Second-generation antipsychotics

Bipolar Disorder Treatment Guidelines: A 2017 Update

By Flavio Guzman, MD This page offers direct links to the most recent guidelines for the treatment of bipolar disorder. You may notice that we have not included the guidelines published by the American Psychiatric Asssociation, this is because the document has not been updated since 2005. – 2016 – British Association for Psychopharmacology Evidence-based…

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Long-Acting Injectable Antipsychotics: A Practical Guide for Prescribers

Author: Flavio Guzman, MD Competing interests: none This article summarizes the most clinically relevant features of long-acting injectable antipsychotics (LAIs, previously known as depot antipsychotics). We discuss general concepts as well as key prescribing facts of individual agents. The guide also includes two new formulations: aripiprazole lauroxil (Aristada) and 3-month paliperidone palmitate (Invega Trinza). Advantages and disadvantages of long-acting antipsychotics…

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Summary of Newly Approved Antipsychotics

By Flavio Guzman, MD Two new second-generation antipsychotics were approved in 2015: brexpiprazole (Rexulti) and cariprazine (Vraylar). Like aripiprazole (Abilify), they are both D2 partial agonists and are associated with risk of akathisia. Aripiprazole, brexpiprazole and cariprazine are FDA-approved for the treatment of schizophrenia. Aripiprazole and cariprazine are approved for the treatment of manic episodes in…

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Reviewing Antipsychotic Adverse Effects with Prof. Mark Taylor

Professor Mark Taylor is a consultant psychiatrist at the NHS in the UK. He is also Associate Professor at the University of Queensland in Brisbane Australia. He is the coauthor of a paper published in the Journal of Psychopharmacology: “First do no harm.” A systematic review of the prevalence and management of antipsychotic adverse effects”.…

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Aripiprazole Lauroxil Extended-Release Injectable (ARISTADA)

By Flavio Guzman, MD Prescribing information highlights To be 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. For patients naïve to aripiprazole, establish tolerability with oral aripiprazole prior to initiating treatment with ARISTADA. ARISTADA can be initiated at…

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Pharmacotherapy of Treatment-Resistant OCD: Augmentation Strategies

Treatment of obsessive compulsive disorder is often challenging. Treatment resistance is quite common, between 40 to 60% of patients do not show and adequate response to first-line treatments. We invited Dr. David Veale to comment on his meta-analysis published in BMC Psychiatry : “Atypical antipsychotic augmentation in SSRI treatment refractory obsessive-compulsive disorder: a systematic review…

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FDA Warning: Ziprasidone Associated with DRESS Syndrome

The FDA has issued a warning (December 11, 2014) that the second generation antipsychotic ziprasidone (Geodon and others) is associated with a rare but serious skin condition known as Drug Reaction with Eosinophilia (DRESS)and Systemic Symptoms . Excerpts from the FDA website: A new warning has been added to the Geodon drug label to describe…

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Ziprasidone Adverse Effects

Source: Drug labeling information submitted to the Food and Drug Administration (FDA), updated by the National Library of Medicine (NLM). Commonly observed adverse reactions (incidence ≥5% and at least twice the incidence for placebo) were: Schizophrenia: Somnolence, respiratory tract infection. Manic and Mixed Episodes Associated with Bipolar Disorder: Somnolence, extrapyramidal symptoms, dizziness, akathisia, abnormal vision,…

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Ziprasidone (Geodon) Pharmacokinetics

Source: Drug labeling information submitted to the Food and Drug Administration (FDA), updated by the National Library of Medicine (NLM). Oral Pharmacokinetics Ziprasidone’s activity is primarily due to the parent drug. The multiple-dose pharmacokinetics of ziprasidone are dose-proportional within the proposed clinical dose range, and ziprasidone accumulation is predictable with multiple dosing. Elimination of ziprasidone…

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Mechanism of Action and Pharmacodynamics of Ziprasidone

By: Flavio Guzman, MD Mechanism of Action The mechanism of action of ziprasidone, as with other drugs having efficacy in schizophrenia, is unknown. However, it has been proposed that this drug’s efficacy in schizophrenia is mediated through a combination of dopamine type 2 (D2) and serotonin type 2 (5HT2) antagonism. As with other drugs having…

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