discontinuation of strong CYP3A4 inducers: Reduce quetiapine dose Depressive Episodes by 5 fold within 7-14 days of discontinuation of CYP3A4 inducers - Adults (2.2) (2.6, 7.1, 12.3) 1 Reference ID: 4356288 ----------------------- USE IN SPECIFIC POPULATIONS ---------------------- See 17 for PATIENT COUNSELING INFORMATION and Medication Pregnancy: Limited human data. Based on animal data, may cause fetal Guide harm. Quetiapine should be used only if the potential benefit justifies Revised: 11/2018 the potential risk (8.1) Nursing Mothers: Discontinue drug or nursing, taking into consideration importance of drug to mother’s health (8.3) FULL PRESCRIBING INFORMATION: CONTENTS* WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS 5.18 Dysphagia WITH DEMENTIA-RELATED PSYCHOSIS; AND SUICIDAL 5.19 Discontinuation Syndrome THOUGHTS AND BEHAVIORS 5.20 Anticholinergic (antimuscarinic) Effects 1 INDICATIONS AND USAGE 6 ADVERSE REACTIONS 1.1 Schizophrenia 6.1 Clinical Studies Experience 1.2 Bipolar Disorder 6.2 Postmarketing Experience 1.3 Adjunctive Treatment of Major Depressive Disorder (MDD) 7 DRUG INTERACTIONS 1.4 Special Considerations in Treating Pediatric Schizophrenia and Bipolar 7.1 Effect of Other Drugs on Quetiapine I Disorder 7.2 Effect of Quetiapine on Other Drugs 2 DOSAGE AND ADMINISTRATION 8 USE IN SPECIFIC POPULATIONS 2.1 Important Administration Instructions 8.1 Pregnancy 2.2 Recommended Dosing 8.2 Labor and Delivery 2.3 Dose Modifications in Elderly Patients 8.3 Nursing Mothers 2.4 Dose Modifications in Hepatically Impaired Patients 8.4 Pediatric Use 2.5 Dose Modifications when used with CYP3A4 Inhibitors 8.5 Geriatric Use 2.6 Dose Modifications when used with CYP3A4 Inducers 8.6 Renal Impairment 2.7 Re-initiation of Treatment in Patients Previously Discontinued 8.7 Hepatic Impairment 2.8 Switching Patients from SEROQUEL Tablets to SEROQUEL XR 9 DRUG ABUSE AND DEPENDENCE Tablets 9.1 Controlled Substance 2.9 Switching from Antipsychotics 9.2 Abuse 3 DOSAGE FORMS AND STRENGTHS 10 OVERDOSAGE 4 CONTRAINDICATIONS 10.1 Human Experience 5 WARNINGS AND PRECAUTIONS 10.2 Management of Overdosage 5.1 Increased Mortality in Elderly Patients with Dementia-Related 11 DESCRIPTION Psychosis 12 CLINICAL PHARMACOLOGY 5.2 Suicidal Thoughts and Behaviors in Adolescents and Young Adults 12.1 Mechanism of Action 5.3 Cerebrovascular Adverse Reactions, Including Stroke, in Elderly 12.2 Pharmacodynamics Patients with Dementia-Related Psychosis 12.3 Pharmacokinetics 5.4 Neuroleptic Malignant Syndrome (NMS) 13 NONCLINICAL TOXICOLOGY 5.5 Metabolic Changes 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility 5.6 Tardive Dyskinesia 13.2 Animal Toxicology and/or Pharmacology 5.7 Hypotension 14 CLINICAL STUDIES 5.8 Falls 14.1 Schizophrenia 5.9 Increases in Blood Pressure (Children and Adolescents) 14.2 Bipolar Disorder 5.10 Leukopenia, Neutropenia and Agranulocytosis 14.3 Major Depressive Disorder, Adjunctive Therapy to Antidepressants 5.11 Cataracts 16 HOW SUPPLIED/STORAGE AND HANDLING 5.12 QT Prolongation 17 PATIENT COUNSELING INFORMATION 5.13 Seizures 17.1 Information for Patients 5.14 Hypothyroidism MEDICATION GUIDE 5.15 Hyperprolactinemia 5.16 Potential for Cognitive and Motor Impairment 5.17 Body Temperature
Load more

Recommended publications
  • Drug Use Evaluation: Antipsychotic Utilization in Schizophrenia Patients
    © Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 | Fax 503-947-1119 Drug Use Evaluation: Antipsychotic Utilization in Schizophrenia Patients Research Questions: 1. How many schizophrenia patients are prescribed recommended first-line second-generation treatments for schizophrenia? 2. How many schizophrenia patients switch to an injectable antipsychotic after stabilization on an oral antipsychotic? 3. How many schizophrenia patients are prescribed 2 or more concomitant antipsychotics? 4. Are claims for long-acting injectable antipsychotics primarily billed as pharmacy or physician administered claims? 5. Does adherence to antipsychotic therapy differ between patients with claims for different routes of administration (oral vs. long-acting injectable)? Conclusions: In total, 4663 schizophrenia patients met inclusion criteria, and approximately 14% of patients (n=685) were identified as treatment naïve without claims for antipsychotics in the year before their first antipsychotic prescription. Approximately 45% of patients identified as treatment naïve had a history of remote antipsychotic use, but it is unclear if antipsychotics were historically prescribed for schizophrenia. Oral second-generation antipsychotics which are recommended as first-line treatment in the MHCAG schizophrenia algorithm were prescribed as initial treatment in 37% of treatment naive patients and 28% of all schizophrenia patients. Recommended agents include risperidone, paliperidone, and aripiprazole. Utilization of parenteral antipsychotics was limited in patients with schizophrenia. Overall only 8% of patients switched from an oral to an injectable therapy within 6 months of their first claim. Approximately, 60% of all schizophrenia patients (n=2512) had claims for a single antipsychotic for at least 12 continuous weeks and may be eligible to transition to a long-acting injectable antipsychotic.
    [Show full text]
  • Schizophrenia Care Guide
    August 2015 CCHCS/DHCS Care Guide: Schizophrenia SUMMARY DECISION SUPPORT PATIENT EDUCATION/SELF MANAGEMENT GOALS ALERTS Minimize frequency and severity of psychotic episodes Suicidal ideation or gestures Encourage medication adherence Abnormal movements Manage medication side effects Delusions Monitor as clinically appropriate Neuroleptic Malignant Syndrome Danger to self or others DIAGNOSTIC CRITERIA/EVALUATION (PER DSM V) 1. Rule out delirium or other medical illnesses mimicking schizophrenia (see page 5), medications or drugs of abuse causing psychosis (see page 6), other mental illness causes of psychosis, e.g., Bipolar Mania or Depression, Major Depression, PTSD, borderline personality disorder (see page 4). Ideas in patients (even odd ideas) that we disagree with can be learned and are therefore not necessarily signs of schizophrenia. Schizophrenia is a world-wide phenomenon that can occur in cultures with widely differing ideas. 2. Diagnosis is made based on the following: (Criteria A and B must be met) A. Two of the following symptoms/signs must be present over much of at least one month (unless treated), with a significant impact on social or occupational functioning, over at least a 6-month period of time: Delusions, Hallucinations, Disorganized Speech, Negative symptoms (social withdrawal, poverty of thought, etc.), severely disorganized or catatonic behavior. B. At least one of the symptoms/signs should be Delusions, Hallucinations, or Disorganized Speech. TREATMENT OPTIONS MEDICATIONS Informed consent for psychotropic
    [Show full text]
  • (KPIC) PPO and Out-Of- Area Indemnity (OOA) Drug Formulary with Specialty Drug Tier
    Kaiser Permanente Insurance Company (KPIC) PPO and Out-of- Area Indemnity (OOA) Drug Formulary with Specialty Drug Tier This Drug Formulary was updated: September 1, 2021 NOTE: This drug formulary is updated often and is subject to change. Upon revision, all previous versions of the drug formulary are no longer in effect. This document contains information regarding the drugs that are covered when you participate in the California Nongrandfathered PPO and Out-of- Area Indemnity (OOA) Health Insurance Plans with specialty drug tier offered by Kaiser Permanente Insurance Company (KPIC) and fill your prescription at a MedImpact network pharmacy. Access to the most current version of the Formulary can be obtained by visiting kp.org/kpic-ca-rx-ppo-ngf. For help understanding your KPIC insurance plan benefits, including cost sharing for drugs under the prescription drug benefit and under the medical benefit, please call 1-800-788-0710 or 711 (TTY) Monday through Friday, 7a.m. to 7p.m. For help with this Formulary, including the processes for submitting an exception request and requesting prior authorization and step therapy exceptions, please call MedImpact 24 hours a day, 7 days a week, at 1-800-788-2949 or 711 (TTY). For cost sharing information for the outpatient prescription drug benefits in your specific plan, please visit: kp.org/kpic-ca-rx-ppo-ngf. For help in your preferred language, please see the Kaiser Permanente Insurance Company Notice of Language Assistance in this document. KPIC PPO NGF Table of Contents Informational Section................................................................................................................................2
    [Show full text]
  • Traditional Open Drug List
    Traditional Open Drug List Drug list — Four Tier Drug Plan Your prescription benefit comes with a drug list, which is also called a formulary. This list is made up of brand-name and generic prescription drugs approved by the U.S. Food & Drug Administration (FDA). Here are a few things to remember about the list: o You and your doctor can use it as a guide to choose drugs that are best for you. Drugs that aren’t on this list may not be covered by your plan and may cost you more out of pocket. o Your coverage has limitations and exclusions, which means there are certain rules about what's covered by your plan and what isn't. To find out more, view your Certificate/Evidence of Coverage or your Summary Plan Description by logging in at anthem.com and go to My Plan ->Benefits-> Plan Documents. o To help you see how the drug list works with your drug benefit, we've included some frequently asked questions (FAQ) about how the list is set up and what to do if a drug you take isn't on it. o This booklet is updated on a quarterly basis. To view the most up-to-date list of drugs for your plan - including drugs that have been added, generic drugs and more - log in at anthem.com and choose Prescription Benefits. If you have questions about your pharmacy benefits, we're here to help. Just call us at the Pharmacy Member Services number on your ID card. 05374MUMENABS Traditional Open Drug List What is a drug list? The drug list, also called a formulary, is a list of prescription medicines your plan covers.
    [Show full text]
  • Identification, Isolation, Synthesis and Characterization of Impurities of Quetiapine Fumarate
    ORIGINAL ARTICLES Aurobindo Pharma Ltd. Research Centre1, Bachupally, J. N. T. University2, Kukatpally, Hyderabad, India Identification, isolation, synthesis and characterization of impurities of quetiapine fumarate Ch. Bharathi1, K. J. Prabahar1, Ch. S. Prasad1, M. Srinivasa Rao1, G. N. Trinadhachary1, V. K. Handa1, R. Dandala1, A. Naidu2 Received May 28, 2007, accepted June 18, 2007 Ramesh Dandala, Senior Vice-President, A. P. L. Research centre, 313, Bachupally, Hyderabad 500072, India [email protected] Pharmazie 63: 14–19 (2008) doi: 10.1691/ph.2008.7174 In the process for the preparation of quetiapine fumarate (1), six unknown impurities and one known impurity (intermediate) were identified ranging from 0.05–0.15% by reverse-phase HPLC. These impu- rities were isolated from crude samples using reverse-phase preparative HPLC. Based on the spectral data, the impurities were characterized as 2-[4-dibenzo[b,f ][1,4]thiazepine-11-yl-1-piperazinyl]1-2-etha- nol (impurity I, desethanol quetiapine), 11-[(N-formyl)-1-piperazinyl]-dibenzo[b,f ][1,4]thiazepine (impur- ity II, N-formyl piperazinyl thiazepine), 2-(2-hydroxy ethoxy)ethyl-2-[2-[4-dibenzo[b,f ][1,4]thiazepine-11- piperazinyl-1-carboxylate (impurity III, quetiapine carboxylate), 11-[4-ethyl-1-piperazinyl]dibenzo [b,f ][1,4] thiazepine (impurity IV, ethylpiperazinyl thiazepine), 2-[2-(4-dibenzo[b,f ][1,4]thiazepin-11-yl-1-piperazi- nyl)ethoxy]1-ethyl ethanol [impurity V, ethyl quetiapine), 1,4-bis[dibenzo[b,f ][1,4]thiazepine-11-yl] piper- azine [impurity VI, bis(dibenzo)piperazine]. The known impurity was an intermediate, 11-piperazinyl- dibenzo [b,f ][1,4]thiazepine (piperazinyl thiazepine).
    [Show full text]
  • Should Inverse Agonists Be Defined by Pharmacological Mechanism Or
    CNS Spectrums,(2019), 24 419 – 425. © Cambridge University Press 2018. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. doi:10.1017/S1092852918000986 ORIGINAL RESEARCH Switching stable patients with schizophrenia from their oral antipsychotics to aripiprazole lauroxil: a post hoc safety analysis of the initial 12-week crossover period Peter J. Weiden,1* Yangchun Du,2 Chih-Chin Liu,2 and Arielle D. Stanford3 1 Medical Affairs, Alkermes, Inc., Waltham, Massachusetts, USA 2 Clinical Development, Alkermes, Inc., Waltham, Massachusetts, USA 3 Clinical Science, Alkermes, Inc., Waltham, Massachusetts, USA Objective. Switching antipsychotic medications is common in patients with schizophrenia who are experiencing persistent symptoms or tolerability issues associated with their current drug regimen. This analysis assessed the safety of switching from an oral antipsychotic to the long-acting injectable antipsychotic aripiprazole lauroxil (AL). Methods. This was a post hoc analysis of outpatients with schizophrenia who were prescribed an oral antipsychotic and who enrolled in an international, open-label, long-term (52-week) safety study of AL. The analysis focused on the first 3 injections of AL 882 mg over 12 weeks, divided into the immediate 4-week crossover period between the first and second AL injections (initiation phase) and the subsequent 8 weeks (stabilization phase). Patients were grouped by preswitch oral antipsychotic medication, and safety and clinical symptoms were assessed. Results. In total, 190 patients had switched from one of the following oral antipsychotic medications: aripiprazole, conventional antipsychotics, risperidone/paliperidone, olanzapine, or quetiapine.
    [Show full text]
  • Anthem Blue Cross Prescription Formulary List
    National Drug List Drug list — Three Tier Drug Plan Your prescription benefit comes with a drug list, which is also called a formulary. This list is made up of brand-name and generic prescription drugs approved by the U.S. Food & Drug Administration (FDA). We’re here to help. If you are a current Anthem member with questions about your pharmacy benefits, we're here to help. Just call us at the Member Services number on your ID card. The plan names to which this formulary applies are shown below. Solution PPO 1500/15/20 $5/$15/$50/$65/30% to $250 after deductible Solution PPO 2000/20/20 $5/$20/$30/$50/30% to $250 Solution PPO 2500/25/20 $5/$20/$40/$60/30% to $250 Solution PPO 3500/30/30 $5/$20/$40/$60/30% to $250 Rx ded $150 Solution PPO 4500/30/30 $5/$20/$40/$75/30% to $250 Solution PPO 5500/30/30 $5/$20/$40/$75/30% to $250 Rx ded $250 $5/$15/$25/$45/30% to $250 $5/$20/$50/$65/30% to $250 Rx ded $500 $5/$15/$30/$50/30% to $250 $5/$20/$50/$70/30% to $250 $5/$15/$40/$60/30% to $250 $5/$20/$50/$70/30% to $250 after deductible Here are a few things to remember: o You can view and search our current drug lists when you visit anthem.com/ca/pharmacyinformation. Please note: The formulary is subject to change and all previous versions of the formulary are no longer in effect.
    [Show full text]
  • Central Nervous System 5 Objectives
    B978-0-7234-3630-0.00005-4, 00005 Central nervous system 5 Objectives After reading this chapter, you will: ● Understand the functions of the central nervous system and the diseases that can occur ● Know the drug classes used to treat these conditions, their mechanisms of action and adverse effects. Parkinson’s disease is progressive, with continued BASIC CONCEPTS loss of dopaminergic neurons in the substantia nigra correlating with worsening of clinical symptoms. The The central nervous system consists of the brain and the possibility of a neurotoxic cause has been strengthe- spinal cord, which are continuous with one another. ned by the finding that 1-methyl-4-phenyl-1,2,3, The brain is composed of the cerebrum (which consists 6-tetrahydropyridine (MPTP), a chemical contaminant of the frontal, temporal, parietal and occipital lobes), of heroin, causes irreversible damage to the nigrostriatal the diencephalon (which includes the thalamus and dopaminergic pathway. Thus, this damage can lead hypothalamus), the brainstem (which consists of the mid- to the development of symptoms similar to those of brain, pons and medulla oblongata) and the cerebellum. idiopathic Parkinson’s disease. Drugs that block The brain functions to interpret sensory information dopamine receptors can also induce parkinsonism. obtained about the internal and external environments Neuroleptic drugs (p. 000) used in the treatment of TS1 and send messages to effector organs in response to a schizophrenia can produce parkinsonian symptoms as situation. Different parts of the brain are associated an adverse effect. Rare causes of parkinsonism are cere- with specific functions (Fig. 5.1). However, the brain is a bral ischaemia (progressive atherosclerosis or stroke), complex organ and is not yet completely understood.
    [Show full text]
  • Advice on Prescribing for Adults with Obsessive-Compulsive Disorder (OCD)
    Advice on Prescribing for Adults with Obsessive-Compulsive Disorder (OCD) Dr Lynne M Drummond, Local and National OCD Services, Behavioural and Cognitive Psychotherapy Unit, South West London and St George’s Menat Health NHS Trust 9th April 2008 Introduction Obsessive-Compulsive Disorder (OCD) is a common psychiatric disorder which untreated has a chronic often deteriorating course. OCD does respond well to treatment with either psychological approaches involving Graded Exposure and Self-Imposed Ritual Prevention (ERP) or with specific pharmacological agents. This paper aims to outline the various psychopharmacological approaches. Psychopharmacological approaches Repeated trials have demonstrated that drugs which act of the serotonin system are effective in many patients with OCD (SRI and SSRIs) • The Selective Serotonin Reuptake Inhibitors (SSRIs) are generally used as first line rather than clomipramine (a Serotonin Reuptake Inhibitor- SRI) due to fewer side effects. • There is little evidence of any particular advantage of any of the SSRIs apart from some evidence that Escitalopram* may reduce relapse of OCD. • In general if there is no response to the SRI on maximal doses for 12 weeks it is worthwhile switching to an alternative. • However there is evidence that benefit from SRI can accrue over as long as 2 years Drug Dose Major side effects Any special features Seizures in a small number of patients The first SRI to and less likely if demonstrate Clomipramine Up to 225mg at <250mg effectiveness in night (increase reducing OCD slowly as tolerated) Sexual Dysfunction symptoms in 80 % Dry mouth; blurred It is a tricyclic vision drowsiness; antidepressant weight gain and orthostatic hypotension 1 50 mg in evening Gastro-intestinal initially and upsets; anorexia and increased weight loss.
    [Show full text]
  • Clinical Trial Protocol
    Clinical Trial Protocol - Clinical effectiveness of the newer antipsychotic compounds olanzapine, quetiapine and aripiprazole in comparison with low dose conventional antipsychotics (haloperidol and flupentixol) in patients with schizophrenia - NeSSy (Neuroleptic Strategy Study) ------------------------------------------------------------------------------------------------------------------------------------------------------- - Confidential - Confidential - Confidential - Confidential - Clinical Trial Protocol Clinical Effectiveness Of The Newer Antipsychotic Compounds Olanzapine, Quetiapine And Aripiprazole In Comparison With Low Dose Conventional Antipsychotics (Haloperidol And Flupentixol) In Patients With Schizophrenia The Neuroleptic Strategy Study – NeSSy Protocol-ID.: NeSSy_200901 EudraCT Number 2009-010966-47 ---------------------------------------------------------------------------------------------------------------------------------------------------------- Protocol Authors: Prof. Dr. med. Mühlbauer, Dr. med. Bobis Seidenschwanz, Department of Pharmacology, Klinikum Bremen-Mitte; Prof. Dr. rer. nat. Dr. h.c. Timm, Competence Center for Clinical Trials Bremen, Version 04, 05 December 2012 Page 1 of 44 Clinical Trial Protocol - Clinical effectiveness of the newer antipsychotic compounds olanzapine, quetiapine and aripiprazole in comparison with low dose conventional antipsychotics (haloperidol and flupentixol) in patients with schizophrenia - NeSSy (Neuroleptic Strategy Study) -------------------------------------------------------------------------------------------------------------------------------------------------------
    [Show full text]
  • NIH Public Access Author Manuscript Expert Opin Drug Saf
    NIH Public Access Author Manuscript Expert Opin Drug Saf. Author manuscript; available in PMC 2009 March 1. NIH-PA Author ManuscriptPublished NIH-PA Author Manuscript in final edited NIH-PA Author Manuscript form as: Expert Opin Drug Saf. 2008 March ; 7(2): 181±194. Sudden cardiac death secondary to antidepressant and antipsychotic drugs Serge Sicouri, MD and Charles Antzelevitch, PhD† Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, NY, USA Abstract A number of antipsychotic and antidepressant drugs are known to increase the risk of ventricular arrhythmias and sudden cardiac death. Based largely on a concern over QT prolongation and the development of life-threatening arrhythmias, a number of antipsychotic drugs have been temporarily or permanently withdrawn from the market or their use restricted. Some antidepressants and antipsychotics have been linked to QT prolongation and the development of Torsade de pointes arrhythmias, whereas others have been associated with a Brugada syndrome phenotype and the development of polymorphic ventricular arrhythmias. This review examines the mechanisms and predisposing factors underlying the development of cardiac arrhythmias, and sudden cardiac death, associated with antidepressant and antipsychotic drugs in clinical use. Keywords antidepressants; antipsychotics; arrhythmias; Brugada syndrome; long QT syndrome; sudden cardiac death 1. Introduction Sudden unexplained death in individuals with mental health problems was first described in 1849 and a link with antipsychotic drugs was postulated over 40 years ago [1,2]. Starting in early 1990, a clear relationship has been established between antipsychotics, prolongation of the QT interval of the electrocardiogram (ECG), an atypical polymorphic tachycardia known as Torsade de pointes (TdP), and sudden cardiac death (SCD).
    [Show full text]
  • CENTRAL NERVOUS SYSTEM DEPRESSANTS Opioid Pain Relievers Anxiolytics (Also Belong to Psychiatric Medication Category) • Codeine (In 222® Tablets, Tylenol® No
    CENTRAL NERVOUS SYSTEM DEPRESSANTS Opioid Pain Relievers Anxiolytics (also belong to psychiatric medication category) • codeine (in 222® Tablets, Tylenol® No. 1/2/3/4, Fiorinal® C, Benzodiazepines Codeine Contin, etc.) • heroin • alprazolam (Xanax®) • hydrocodone (Hycodan®, etc.) • chlordiazepoxide (Librium®) • hydromorphone (Dilaudid®) • clonazepam (Rivotril®) • methadone • diazepam (Valium®) • morphine (MS Contin®, M-Eslon®, Kadian®, Statex®, etc.) • flurazepam (Dalmane®) • oxycodone (in Oxycocet®, Percocet®, Percodan®, OxyContin®, etc.) • lorazepam (Ativan®) • pentazocine (Talwin®) • nitrazepam (Mogadon®) • oxazepam ( Serax®) Alcohol • temazepam (Restoril®) Inhalants Barbiturates • gases (e.g. nitrous oxide, “laughing gas”, chloroform, halothane, • butalbital (in Fiorinal®) ether) • secobarbital (Seconal®) • volatile solvents (benzene, toluene, xylene, acetone, naptha and hexane) Buspirone (Buspar®) • nitrites (amyl nitrite, butyl nitrite and cyclohexyl nitrite – also known as “poppers”) Non-Benzodiazepine Hypnotics (also belong to psychiatric medication category) • chloral hydrate • zopiclone (Imovane®) Other • GHB (gamma-hydroxybutyrate) • Rohypnol (flunitrazepam) CENTRAL NERVOUS SYSTEM STIMULANTS Amphetamines Caffeine • dextroamphetamine (Dexadrine®) Methelynedioxyamphetamine (MDA) • methamphetamine (“Crystal meth”) (also has hallucinogenic actions) • methylphenidate (Biphentin®, Concerta®, Ritalin®) • mixed amphetamine salts (Adderall XR®) 3,4-Methelynedioxymethamphetamine (MDMA, Ecstasy) (also has hallucinogenic actions) Cocaine/Crack
    [Show full text]