ARISTADA INITIO and ARISTADA Patient Transition Form
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Aristada™ (Aripiprazole Lauroxil)
Aristada™ (aripiprazole lauroxil) – New Drug Approval • On October 5, 2015, Alkermes’ announced the FDA approval of Aristada (aripiprazole lauroxil) extended-release injection, an atypical antipsychotic, for the treatment of schizophrenia. • Schizophrenia is a chronic, severe and disabling brain disorder affecting an estimated 2.4 million Americans. Typically, symptoms include hearing voices, believing other people are reading their minds or controlling their thoughts, and being suspicious or withdrawn. • Aristada’s approval was based on data from a double-blind, placebo-controlled 12-week trial involving 622 patients with schizophrenia. In addition, the efficacy of Aristada was established, in part, on the basis of efficacy data from trials with oral aripiprazole. — Aristada significantly improved symptoms of schizophrenia compared to placebo at day 85. • Similar to other atypical antipsychotics, Aristada carries a boxed warning for increased mortality in elderly patients with dementia-related psychosis. • Other warnings and precautions for Aristada include cerebrovascular adverse reactions, including stroke; neuroleptic malignant syndrome; tardive dyskinesia; metabolic changes; orthostatic hypotension; leukopenia, neutropenia, and agranulocytosis; seizures; potential for cognitive and motor impairment; body temperature regulation; and dysphagia. • The most common adverse reaction (≥ 5% and at least twice that for placebo) with Aristada use was akathisia. • Aristada is administered by intramuscular injection in the deltoid (441 mg dose only) or gluteal (441 mg, 662 mg, or 882 mg) muscle by a healthcare professional. — Aristada can be initiated at a monthly dose (441 mg, 662 mg or 882 mg) or every 6 week dose (882 mg). — For patients naïve to aripiprazole, tolerability should be established with oral aripiprazole prior to initiating treatment with Aristada. -
Product Monograph
PRODUCT MONOGRAPH PrFLUANXOL® Flupentixol Tablets (as flupentixol dihydrochloride) 0.5 mg, 3 mg, and 5 mg PrFLUANXOL® DEPOT Flupentixol Decanoate Intramuscular Injection 2% and 10% flupentixol decanoate Antipsychotic Agent Lundbeck Canada Inc. Date of Revision: 2600 Alfred-Nobel December 12th, 2017 Suite 400 St-Laurent, QC H4S 0A9 Submission Control No : 209135 Page 1 of 35 Table of Contents PART I: HEALTH PROFESSIONAL INFORMATION .........................................................3 SUMMARY PRODUCT INFORMATION ........................................................................3 INDICATIONS AND CLINICAL USE ..............................................................................3 CONTRAINDICATIONS ...................................................................................................4 WARNINGS AND PRECAUTIONS ..................................................................................4 ADVERSE REACTIONS ..................................................................................................10 DRUG INTERACTIONS ..................................................................................................13 DOSAGE AND ADMINISTRATION ..............................................................................15 OVERDOSAGE ................................................................................................................18 ACTION AND CLINICAL PHARMACOLOGY ............................................................19 STORAGE AND STABILITY ..........................................................................................21 -
Pharmacotherapy, Drug-Drug Interactions and Potentially
medRxiv preprint doi: https://doi.org/10.1101/2021.03.31.21254518; this version posted April 6, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Pharmacotherapy, drug-drug interactions and potentially inappropriate medication in depressive disorders Jan Wolff1,2,3, Pamela Reißner4, Gudrun Hefner5, Claus Normann2, Klaus Kaier6, Harald Binder6, Christoph Hiemke7, Sermin Toto8, Katharina Domschke2, Michael Marschollek1, Ansgar Klimke4,9 1 Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Germany. 2 Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. 3 Evangelical Foundation NeuerKerode, Germany. 4 Vitos Hochtaunus, Friedrichsdorf, Germany. 5 Vitos Clinic for Forensic Psychiatry, Eltville, Germany 6 Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. 7 Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany. 8 Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany. 9 Heinrich-Heine-University Düsseldorf, Germany. ___ Correspondence Dr. Jan Wolff, Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, Hannover, Germany. Address: Karl- Wiechert-Allee 3, 30625 Hannover. Email: [email protected], wolff.jan@mh- hannover.de, ORCID: https://orcid.org/0000-0003-2750-0606 Key words (MeSH) Depression, Polypharmacy, Antidepressants, Hospitals, Drug Interactions, Psychiatry NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. -
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 -
Effects of Typical and Atypical Antipsychotics and Receptor
Effects of Typical and Atypical Antipsychotics and Receptor Selective Compounds on Acetylcholine Efflux in the Hippocampus of the Rat Sudabeh Shirazi-Southall, M.A., Dana Ellen Rodriguez, A.H.T., George G. Nomikos, M.D., Ph.D. Some atypical antipsychotic drugs appear to improve 100,907), the 5-HT2C (SB 242,084), the 5-HT6 (Ro 04-6790), ␣ cognitive function in schizophrenia and since acetylcholine the D2 (raclopride) receptors, and the 1-adrenoceptors (ACh) is of importance in cognition, we used in vivo (prazosin) modestly increased ACh by about 50%. The ϩ ␣ microdialysis to examine the effects of antipsychotics 5-HT1A agonist R-( )-8-OH-DPAT and the 2- administered acutely (SC or IP) at pharmacologically adrenoceptor antagonist yohimbine significantly increased comparable doses on ACh outflow in the hippocampus of the ACh by about 100% and 50%, respectively. Thus, olanzapine rat. The atypical antipsychotics olanzapine and clozapine and clozapine increased ACh to a greater extent than other tested produced robust increases in ACh up to 1500% and 500%, antipsychotics, explaining perhaps their purported beneficial respectively. The neuroleptics haloperidol, thioridazine, and effect in cognitive function in schizophrenia. It appears that chlorpromazine, as well as the atypical antipsychotics selective activity at each of the monoaminergic receptors studied risperidone and ziprasidone produced modest increases in is not the sole mechanism underlying the olanzapine and ACh by about 50–100%. Since most atypical antipsychotics clozapine induced increases in hippocampal ACh. affect a variety of monoaminergic receptors, we examined [Neuropsychopharmacology 26:583–594, 2002] whether selective ligands for some of these receptors affect © 2002 American College of Neuropsychopharmacology. -
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. -
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. -
Atypical Antipsychotics
Pharmacy Policy Bulletin Category: Managed Rx Coverage Number: J-307 Subject: Atypical Antipsychotics Effective Date Begin: September 1, 2010 Effective Date End: Original Date: March 4, 2009 Review Date(s): March 3, 2010 September 2, 2009 March 4, 2009 NOTE: This version of the policy is effective 9/1/2010, the previous version is effective up to 8/31/20. Please click version 002 of J- 307 below for more details. Policy Applies to: Commercial Plans. Agents addressed in this policy: Abilify (aripiprazole), Symbyax (olanzapine & fluoxetine), Seroquel XR (quetiapine) Background: Antipsychotics are used to treat a myriad of mental health conditions. There are two categories of antipsychotics, first generation or typical antipsychotics and second generation or atypical antipsychotics. Typical antipsychotics (e.g, chlorpromazine) exhibit a high incidence of adverse reactions such as extrapyramidal signs (EPS) and tardive dyskinesia at clinically effective doses. Atypical antipsychotics (e.g. quetiapine, risperidone, olanzapine) may exhibit adverse reactions mentioned above but the incidence is much less often. It is important that both classes of drugs are utilized in appropriate patient populations. The US Food and Drug Administration has required manufacturers of all antipsychotic drugs to add a boxed warning to the drugs' prescribing information about the risk of mortality in elderly patients treated for dementia-related psychosis. Abilify (aripiprazole) is an atypical antipsychotic that is approved for the treatment of schizophrenia, bipolar mania, and as adjunctive treatment of major depressive disorder (MDD). The mechanism of action is unknown but it has been proposed that aripiprazole acts as a partial agonist against D2 and 5-HT1A receptors and antagonist activity at 5-HT2A receptors. -
HALDOL Decanoate 50 (Haloperidol)
HALDOL® Decanoate 50 (haloperidol) HALDOL® Decanoate 100 (haloperidol) For IM Injection Only WARNING Increased Mortality in Elderly Patients with Dementia-Related Psychosis Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of seventeen placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. HALDOL Decanoate is not approved for the treatment of patients with dementia-related psychosis (see WARNINGS). DESCRIPTION Haloperidol decanoate is the decanoate ester of the butyrophenone, HALDOL (haloperidol). It has a markedly extended duration of effect. It is available in sesame oil in sterile form for intramuscular (IM) injection. The structural formula of haloperidol decanoate, 4-(4-chlorophenyl)-1-[4-(4-fluorophenyl)-4-oxobutyl]-4 piperidinyl decanoate, is: Haloperidol decanoate is almost insoluble in water (0.01 mg/mL), but is soluble in most organic solvents. -
The Benefit of Atypical Antipsychotics Over Standard Drugs Disappears
Evid Based Mental Health: first published as 10.1136/ebmh.4.3.77 on 1 August 2001. Downloaded from Review: the benefit of atypical antipsychotics over standard drugs disappears after controlling for comparator dose Geddes J, Freemantle N, Harrison P,et al, for the National Schizophrenia Guideline Development Group. Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. BMJ 2000 Dec 2;321:1371–6. QUESTION: In patients with schizophrenia, are atypical antipsychotic drugs effective and tolerable for controlling symptoms? Data sources advantage for atypicalantipsychotic drugs as the dose of Studies were identified by searching Medline, EMBASE/ haloperidol increased; the benefit disappeared when Source of funding: UK Excerpta Medica, PsycLIT, and the Cochrane Controlled the haloperidol dose decreased. A similar effect was Department of Health. Trials Register. Additional trials were found by seen for chlorpromazine. For correspondence: contacting pharmaceutical companies and consulting Dr J Geddes, Cochrane group members. Conclusion Department of In patients with schizophrenia, atypical antipsychotic Psychiatry, University of Oxford, Warneford Study selection drugs reduce symptoms and dropout rates, but the Hospital, Oxford Studies were selected if they were randomised con- benefits do not remain after controlling for the dose of OX3 7JX, UK. Fax trolled trials (RCTs) comparing the effectiveness of conventional antipsychotic comparator drugs. +44 (0)1865 793 101. atypical and conventional -
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. -
List Item Olanzapine Teva
EMA/685358/2012 EMEA/H/C/000810 EPAR summary for the public Olanzapine Teva olanzapine This is a summary of the European public assessment report (EPAR) for Olanzapine Teva. It explains how the Committee for Medicinal Products for Human Use (CHMP) assessed the medicine to reach its opinion in favour of granting a marketing authorisation and its recommendations on the conditions of use for Olanzapine Teva. What is Olanzapine Teva? Olanzapine Teva is a medicine containing the active substance olanzapine. It is available as tablets (2.5, 5, 7.5, 10, 15 and 20 mg) and as ‘orodispersible’ tablets (5, 10, 15 and 20 mg). Orodispersible tablets are tablets that dissolve in the mouth. Olanzapine Teva is a ‘generic medicine’. This means that Olanzapine Teva is similar to ‘reference medicines’ already authorised in the European Union (EU) called Zyprexa and Zyprexa Velotab. For more information on generic medicines, see the question-and-answer document here. What is Olanzapine Teva used for? Olanzapine Teva is used to treat adults with schizophrenia. Schizophrenia is a mental illness that has a number of symptoms including disorganised thinking and speech, hallucinations (hearing or seeing things that are not there), suspiciousness and delusions (mistaken beliefs). Olanzapine Teva is also effective in maintaining improvement in patients who have responded to an initial course of treatment. Olanzapine Teva is also used to treat moderate to severe manic episodes (extremely high mood) in adults. It can also be used to prevent the recurrence of these episodes (when symptoms come back) in adults with bipolar disorder (a mental illness causing alternating periods of high mood and depression) who have responded to an initial course of treatment.