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No.3 some pointers new meds.docWorld Fellowship for Schizophrenia
And Allied Disorders
124 Merton Street, Suite 507, Toronto, On M4S 2Z2, Canada Website: www.world-schizophrenia.org Email: [email protected] Some Pointers on Second Generation Antipsychotics
Risperidone - commercial name: Risperdal- made by Janssen
Dose range: 2-8 mg/day
J Less likely to cause weight gain; easy to adjust dose; not particularly sedating; possible mood stabilizer; can be given once a day; available in liquid form; long-acting injectable preparation available soon; blood level testing available. Optimum dose range: 2-6 mg per day L Increases prolactin (can cause menstrual irregularities, decreased libido, impotence, etc.); more likely to cause muscle and movement side effects than other new medications. Information on the web from the manufacturer Janssen: http://www.risperdal.com/
Risperidone depot – commercial name Risperdal Consta – made by Janssen
Available 2004 in many countries
J For those who are forgetful of taking their medications or those who do not like to take pills every day, this new medication may prove very useful. Depot medications provide
the added benefit that the doctor knows that the patient is being treated and is alerted
to non-adherence when the patient does not come for his injection.
More about this new medication from the manufacturer at: www.risperdalconsta.com/
Olanzapine - commercial name: Zyprexa– made by Eli Lilly
Dose range: 10-20 mg/day:
J Easy to adjust dose; sedating (good for insomnia); good mood stabilizer; can be given once a day; available in rapidly dissolving tablet (Zydis)’ short-acting injectable form available soon, long-acting in a year or two; blood level testing available. L High risk of weight gain regardless of dose; 40% increase 7% of their body weight; this is usually seen in the first 2 – 4 weeks; likely increased risk of glucose intolerance / diabetes. Information on the web from the manufacturer Eli Lilly: http://www.zyprexa.com/index.jsp
Quetiapine - commercial name Seroquel– made by AstraZeneca
Dose range: 300 – 750 mg/day
J Somewhat sedating; no risk of muscle / movement side effects; modest risk of weight
gain; generally very well tolerated; often given once a day L Difficult to adjust dose; no blood level testing available; sometimes given twice a day. It may take up to 3 weeks to get the right dose since one has to start at 25 mg. A dosetter (pill container with days marked) is a help. Information on the web from the manufacturer AstraZeneca website: http://www.seroquel.com/ Clozapine – commercial name Clozaril-- made by Novartis – but now off patent
Dose range: 150 - 600mg/day
J Most effective medication for treatment-resistant psychosis; good mood stabilizer; probably decreases risk of aggression, suicide; can be given once a day; sedating; no risk of muscle / movement side effects; blood level testing available. May improve verbal memory. Some people on clozapine seem to smoke and drink less. L Rare risk of serious drop in white blood cell count – weekly blood monitoring for first 6 months of treatment, bi-weekly after that; high risk of weight gain; likely increased risk of glucose intolerance / diabetes; increased risk of seizures; nocturnal incontinence in some patients; increased nocturnal salivation; rare risk of heart disease. An annual check-up of heart function is recommended. Information on the web from manufacturer Novartis website:
Ziprasidone – commercial name: Geodon - made by Pfizer
Dose range: 120-160 mg/day
J Medication available since 2002 in many countries. Best taken with food at the same time each day. Is reported to be weight neutral. Because medications like ziprasidone sometimes affect heart rhythms, you should not take the medication if you have heart disease. It is wise to have a regular check up with a cardiologist recommended by your family physician. Information on the web from the manufacturer Pfizer website:
Aripiprazole – commercial name Abilify – made by Bristol-Myers, Squibb
Dose range: 10 – 30 mg/day
Please find information from the manufacturer on the Bristol-Myers’ website: www.abilify.com
Early Intervention/ First Episode
People being treated for a first episode of schizophrenia are usually put on a simple medication
regimen. Psychiatrists advise that there is no benefit to taking two or more antipsychotic
medications on a regular basis, though patients with schizophrenia are often prescribed anti-
anxiety or anti-depressant tablets along with their anti-psychotic medication. We are now
moving away from choosing the medication of least harm towards targeting the patient’s
symptoms through the appropriate medication.
Taking more than one antipsychotic or adjunctive medication
The medical profession does not generally recommend the use of more than one antipsychotic
medication. If the person has been tried on two medications (first or second generation, i.e.
old or new) one after the other with no beneficial effect, a trial of clozapine is often
recommended. Trials of medications should last 4-6 weeks or even as long as 6 months with
regular monitoring by the doctor.
A person may be doing well on his antipsychotic medication but still have symptoms of
depression, anxiety or obsessive compulsivity. In this case a doctor may prescribe medications
intended for this purpose. In any event the person’s condition should be monitored regularly
with regular visits to the doctor.
Note on Dosage Information
The Dose ranges given in the above pamphlet are those given in the U.S. PORT Update of
Treatment Recommendations published in the Schizophrenia Bulletin Vol. 30 No.3. 2004.
The information given above is to make people aware that new medications are
available for the treatment of schizophrenia. It is not meant to be a comprehensive
guide nor a recommendation for treatment with these compounds. Please talk to
your physician/ psychiatrist about any concerns you have about your own treatment.
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