DOCSLIB.ORG

TOX.LC.3499 Rev 07, Effective 2015-08-12 to Present

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
TOX.LC.3499 Rev 07, Effective 2015-08-12 to Present Harris County Institute of Forensic Sciences Section: Toxicology Approved By: Chief Toxicologist Document Type: LC & LCMSMS Procedure No.: TOX.LC.3499 Title: Amitriptyline, Clozapine, Doxepin, Fluoxetine, Quetiapine and Olanzapine Rev.7 (LLE) by LCMSMS 1.0 Purpose 1.1 Amitriptyline, Nortriptyline, Clozapine, Doxepin, Nordoxepin (Desmethyldoxepin), Fluoxetine, Norfluoxetine, Quetiapine, Norquetiapine, and Olanzapine are assayed by High Performance Liquid Chromatography/Mass Spectrometry/Mass Spectrometry (HPLC/MS/MS) using multiple reaction monitoring (MRM) and their corresponding deuterated standards. 2.0 Scope 2.1 The analysis is applicable to all types of forensic specimens when compared with matrix matched controls. 3.0 Definitions and Abbreviations 3.1 None Applicable 4.0 Materials 4.1 Instruments and Equipment 4.1.1 Pipettes 4.1.2 13 x 100 mm screw cap test tubes 4.1.3 16 x 100 mm test tubes 4.1.4 Vortex mixer 4.1.5 Centrifuge 4.1.6 Autosampler vials 4.1.7 Vial caps with puncture seals 4.1.8 Solvent evaporator 4.1.9 Nitrogen compressed gas 4.1.10 0.2 m Filters 4.1.11 3 c.c. Syringe 4.1.12 C18 PLC column 4.1.13 LC-MS/MS 4.2 Reagents 4.2.1 Methanol, HPLC grade 4.2.2 n-Butyl Chloride, HPLC grade 4.2.3 Acetonitrile, HPLC grade 4.2.4 Formic Acid 88% 4.2.5 Water, 18.2 mega ohm or HPLC grade 4.2.6 Ammonium formate. Page 1 of 12 Harris County Institute of Forensic Sciences Section: Toxicology Approved By: Chief Toxicologist Document Type: LC & LCMSMS Procedure No.: TOX.LC.3499 Title: Amitriptyline, Clozapine, Doxepin, Fluoxetine, Quetiapine and Olanzapine Rev.7 (LLE) by LCMSMS 4.2.7 Saturated Sodium Borate Buffer A. Weigh 100 g of Sodium Tetraborate B. Add to 900 mL of deionized water. C. Heat with stirring bar in a 1 L beaker until dissolved. D. Add 50 mL of 10 N Sodium Hydroxide E. Stir and allow to cool. F. Check pH with meter. Should be pH 12 + 0.2. Adjust as necessary with 10 N NaOH. G. Stable 6 months at room temperature. 4.2.8 Mobile phase A: 0.05% formic Acid and 7 mM ammonium formate A. Measure 1L of Milli-Q filtered or HPLC grade water into a clean 1 L bottle. B. Add 0.45 g of ammonium formate and 0.568 mL of formic acid to the water. Mix well. C. Stable for 3 months at room temperature. 4.2.9 Mobile phase B: Acetonitrile. Stable for 3 months at room temperature. 4.2.10 Reconstitution buffer: 90% of 0.05% formic acid 7mM ammonium formate in water / 10% acetonitrile. A. Prepare enough for 2 mL per sample B. For every 9 mL of 0.05% formic acid + 7mM ammonium formate in water add 1 mL of acetonitrile and mix. C. Stable for 3 months at room temperature (not to exceed expiration date of mobile phase used) 4.3 Stock Standards and Controls Note: Cerilliant standards should be used within the manufacturer’s expiration date and should be stored at the recommended storage temperature. 4.3.1 Amitriptyline 1 mg/mL, Cerilliant #A-923, or equivalent 4.3.2 Nortriptyline 1 mg/mL, Cerilliant #N-907, or equivalent 4.3.3 Clozapine 1 mg/mL, Cerilliant #C-059 , or equivalent 4.3.4 Doxepin 1 mg/mL, Cerilliant #D-927, or equivalent 4.3.5 Desmethyldoxepin 1 mg/mL, Cerilliant #D-007, or equivalent 4.3.6 Fluoxetine 1 mg/mL, Cerilliant #F-918, or equivalent 4.3.7 Norfluoxetine Oxalate 1 mg/mL, Cerilliant #N-923, or equivalent 4.3.8 Quetiapine 1 mg/mL, Cerilliant #Q-001, or equivalent 4.3.9 Norquetiapine 1 mg/mL, Cerilliant #N-070, or equivalent 4.3.10 Olanzapine 1 mg/mL, Cerilliant #O-024, or equivalent 4.3.11 Amitriptyline-D3 100 μg/mL, Cerilliant #A-085, or equivalent 4.3.12 Nortriptyline-D3 100 μg/mL, Cerilliant #N-902, or equivalent 4.3.13 Clozapine-D4 100 g/mL, Cerilliant #C-091 , or equivalent 4.3.14 Doxepin-D3 100 g/mL, Cerilliant #D-060 , or equivalent Page 2 of 12 Harris County Institute of Forensic Sciences Section: Toxicology Approved By: Chief Toxicologist Document Type: LC & LCMSMS Procedure No.: TOX.LC.3499 Title: Amitriptyline, Clozapine, Doxepin, Fluoxetine, Quetiapine and Olanzapine Rev.7 (LLE) by LCMSMS 4.3.15 N-Desmethyldoxepin-D3 100 g/mL, Cerilliant #D-075, or equivalent 4.3.16 Fluoxetine-D6 Oxalate 100 μg/mL, Cerilliant #F-919, or equivalent 4.3.17 Norfluoxetine-D6 100 μg/mL, Cerilliant #N-922, or equivalent 4.3.18 Quetiapine-D8, 100 μg/mL, Cerilliant #Q-002, or equivalent 4.3.19 Olanzapine-D8 100 μg/mL Cerilliant #O-035, or equivalent 4.4 Working Standards Note: Standards and controls must be prepared by different analysts. Note: Prepared working internal standards/standards/controls may not have an expiration date that exceeds the expiration date of the stock standard used to prepare it. Note: Prepared working internal standards/standards/controls are stable until the manufacturer’s expiration date when stored at manufacturer’s recommended storage temperature (<0°C). 4.4.1 Amitriptyline/Nortriptyline Working Standard A 10 µg/mL A. Pipette 250 µL of amitriptyline 1.0 mg/mL stock standard into a 25 mL volumetric flask B. Pipette 250 µL of nortriptyline 1.0 mg/mL stock standard into the same 25 mL volumetric flask C. Dilute to 25 mL with methanol 4.4.2 Amitriptyline/Nortriptyline Working Standard B 1.0 µg/mL A. Pipette 2.5 mL of Amitriptyline/Nortriptyline Standard A into a 25 mL volumetric flask. B. Dilute to 25 mL with methanol. 4.4.3 Clozapine Working Standard A 10 µg/mL A. Pipette 250 µL of clozapine 1.0 mg/mL stock standard into a 25 mL volumetric flask. B. Dilute to 25 mL with methanol. 4.4.4 Clozapine Working Standard B 1.0 µg/mL A. Pipette 2.5 mL of Clozapine Standard A into a 25 mL volumetric flask B. Dilute to 25 mL with methanol. 4.4.5 Doxepin/Nordoxepin Working Standard A 10 µg/mL A. Pipette 250 µL of doxepin 1.0 mg/mL stock standard into a 25 mL volumetric flask B. Pipette 250 µL of desmethyldoxepin 1.0 mg/mL stock standard into the same 25 mL volumetric flask Page 3 of 12 Harris County Institute of Forensic Sciences Section: Toxicology Approved By: Chief Toxicologist Document Type: LC & LCMSMS Procedure No.: TOX.LC.3499 Title: Amitriptyline, Clozapine, Doxepin, Fluoxetine, Quetiapine and Olanzapine Rev.7 (LLE) by LCMSMS C. Dilute to 25 mL with methanol 4.4.6 Doxepin/Nordoxepin Working Standard B 1.0 µg/mL A. Pipette 2.5 mL of Doxepin/Nordoxepin Standard A into a 25 mL volumetric flask B. Dilute to 25 mL with methanol 4.4.7 Fluoxetine/Norfluoxetine Working Standard A 10 µg/mL A. Pipette 250 µL of fluoxetine 1.0 mg/mL stock standard into a 25 mL volumetric flask B. Pipette 250 µL of norfluoxetine 1.0 mg/mL stock standard into the same 25 mL volumetric flask C. Dilute to 25 mL with methanol 4.4.8 Fluoxetine/Norfluoxetine Working Standard B 1.0 µg/mL A. Pipette 2.5 mL of Fluoxetine/Norfluoxetine Standard A into a 25 mL volumetric flask B. Dilute to 25 mL with methanol 4.4.9 Olanzapine Working Standard A 10 µg/mL A. Pipette 250 µL of olanzapine 1.0 mg/mL stock standard into a 25 mL volumetric flask B. Dilute to 25 mL with methanol 4.4.10 Olanzapine Working Standard B 1.0 µg/mL A. Pipette 2.5 mL of Olanzapine Standard A into a 25 mL volumetric flask B. Dilute to 25 mL with methanol 4.4.11 Quetiapine/Norquetiapine Working Standard A 10 µg/mL A. Pipette 250 µL of quetiapine 1.0 mg/mL stock standard into a 25 mL volumetric flask B. Pipette 250 µL of norquetiapine 1.0 mg/mL stock standard into the same 25 mL volumetric flask C. Dilute to 25 mL with methanol 4.4.12 Quetiapine/Norquetiapine Working Standard B 1.0 µg/mL A. Pipette 2.5 mL of Quetiapine/Norquetiapine Standard A into a 25 mL volumetric flask B. Dilute to 25 mL with methanol 4.5 Working Controls Page 4 of 12 Harris County Institute of Forensic Sciences Section: Toxicology Approved By: Chief Toxicologist Document Type: LC & LCMSMS Procedure No.: TOX.LC.3499 Title: Amitriptyline, Clozapine, Doxepin, Fluoxetine, Quetiapine and Olanzapine Rev.7 (LLE) by LCMSMS 4.5.1 Amitriptyline/Nortriptyline Working QC A 10 µg/mL A. Pipette 250 µL of amitriptyline 1.0 mg/mL stock control into a 25 mL volumetric flask B. Pipette 250 µL of nortriptyline 1.0 mg/mL stock control into the same 25 mL volumetric flask C. Dilute to 25 mL with methanol 4.5.2 Amitriptyline/Nortriptyline Working QC B 1.0 µg/mL A. Pipette 2.5 mL of Amitriptyline/Nortriptyline QC A into a 25 mL volumetric flask. B. Dilute to 25 mL with methanol 4.5.3 Clozapine Working QC A 10 µg/mL A. Pipette 250 µL of clozapine 1.0 mg/mL stock control into a 25 mL volumetric flask B. Dilute to 25 mL with methanol 4.5.4 Clozapine Working QC B 1.0 µg/mL A. Pipette 2.5 mL of Clozapine QC A into a 25 mL volumetric flask. B. Dilute to 25 mL with methanol 4.5.5 Doxepin/Nordoxepin Working QC A 10 µg/mL A.
Load more

Recommended publications
  • 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]
  • Current P SYCHIATRY
    Current p SYCHIATRY N ew Investigators Tips to manage and prevent discontinuation syndromes Informed tapering can protect patients when you stop a medication Sriram Ramaswamy, MD Shruti Malik, MBBS, MHSA Vijay Dewan, MD Instructor, department of psychiatry Foreign medical graduate Assistant professor Creighton University Department of psychiatry Omaha, NE University of Nebraska Medical Center Omaha, NE bruptly stopping common psychotropics New insights on psychotropic A —particularly antidepressants, benzodi- drug safety and side effects azepines, or atypical antipsychotics—can trigger a discontinuation syndrome, with: This paper was among those entered in the 2005 • rebound or relapse of original symptoms Promising New Investigators competition sponsored • uncomfortable new physical and psycho- by the Neuroleptic Malignant Syndrome Information Service (NMSIS). The theme of this year’s competition logical symptoms was “New insights on psychotropic drug safety and • physiologic withdrawal at times. side effects.” To increase health professionals’ awareness of URRENT SYCHIATRY 1 C P is honored to publish this peer- the risk of these adverse effects, this article reviewed, evidence-based article on a clinically describes discontinuation syndromes associated important topic for practicing psychiatrists. with various psychotropics and offers strategies to NMSIS is dedicated to reducing morbidity and anticipate, recognize, and manage them. mortality of NMS by improving medical and psychiatric care of patients with heat-related disorders; providing
    [Show full text]
  • Antipsychotic Combinations
    Graylands Hospital DRUG BULLETIN Pharmacy Department Brockway Road Mount Claremont WA 6010 Telephone (08) 9347 6400 Email [email protected] Fax (08) 9384 4586 Antipsychotic Combinations Graylands Hospital Drug Bulletin 2008 Vol. 15 No. 3 February ISSN 1323-1251 Antipsychotic combinations Reasons for antipsychotic combinations Despite the development of efficacious medications for the treatment of schizophrenia, many people do There are a number of theoretical benefits and not respond adequately. To address this problem, reasons cited for antipsychotic combination the use of two or more antipsychotics simultaneously prescribing, these include: is a commonly employed treatment strategy. Although the use of combination antipsychotics is Complementary mechanisms of action4 (e.g. common in clinical practice, the risks and benefits adding an antipsychotic with strong dopamine have not been systematically evaluated to date. As a D2 blockade to a weak D2 blocker) result, current Australian treatment algorithms Partial replacement of antipsychotic action for including the Royal Australian and New Zealand drugs with intolerable adverse effects at higher College of Psychiatry Schizophrenia Guidelines and 5 doses (e.g. adding quetiapine to clozapine to the Western Australian Therapeutic Advisory Group minimise metabolic adverse effects) Antipsychotic Guidelines advise against the use of combined antipsychotics, except for short periods of Alternative where clozapine cannot be used6 changeover1,2. Most data on antipsychotic
    [Show full text]
  • Doxepin Exacerbates Renal Damage, Glucose Intolerance, Nonalcoholic Fatty Liver Disease, and Urinary Chromium Loss in Obese Mice
    pharmaceuticals Article Doxepin Exacerbates Renal Damage, Glucose Intolerance, Nonalcoholic Fatty Liver Disease, and Urinary Chromium Loss in Obese Mice Geng-Ruei Chang 1,* , Po-Hsun Hou 2,3, Wei-Cheng Yang 4, Chao-Min Wang 1 , Pei-Shan Fan 1, Huei-Jyuan Liao 1 and To-Pang Chen 5,* 1 Department of Veterinary Medicine, National Chiayi University, 580 Xinmin Road, Chiayi 60054, Taiwan; [email protected] (C.-M.W.); [email protected] (P.-S.F.); [email protected] (H.-J.L.) 2 Department of Psychiatry, Taichung Veterans General Hospital, 1650 Taiwan Boulevard (Section 4), Taichung 40705, Taiwan; [email protected] 3 Faculty of Medicine, National Yang-Ming University, 155 Linong Street (Section 2), Taipei 11221, Taiwan 4 School of Veterinary Medicine, National Taiwan University, 1 Roosevelt Road (Section 4), Taipei 10617, Taiwan; [email protected] 5 Division of Endocrinology and Metabolism, Show Chwan Memorial Hospital, 542 Chung-Shan Road (Section 1), Changhua 50008, Taiwan * Correspondence: [email protected] (G.-R.C.); [email protected] (T.-P.C.); Tel.: +886-5-2732946 (G.-R.C.); +886-4-7256166 (T.-P.C.) Abstract: Doxepin is commonly prescribed for depression and anxiety treatment. Doxepin-related disruptions to metabolism and renal/hepatic adverse effects remain unclear; thus, the underlying mechanism of action warrants further research. Here, we investigated how doxepin affects lipid Citation: Chang, G.-R.; Hou, P.-H.; change, glucose homeostasis, chromium (Cr) distribution, renal impairment, liver damage, and fatty Yang, W.-C.; Wang, C.-M.; Fan, P.-S.; liver scores in C57BL6/J mice subjected to a high-fat diet and 5 mg/kg/day doxepin treatment for Liao, H.-J.; Chen, T.-P.
    [Show full text]
  • Olanzapine-Induced Acute Pancreatitis and New Diabetes Mellitus
    Open Journal of Psychiatry, 2012, 2, 110-112 OJPsych http://dx.doi.org/10.4236/ojpsych.2012.22015 Published Online April 2012 (http://www.SciRP.org/journal/ojpsych/) Case report: Olanzapine-induced acute pancreatitis and new diabetes mellitus Erik Monasterio1*, Ruchi Bhalla2, Andrew McKean3 1Department of Psychological Medicine, University of Otago, Christchurch, New Zealand 2Hammersmith and Fulham Mental Health Unit, West London Mental Health NHS Trust, London, UK 3Hillmorton Hospital, Christchurch, New Zealand Email: *[email protected] Received 29 December 2011; revised 31 January 2012; accepted 15 February 2012 ABSTRACT criteria and required application from a psychiatrist for a patient who had been trialled unsuccessfully on risperi- The aim of this case study is to review the literature done or required treatment with olanzapine short acting and report the first published case of olanzapine-in- intra-muscular injection [4]. In June 2011, significantly duced acute pancreatitis in New Zealand. A case re- cheaper generic versions of olanzapine were introduced port of acute pancreatitis with new onset diabetes and the special authority criteria for olanzapine with- mellitus secondary to olanzapine in a 42-year-old male, drawn [5]. We aim to highlight lesser known and poten- in the absence of medical risk factors is reported. tially fatal side effects through our case report. Eleven previous case reports of olanzapine induced acute-pancreatitis were identified in the literature. A 2. CASE REPORT 42-year-old male was diagnosed with acute pancreati- tis and new diabetes mellitus induced by olanzapine. Mr. X is a 42 year old man who had come into contact Although rare, pancreatitis is associated with use of with mental health services on many occasions during some atypical antipsychotic medications.
    [Show full text]
  • Treatment Options for Clozapine-Induced Enuresis: a Review of Clinical Effectiveness
    TITLE: Treatment Options for Clozapine-Induced Enuresis: A Review of Clinical Effectiveness DATE: 27 September 2010 CONTEXT AND POLICY ISSUES: Clozapine is an atypical antipsychotic indicated in the management of treatment-resistant schizophrenia.1 Clozapine binds dopamine receptors as well as exerting potent anticholinergic, adrenolytic, antihistaminic, and antiserotoninergic activity.1 It has been shown to be efficacious in treating both the positive (e.g., hallucinations) and negative symptoms (e.g., social withdrawal) associated with schizophrenia. Patients treated with clozapine may experience adverse effects ranging in severity from relatively benign to serious and potentially life-threatening conditions such as seizures and agranulocytosis.1,2 One potential adverse effect is enuresis, or an inability to control urination, which can cause emotional stress and poor compliance among the affected patients.3 The true prevalence of clozapine-induced enuresis has yet to be determined as published estimates range from 0.23% to 44%.4,5 The reasons for this lack of consistency is are unclear and may be related to differences in dosage,6 ethnicity,7 and treatment setting.3 The mechanism for clozapine-induced enuresis has not been fully elucidated; however, a leading hypothesis involves blockade of the α-adrenergic receptors resulting in a decrease in internal bladder sphincter tone.7 A number of treatments are available for the management of enuresis including desmopressin,8 tricyclic antidepressants,9 anticholinergics,10 and alarms.11 However, there is currently no universally accepted approach to addressing clozapine-induced enuresis.2,6 This report reviews the safety and effectiveness of the various treatment strategies for clozapine- induced enuresis.
    [Show full text]
  • Clozapine and Gastrointestinal Adverse Effects – a Pain in the Gut? Graylands Hospital Drug Bulletin 2004 Vol
    Clozapine and Gastrointestinal Adverse Effects – A Pain in the Gut? Graylands Hospital Drug Bulletin 2004 Vol. 12 No. 3 September ISSN 1323-1251 Gastrointestinal adverse effects of clozapine impaction5. The patient died three weeks after are very common and include nausea, presentation from refractory shock and vomiting and constipation. Other troublesome progressive multi-system organ failure, unwanted effects include dry mouth and despite maximal care. hypersalivation, which involve the autonomic nervous system. A further case involved a 29 year old man who had only been taking clozapine for 36 Constipation is a particularly common days2. He died after aspiration of vomitus adverse effect that has been reported to occur secondary to bowel obstruction. in 14-60% of patients1,2. The management of clozapine-induced constipation has been the Intestinal Obstruction/Occlusion subject of a past Drug Bulletin3. Clozapine’s association with constipation could be There is a French report of three cases of intestinal occlusion in clozapine treated explained by its potent anticholinergic 6 properties. patients, one of which was fatal . Another report describes two cases of Rarely, clozapine-induced constipation has 7 lead to serious complications including ileus, clozapine-induced intestinal obstruction . bowel obstruction and necrotising colitis. A One of these involved a 51 year old man with review was conducted to determine what no past history of constipation, who had been serious gastrointestinal adverse effects have taking clozapine for two months. He suffered been reported in the literature and these are from an intestinal obstruction, from which he discussed below. fully recovered and clozapine was recommenced. The other case involved a 35 Faecal Impaction year old woman who had been taking clozapine for four months when she There are three reported cases of death developed abdominal symptoms.
    [Show full text]
  • Drug-Facilitated Sexual Assault Panel, Blood
    DRUG-FACILITATED SEXUAL ASSAULT PANEL, BLOOD Blood Specimens (Order Code 70500) Alcohols Analgesics, cont. Anticonvulsants, cont. Antihistamines, cont. Ethanol Phenylbutazone Phenytoin Cyclizine Amphetamines Piroxicam Pregabalin Diphenhydramine Amphetamine Salicylic Acid* Primidone Doxylamine BDB Sulindac* Topiramate Fexofenadine Benzphetamine Tapentadol Zonisamide Guaifenesin Ephedrine Tizanidine Antidepressants Hydroxyzine MDA Tolmetin Amitriptyline Loratadine MDMA Tramadol Amoxapine Oxymetazoline* Mescaline* Anesthetics Bupropion Pyrilamine Methcathinone Benzocaine Citalopram Tetrahydrozoline Methamphetamine Bupivacaine Clomipramine Triprolidine Phentermine Etomidate Desipramine Antipsychotics PMA Ketamine Desmethylclomipramine 9-hydroxyrisperidone Phenylpropanolamine Lidocaine Dosulepin Aripiprazole Pseudoephedrine Mepivacaine Doxepin Buspirone Analgesics Methoxetamine Duloxetine Chlorpromazine Acetaminophen Midazolam Fluoxetine Clozapine Baclofen Norketamine Fluvoxamine Fluphenazine Buprenorphine Pramoxine* Imipramine Haloperidol Carisoprodol Procaine 1,3-chlorophenylpiperazine (mCPP) Mesoridazine Cyclobenzaprine Rocuronium Mianserin* Norclozapine Diclofenac Ropivacaine Mirtazapine Olanzapine Etodolac Antibiotics Nefazodone Perphenazine Fenoprofen Azithromycin* Nordoxepin Pimozide Hydroxychloroquine Chloramphenicol* Norfluoxetine Prochlorperazine Ibuprofen Ciprofloxacin* Norsertraline Quetiapine Ketoprofen Clindamycin* Nortriptyline Risperidone Ketorolac Erythromycin* Norvenlafaxine Thioridazine Meclofenamic Acid* Levofloxacin* Paroxetine
    [Show full text]
  • Antipsychotics
    bmchp.org | 888-566-0008 wellsense.org | 877-957-1300 Pharmacy Policy Antipsychotics Policy Number: 9.503 Version Number: 2.1 Version Effective Date: 9/1/2021 Product Applicability All Plan+ Products Well Sense Health Plan Boston Medical Center HealthNet Plan New Hampshire Medicaid MassHealth - MCO MassHealth - ACO Qualified Health Plans/ConnectorCare/Employer Choice Direct Senior Care Options __________________________________ Note: Disclaimer and audit information is located at the end of this document. Prior Authorization Policy Products Affected: aripiprazole ODT Latuda (lurasidone) aripiprazole Sol Nuplazid (pimavanserin) asenapine maleate Rexulti (brexpiprazole) clozapine ODT Vraylar (cariprazine) risperidone ODT Versacloz (clozapine) Fanapt (iloperidone) Secuado (asenapine) Paliperidone The Plan may authorize coverage of the above products for members meeting the following criteria: Covered All FDA approved indications not otherwise excluded Use All indications supported by established clinical literature for the medical condition and age + Plan refers to Boston Medical Center Health Plan, Inc. and its affiliates and subsidiaries offering health coverage plans to enrolled members. The Plan operates in Massachusetts under the trade name Boston Medical Center HealthNet Plan and in other states under the trade name Well Sense Health Plan. Antipsychotics 1 of 6 Exclusion None Criteria Required Medical Information clozapine ODT, risperidone ODT, aripiprazole ODT, aripiprazole sol, Versacloz 1. A diagnosis of bipolar disorder, schizophrenia, or other psychotic disorder; OR 2. A diagnosis of major depression requiring adjunct therapy ( aripiprazole ODT, aripiprazole sol only); AND 3. Clinical swallowing difficulties (including unwillingness to swallow tablets) Fanapt, palipedione (oral), Latuda, Vraylar 1. A diagnosis of bipolar disorder, schizophrenia, or other psychotic disorder; AND 2. An inadequate response, intolerance or contraindication to a trial of two covered atypical antipsychotics (See Appendix A) Nuplazid 1.
    [Show full text]
  • Clozapine and Haloperidol in Moderately Refractory Schizophrenia a 6-Month Randomized and Double-Blind Comparison
    ORIGINAL ARTICLE Clozapine and Haloperidol in Moderately Refractory Schizophrenia A 6-Month Randomized and Double-blind Comparison John M. Kane, MD; Stephen R. Marder, MD; Nina R. Schooler, PhD; William C. Wirshing, MD; Daniel Umbricht, MD; Robert W. Baker, MD; Donna A. Wirshing, MD; Allan Safferman, MD; Rohan Ganguli, MD; Marjorie McMeniman, PhD; Michael Borenstein, PhD Background: Despite the demonstrated efficacy of cloza- a priori criterion of improvement (57%) compared with pine in severely refractory schizophrenia, questions re- haloperidol-treated subjects (25%). Significantly greater main regarding its efficacy for primary negative symp- improvement was seen in symptoms of psychosis, hostile- toms, comparison with a moderate dose of a first- suspiciousness, anxiety-depression, thought distur- generation antipsychotic, and adverse effects during a bance, and total score measured on the Brief Psychiatric longer-term trial. This study examined its efficacy in par- Rating Scale. No differences were detected in negative tially responsive, community-based patients, compared symptoms using the Brief Psychiatric Rating Scale or the clozapine with moderate-dose haloperidol, and ex- Schedule for Assessment of Negative Symptoms. Sub- tended treatment to 6 months. jects treated with clozapine experienced more excess sali- vation, dizziness, and sweating and less dry mouth and Methods: Randomized, double-blind, 29-week trial com- decreased appetite than those treated with haloperidol. paring clozapine (n=37) with haloperidol (n=34). Sub- jects with schizophrenia who were being treated in com- Conclusions: Compared with a first-generation anti- munity settings at 3 collaborating clinical facilities were psychotic given in a moderate dose, clozapine offers sub- enrolled. stantial clinical benefits to treatment-refractory subjects who can be treated in the community.
    [Show full text]
  • Antidepressants
    Antidepressants BMF 83 - Antidepressants BMF 83 - Antidepressants Depression is a common psychiatric disorder impacting millions of people worldwide. It is caused by an imbalance of chemicals 1 in the brain, namely serotonin and noradrenaline . Everyone experiences highs and lows, but depression is characterised by 2 persistent sadness for weeks or months . With depression there is lasting feeling of hopelessness, often accompanied by anxiety. Sufferers lose interest in things that they previously enjoyed, and experience bouts of tearfulness. Rational thinking and decision 2 making are impacted. Physical manifestations include tiredness, insomnia, loss of appetite and sex drive, aches and pains . At its worst depression can cause the sufferer to feel suicidal. Depression is usually treated with a combination of counselling and drug therapy. There is also evidence that exercise can help depression. Most people with moderate or severe depression benefit from antidepressant medication. There are a wide range of 3 antidepressants on the market, which can be broadly divided according to mechanism of action ; • Selective serotonin reuptake inhibitors (SSRIs) • Serotonin-norepinephrine reuptake inhibitors (SNRIs) • Serotonin modulator and stimulators (SMSs) • Serotonin antagonist and reuptake inhibitors (SARIs) • Norepinephrine reuptake inhibitors (NRIs or NERIs) • Tetracyclic antidepressants (TeCAs) • Tricyclic antidepressants (TCAs) • Monoamine oxidase inhibitors (MAOIs) www.chiron.no | E-mail: [email protected] | Tel.: +47 73 87 44 90 | Fax.: +47 73 73 87 44 99 | BMF 83 p.1/8 , 10_16 BMF 83 - Antidepressants BMF 83 - Antidepressants 1 Today the most common first choice of medication is a SSRI , i.e. Citalopram, Escitalopram, Fluvoxamine, Paroxetine, Sertraline, Fluoxetine. Antidepressants are not addictive, but can result in withdrawal symptoms when therapy is stopped.
    [Show full text]
  • Olanzapine and Clozapine Increase the Gabaergic Neuroactive Steroid Allopregnanolone in Rodents
    Neuropsychopharmacology (2003) 28, 1–13 & 2003 Nature Publishing Group All rights reserved 0893-133X/03 $25.00 www.neuropsychopharmacology.org Olanzapine and Clozapine Increase the GABAergic Neuroactive Steroid Allopregnanolone in Rodents ,1 2,3 2 2 2,3,4 Christine E Marx* , Margaret J VanDoren , Gary E Duncan , Jeffrey A Lieberman and A Leslie Morrow 1Department of Psychiatry and Behavioral Sciences, Duke University Medical Center and Durham VA Medical Center, Durham, North Carolina, USA; 2Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina 27599, USA; 3Center for Alcohol Studies, University of 4 North Carolina, Chapel Hill, North Carolina 27599, USA; Department of Pharmacology, University of North Carolina, Chapel Hill, North Carolina 27599, USA The neuroactive steroid allopregnanolone is a potent g-aminobutyric acid type A (GABAA) receptor modulator with anxiolytic and anticonvulsant effects. Olanzapine and clozapine also have anxiolytic-like effects in behavioral models. We therefore postulated that olanzapine and clozapine would elevate allopregnanolone levels, but risperidone and haloperidol would have minimal effects. Male rats received intraperitoneal olanzapine (2.5–10.0 mg/kg), clozapine (5.0–20.0 mg/kg), risperidone (0.1–1.0 mg/kg), haloperidol (0.1–1.0 mg/ kg), or vehicle. Cerebral cortical allopregnanolone and peripheral progesterone and corticosterone levels were determined. Adrenalectomized animals were also examined. Both olanzapine and clozapine increased cerebral cortical allopregnanolone levels, but neither risperidone nor haloperidol had significant effects. Olanzapine and clozapine also increased serum progesterone and corticosterone levels. Adrenalectomy prevented olanzapine- and clozapine-induced elevations in allopregnanolone. Allopregnanolone induction may contribute to olanzapine and clozapine anxiolytic, antidepressant, and mood-stabilizing actions.
    [Show full text]