Matching articles for "antipsychotics"
Xanomeline/Trospium (Cobenfy) for Schizophrenia
The Medical Letter on Drugs and Therapeutics • November 11, 2024; (Issue 1715)
The FDA has approved Cobenfy (BMS), an oral
fixed-dose combination of the muscarinic agonist
xanomeline and the peripheral muscarinic antagonist
trospium chloride, for treatment of schizophrenia in
adults....
The FDA has approved Cobenfy (BMS), an oral
fixed-dose combination of the muscarinic agonist
xanomeline and the peripheral muscarinic antagonist
trospium chloride, for treatment of schizophrenia in
adults. It is the first antipsychotic drug to be approved
in the US for treatment of schizophrenia that does not
block dopamine receptors. This is the first approval
for xanomeline; trospium has been available for many
years for treatment of overactive bladder.
In Brief: Erzofri — Another Once-Monthly Paliperidone Formulation (online only)
The Medical Letter on Drugs and Therapeutics • October 14, 2024; (Issue 1713)
The FDA has approved Erzofri (Luye), an extended-release
injectable formulation of the second-generation
antipsychotic drug paliperidone palmitate,
for treatment of schizophrenia and...
The FDA has approved Erzofri (Luye), an extended-release
injectable formulation of the second-generation
antipsychotic drug paliperidone palmitate,
for treatment of schizophrenia and schizoaffective
disorder in adults. It is the second once-monthly
formulation of paliperidone palmitate to be approved
in the US for these indications; Invega Sustenna was
the first. Longer-acting injectable formulations of
paliperidone palmitate are also available (see Table 1).
Iloperidone (Fanapt) — A New Indication for Bipolar Disorder
The Medical Letter on Drugs and Therapeutics • July 22, 2024; (Issue 1707)
The oral second-generation antipsychotic drug
iloperidone (Fanapt – Vanda) has been approved
by the FDA for acute treatment of manic or mixed
episodes associated with bipolar I disorder in adults.
First...
The oral second-generation antipsychotic drug
iloperidone (Fanapt – Vanda) has been approved
by the FDA for acute treatment of manic or mixed
episodes associated with bipolar I disorder in adults.
First approved in 2009 for treatment of schizophrenia,
iloperidone is the eighth second-generation antipsychotic
to be approved for acute treatment of manic
or mixed episodes of bipolar I disorder (see Table 1).
Drugs for Bipolar Disorder
The Medical Letter on Drugs and Therapeutics • April 1, 2024; (Issue 1699)
Bipolar disorder is characterized by episodes of
mania, hypomania, and depression. Recurrences of
manic or (more frequently) depressive symptoms
are common. About 15-20% of patients with bipolar
disorder...
Bipolar disorder is characterized by episodes of
mania, hypomania, and depression. Recurrences of
manic or (more frequently) depressive symptoms
are common. About 15-20% of patients with bipolar
disorder die by suicide.
Addendum: Drugs for Depression
The Medical Letter on Drugs and Therapeutics • February 5, 2024; (Issue 1695)
In our article on Drugs for Depression, we should have
included tardive dyskinesia (TD) in our list of adverse
effects of second-generation antipsychotic (SGA) drugs.
TD, which is more commonly associated...
In our article on Drugs for Depression, we should have
included tardive dyskinesia (TD) in our list of adverse
effects of second-generation antipsychotic (SGA) drugs.
TD, which is more commonly associated with first-generation-
antipsychotics, can also occur in patients
taking an SGA, especially with prolonged use. A metaanalysis
found that the annualized incidence of TD was
2.6% in SGA users (M Carbon et al. World Psychiatry 2018;
17:330). Older adults are at increased risk.
In Brief: Three New Injectable Antipsychotic Drugs
The Medical Letter on Drugs and Therapeutics • December 25, 2023; (Issue 1692)
Three extended-release injectable formulations of
second-generation antipsychotic drugs — two of
risperidone (Rykindo, Uzedy) and one of aripiprazole
(Abilify Asimtufii) — have been approved by the...
Three extended-release injectable formulations of
second-generation antipsychotic drugs — two of
risperidone (Rykindo, Uzedy) and one of aripiprazole
(Abilify Asimtufii) — have been approved by the FDA
for treatment of schizophrenia in adults. Rykindo and
Abilify Asimtufii are also approved for maintenance
treatment of bipolar I disorder in adults. Other
extended-release injectable formulations of
risperidone and aripiprazole have been available in
the US for years (see Table 1).
Drugs for Depression
The Medical Letter on Drugs and Therapeutics • December 11, 2023; (Issue 1691)
A selective serotonin reuptake inhibitor (SSRI) is
generally used for initial treatment of major depressive
disorder (MDD). A serotonin-norepinephrine reuptake
inhibitor (SNRI), bupropion (Wellbutrin SR,...
A selective serotonin reuptake inhibitor (SSRI) is
generally used for initial treatment of major depressive
disorder (MDD). A serotonin-norepinephrine reuptake
inhibitor (SNRI), bupropion (Wellbutrin SR, and
others), and mirtazapine (Remeron, and others) are
reasonable alternatives. Improvement in symptoms
can occur within the first two weeks of treatment
with these drugs, but a substantial benefit may not be
achieved for 4-8 weeks.
Drugs for Anxiety Disorders
The Medical Letter on Drugs and Therapeutics • August 7, 2023; (Issue 1682)
Anxiety disorders (generalized anxiety disorder,
panic disorder, social anxiety disorder, and various
phobias) are the most common form of psychiatric
illness. They can be treated effectively with...
Anxiety disorders (generalized anxiety disorder,
panic disorder, social anxiety disorder, and various
phobias) are the most common form of psychiatric
illness. They can be treated effectively with cognitive
behavioral therapy (CBT) and/or pharmacotherapy.
Drugs for Anxiety Disorders
The Medical Letter on Drugs and Therapeutics • August 7, 2023; (Issue 1682)
Anxiety disorders (generalized anxiety disorder,
panic disorder, social anxiety disorder, and various
phobias) are the most common form of psychiatric
illness. They can be treated effectively with...
Anxiety disorders (generalized anxiety disorder,
panic disorder, social anxiety disorder, and various
phobias) are the most common form of psychiatric
illness. They can be treated effectively with cognitive
behavioral therapy (CBT) and/or pharmacotherapy.
Drugs for Chronic Insomnia
The Medical Letter on Drugs and Therapeutics • January 9, 2023; (Issue 1667)
Cognitive behavioral therapy for insomnia (CBT-I) is
recommended for initial treatment of chronic insomnia.
CBT-I includes stimulus control, sleep education
and hygiene, sleep restriction, relaxation...
Cognitive behavioral therapy for insomnia (CBT-I) is
recommended for initial treatment of chronic insomnia.
CBT-I includes stimulus control, sleep education
and hygiene, sleep restriction, relaxation training, and
cognitive therapy. When CBT-I alone is not effective,
pharmacologic treatment should be added.
Dexmedetomidine Sublingual Film (Igalmi) for Acute Agitation
The Medical Letter on Drugs and Therapeutics • December 26, 2022; (Issue 1666)
The FDA has approved a sublingual film formulation
of the alpha-2 adrenergic receptor agonist
dexmedetomidine (Igalmi — BioXcel Therapeutics)
for acute treatment of agitation associated with
schizophrenia...
The FDA has approved a sublingual film formulation
of the alpha-2 adrenergic receptor agonist
dexmedetomidine (Igalmi — BioXcel Therapeutics)
for acute treatment of agitation associated with
schizophrenia or bipolar I or II disorder in adults. It is
the first alpha-2 agonist and the only sublingual film
to be approved for this indication. Dexmedetomidine
has been available for many years in an injectable
formulation (Precedex) for sedation in the intensive
care unit and to facilitate procedures such as
mechanical ventilation.
Drugs for Cognitive Loss and Dementia
The Medical Letter on Drugs and Therapeutics • August 22, 2022; (Issue 1657)
Alzheimer's disease (AD) is the most common
cause of dementia, but cognitive decline is also
associated with other neurological conditions such
as Parkinson's disease, dementia with Lewy bodies,
vascular...
Alzheimer's disease (AD) is the most common
cause of dementia, but cognitive decline is also
associated with other neurological conditions such
as Parkinson's disease, dementia with Lewy bodies,
vascular dementia, and frontotemporal dementia.
Lumateperone (Caplyta) for Bipolar Depression
The Medical Letter on Drugs and Therapeutics • August 8, 2022; (Issue 1656)
The oral second-generation antipsychotic drug
lumateperone (Caplyta – Intra-Cellular Therapies),
which was approved by the FDA in 2020 for treatment
of schizophrenia, is now approved for use...
The oral second-generation antipsychotic drug
lumateperone (Caplyta – Intra-Cellular Therapies),
which was approved by the FDA in 2020 for treatment
of schizophrenia, is now approved for use as
monotherapy or as an adjunct to lithium or valproate
for treatment of depressive episodes associated with
bipolar I or II disorder in adults.
Daridorexant (Quviviq) for Insomnia
The Medical Letter on Drugs and Therapeutics • July 11, 2022; (Issue 1654)
The FDA has approved daridorexant (Quviviq –
Idorsia), an orexin receptor antagonist, for treatment
of sleep-onset and/or sleep-maintenance insomnia
in adults. Daridorexant is the third orexin...
The FDA has approved daridorexant (Quviviq –
Idorsia), an orexin receptor antagonist, for treatment
of sleep-onset and/or sleep-maintenance insomnia
in adults. Daridorexant is the third orexin receptor
antagonist to be approved for this indication;
suvorexant (Belsomra) and lemborexant (Dayvigo)
were approved earlier.
Olanzapine/Samidorphan (Lybalvi) for Schizophrenia and Bipolar Disorder
The Medical Letter on Drugs and Therapeutics • November 29, 2021; (Issue 1638)
The FDA has approved Lybalvi (Alkermes), a fixed-dose
combination of the second-generation
antipsychotic olanzapine (Zyprexa, and generics) and
samidorphan, a new opioid antagonist, for treatment
of adults...
The FDA has approved Lybalvi (Alkermes), a fixed-dose
combination of the second-generation
antipsychotic olanzapine (Zyprexa, and generics) and
samidorphan, a new opioid antagonist, for treatment
of adults with schizophrenia or with manic or mixed
episodes of bipolar I disorder. The addition of
samidorphan is intended to mitigate the weight gain
that occurs with olanzapine. This is the first FDA
approval for samidorphan.
In Brief: An Asenapine Patch (Secuado) for Schizophrenia
The Medical Letter on Drugs and Therapeutics • January 11, 2021; (Issue 1615)
A transdermal formulation of the second-generation
(atypical) antipsychotic asenapine (Secuado – Noven)
has been approved by the FDA for once-daily treatment of
schizophrenia in adults. Asenapine is the...
A transdermal formulation of the second-generation
(atypical) antipsychotic asenapine (Secuado – Noven)
has been approved by the FDA for once-daily treatment of
schizophrenia in adults. Asenapine is the first antipsychotic
to become available in a transdermal formulation in the US.
A twice-daily sublingual tablet formulation of asenapine
(Saphris) has been available since 2009.
Lumateperone (Caplyta) for Schizophrenia
The Medical Letter on Drugs and Therapeutics • July 27, 2020; (Issue 1603)
The FDA has approved lumateperone (Caplyta —
Intracellular Therapies), an oral second-generation
antipsychotic, for once-daily treatment of schizophrenia
in adults. It is the 13th second-generation...
The FDA has approved lumateperone (Caplyta —
Intracellular Therapies), an oral second-generation
antipsychotic, for once-daily treatment of schizophrenia
in adults. It is the 13th second-generation antipsychotic
drug to be approved by the FDA for this indication.
Drugs for Depression
The Medical Letter on Drugs and Therapeutics • February 24, 2020; (Issue 1592)
Complete remission of symptoms is the goal of
treatment for major depressive disorder; a partial
response is associated with an increased risk of
relapse. Improvement in symptoms can occur within
the first...
Complete remission of symptoms is the goal of
treatment for major depressive disorder; a partial
response is associated with an increased risk of
relapse. Improvement in symptoms can occur within
the first two weeks of treatment with an antidepressant,
but it may take 4-8 weeks to achieve a substantial
benefit. Following successful treatment of a first major
depressive episode, antidepressant treatment should
be continued at the same dose for at least 4-9 months
to consolidate recovery. In patients with recurrent
depressive episodes, long-term maintenance treatment
can reduce the risk of relapse.
Drugs for Anxiety Disorders
The Medical Letter on Drugs and Therapeutics • August 12, 2019; (Issue 1578)
Anxiety disorders (generalized anxiety disorder, panic
disorder, social anxiety disorder, and various phobias)
are the most common form of psychiatric illness. They
can be treated effectively with cognitive...
Anxiety disorders (generalized anxiety disorder, panic
disorder, social anxiety disorder, and various phobias)
are the most common form of psychiatric illness. They
can be treated effectively with cognitive behavioral
therapy (CBT) and/or pharmacotherapy. Obsessive-compulsive
disorder and posttraumatic stress
disorder are now considered separate entities in the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5); they can also be treated with CBT and many
of the same drugs.
Drugs for Chronic Insomnia
The Medical Letter on Drugs and Therapeutics • December 17, 2018; (Issue 1562)
Cognitive behavioral therapy for insomnia (CBT-I)
is recommended for initial treatment of chronic
insomnia. Pharmacologic treatment should be used in
addition to CBT-I when CBT-I alone is not...
Cognitive behavioral therapy for insomnia (CBT-I)
is recommended for initial treatment of chronic
insomnia. Pharmacologic treatment should be used in
addition to CBT-I when CBT-I alone is not effective.
Deutetrabenazine (Austedo) for Huntington's Chorea and Tardive Dyskinesia
The Medical Letter on Drugs and Therapeutics • April 23, 2018; (Issue 1545)
The FDA has approved deutetrabenazine (Austedo –
Teva), a vesicular monoamine transporter 2 (VMAT2)
inhibitor, for treatment of chorea associated with
Huntington's disease and, more recently, for...
The FDA has approved deutetrabenazine (Austedo –
Teva), a vesicular monoamine transporter 2 (VMAT2)
inhibitor, for treatment of chorea associated with
Huntington's disease and, more recently, for treatment
of tardive dyskinesia in adults. It is the second VMAT2
inhibitor to be approved for each of these indications;
tetrabenazine (Xenazine, and generics) was approved
earlier for Huntington's chorea and valbenazine
(Ingrezza) was recently approved for treatment of
adults with tardive dyskinesia.
Drugs for Parkinson's Disease
The Medical Letter on Drugs and Therapeutics • November 20, 2017; (Issue 1534)
The motor symptoms of Parkinson's disease (PD) are
caused primarily by degeneration of dopaminergic
neurons in the substantia nigra. The nonmotor
symptoms of the disease are thought to be caused...
The motor symptoms of Parkinson's disease (PD) are
caused primarily by degeneration of dopaminergic
neurons in the substantia nigra. The nonmotor
symptoms of the disease are thought to be caused by
degeneration of other neurotransmitter systems.
Drugs for Cognitive Loss and Dementia
The Medical Letter on Drugs and Therapeutics • September 25, 2017; (Issue 1530)
Alzheimer's disease (AD) is the most common cause
of dementia, but cognitive loss is also associated with
other neurological conditions such as Parkinson's
disease, dementia with Lewy bodies, vascular...
Alzheimer's disease (AD) is the most common cause
of dementia, but cognitive loss is also associated with
other neurological conditions such as Parkinson's
disease, dementia with Lewy bodies, vascular dementia,
and frontotemporal dementia.
Valbenazine (Ingrezza) for Tardive Dyskinesia
The Medical Letter on Drugs and Therapeutics • May 22, 2017; (Issue 1521)
The FDA has approved valbenazine (Ingrezza –
Neurocrine Biosciences), a vesicular monoamine
transporter 2 (VMAT2) inhibitor, for treatment of
tardive dyskinesia in adults. It is the first drug to
be...
The FDA has approved valbenazine (Ingrezza –
Neurocrine Biosciences), a vesicular monoamine
transporter 2 (VMAT2) inhibitor, for treatment of
tardive dyskinesia in adults. It is the first drug to
be approved in the US for this indication; two other
VMAT2 inhibitors, tetrabenazine (Xenazine, and
generics) and deutetrabenazine (Austedo), were
approved earlier for treatment of chorea associated
with Huntington's disease.
Drugs for Psychotic Disorders
The Medical Letter on Drugs and Therapeutics • December 19, 2016; (Issue 1510)
Oral antipsychotic drugs used for treatment of
schizophrenia, schizoaffective disorder, delusional
disorder, and other manifestations of psychosis or
mania are listed in Table 1. Parenteral
antipsychotic...
Oral antipsychotic drugs used for treatment of
schizophrenia, schizoaffective disorder, delusional
disorder, and other manifestations of psychosis or
mania are listed in Table 1. Parenteral
antipsychotic drugs used for treatment of these
disorders are listed in Table 2.
Drugs for Bipolar Disorder
The Medical Letter on Drugs and Therapeutics • August 15, 2016; (Issue 1501)
Bipolar disorder is characterized by intermittent
episodes of mania and/or depression. Even with
maintenance treatment, recurrences of manic or (more
frequently) depressive episodes are common. Some of
the...
Bipolar disorder is characterized by intermittent
episodes of mania and/or depression. Even with
maintenance treatment, recurrences of manic or (more
frequently) depressive episodes are common. Some of
the drugs and dosages recommended here have not
been approved by the FDA for use in bipolar disorder.
Drugs for Depression
The Medical Letter on Drugs and Therapeutics • July 4, 2016; (Issue 1498)
Complete remission of symptoms is the goal of
antidepressant therapy; partial response is associated
with an increased risk of relapse. Improvement can
occur within the first two weeks of drug therapy,
but...
Complete remission of symptoms is the goal of
antidepressant therapy; partial response is associated
with an increased risk of relapse. Improvement can
occur within the first two weeks of drug therapy,
but it may take 4-8 weeks to achieve a substantial
benefit. Fewer than 50% of patients with depression
respond to first-line pharmacotherapy, and the rate of
response decreases with each subsequent drug trial.
Following remission after a first episode of depression,
many experts recommend continuing antidepressant
treatment at the same dose for at least 6-12 months
to consolidate recovery. For patients with recurrent
depressive episodes, long-term maintenance therapy
can reduce the risk of recurrence.
Pimavanserin (Nuplazid) for Parkinson's Disease Psychosis
The Medical Letter on Drugs and Therapeutics • June 6, 2016; (Issue 1496)
The FDA has approved the atypical antipsychotic
pimavanserin (Nuplazid – Acadia) for treatment
of hallucinations and delusions associated with
Parkinson's disease. It is the first drug to be approved
in...
The FDA has approved the atypical antipsychotic
pimavanserin (Nuplazid – Acadia) for treatment
of hallucinations and delusions associated with
Parkinson's disease. It is the first drug to be approved
in the US for this indication.
Cariprazine (Vraylar) for Schizophrenia and Bipolar I Disorder
The Medical Letter on Drugs and Therapeutics • April 25, 2016; (Issue 1493)
The FDA has approved cariprazine (Vraylar – Actavis), an
oral, once-daily, second-generation antipsychotic, for treatment
of schizophrenia and for acute treatment of manic or
mixed episodes associated with...
The FDA has approved cariprazine (Vraylar – Actavis), an
oral, once-daily, second-generation antipsychotic, for treatment
of schizophrenia and for acute treatment of manic or
mixed episodes associated with bipolar I disorder.
Two Long-Acting Injectable Antipsychotics for Schizophrenia
The Medical Letter on Drugs and Therapeutics • November 9, 2015; (Issue 1481)
The FDA has approved two new long-acting injectable
formulations of second-generation antipsychotics
for treatment of schizophrenia: aripiprazole lauroxil
(Aristada – Alkermes), which is given once every...
The FDA has approved two new long-acting injectable
formulations of second-generation antipsychotics
for treatment of schizophrenia: aripiprazole lauroxil
(Aristada – Alkermes), which is given once every 4-6
weeks, and paliperidone palmitate (Invega Trinza –
Janssen), which is given once every 3 months.
Once-monthly injectable formulations of aripiprazole
(Abilify Maintena) and paliperidone palmitate (Invega
Sustenna) were approved earlier.
Brexpiprazole (Rexulti) for Schizophrenia and Depression
The Medical Letter on Drugs and Therapeutics • August 17, 2015; (Issue 1475)
The FDA has approved the oral, once-daily, second-generation
antipsychotic brexpiprazole (Rexulti –
Otsuka/Lundbeck) for treatment of schizophrenia
and as an adjunct to antidepressants for treatment
of...
The FDA has approved the oral, once-daily, second-generation
antipsychotic brexpiprazole (Rexulti –
Otsuka/Lundbeck) for treatment of schizophrenia
and as an adjunct to antidepressants for treatment
of major depressive disorder (MDD). Aripiprazole
(Abilify), a structurally similar second-generation
antipsychotic also comarketed by Otsuka (with BMS),
recently became available generically.
Drugs for Insomnia
The Medical Letter on Drugs and Therapeutics • July 6, 2015; (Issue 1472)
Pharmacological treatment of insomnia includes
prescription drugs, non-prescription medications, and
"natural" remedies. Behavioral approaches such as
cognitive behavioral therapy, which are not...
Pharmacological treatment of insomnia includes
prescription drugs, non-prescription medications, and
"natural" remedies. Behavioral approaches such as
cognitive behavioral therapy, which are not discussed
here, are also used. Pharmacologic treatment and
behavioral therapy are often combined.
Inhaled Loxapine (Adasuve) for Acute Agitation
The Medical Letter on Drugs and Therapeutics • April 14, 2014; (Issue 1440)
The FDA has approved an inhalation powder formulation
of loxapine (Adasuve – Teva), a first-generation
antipsychotic long available in an oral formulation, for
treatment of acute agitation related to...
The FDA has approved an inhalation powder formulation
of loxapine (Adasuve – Teva), a first-generation
antipsychotic long available in an oral formulation, for
treatment of acute agitation related to schizophrenia or
bipolar I disorder in adults. Adasuve is the first inhaled
drug to be approved for this indication.
In Brief: Khedezla - A New Brand of Desvenlafaxine
The Medical Letter on Drugs and Therapeutics • January 6, 2014; (Issue 1433)
The FDA has approved the marketing of another extended-release brand-name formulation of the serotonin and norepinephrine reuptake inhibitor (SNRI) desvenlafaxine (Khedezla – Par/Osmotica) for treatment of...
The FDA has approved the marketing of another extended-release brand-name formulation of the serotonin and norepinephrine reuptake inhibitor (SNRI) desvenlafaxine (Khedezla – Par/Osmotica) for treatment of depression. It is the third extended-release formulation of desvenlafaxine to become available in the US. Khedezla was approved using a 505(b)(2) application, a new drug application (NDA) that relies upon the FDA's findings of safety and/or effectiveness for a previously approved drug.
Khedezla does not appear to offer any advantage over the other extended-release formulations of desvenlafaxine. There is no evidence that any formulation of desvenlafaxine is more effective for treatment of depression than other SNRIs or any SSRI, which are available in less expensive generic formulations.1
1. Drugs for psychiatric disorders. Treat Guidel Med Lett 2013; 11:53.
Download complete U.S. English article
Khedezla does not appear to offer any advantage over the other extended-release formulations of desvenlafaxine. There is no evidence that any formulation of desvenlafaxine is more effective for treatment of depression than other SNRIs or any SSRI, which are available in less expensive generic formulations.1
1. Drugs for psychiatric disorders. Treat Guidel Med Lett 2013; 11:53.
Download complete U.S. English article
Levomilnacipran (Fetzima): A New SNRI for Depression
The Medical Letter on Drugs and Therapeutics • December 23, 2013; (Issue 1432)
The FDA has approved levomilnacipran (lee" voe mil
na' si pran; Fetzima – Forest), a serotonin and norepinephrine
reuptake inhibitor (SNRI), for treatment of
major depressive disorder. Levomilnacipran is...
The FDA has approved levomilnacipran (lee" voe mil
na' si pran; Fetzima – Forest), a serotonin and norepinephrine
reuptake inhibitor (SNRI), for treatment of
major depressive disorder. Levomilnacipran is the
more active enantiomer of milnacipran (Savella), which
was approved in 2009 for management of fibromyalgia. Fetzima has not been studied in fibromyalgia.
Vortioxetine (Trintellix) for Depression
The Medical Letter on Drugs and Therapeutics • November 25, 2013; (Issue 1430)
The FDA has approved vortioxetine (vor" tye ox' e teen;
Trintellix – Takeda/Lundbeck), a new serotonergic drug,
for treatment of major depressive disorder. Like vilazodone
(Viibryd), another serotonergic...
The FDA has approved vortioxetine (vor" tye ox' e teen;
Trintellix – Takeda/Lundbeck), a new serotonergic drug,
for treatment of major depressive disorder. Like vilazodone
(Viibryd), another serotonergic antidepressant,
it has been claimed to have a low incidence of sexual
side effects and no significant effect on weight.
Drugs for Cognitive Loss and Dementia
The Medical Letter on Drugs and Therapeutics • October 1, 2013; (Issue 134)
Alzheimer's disease (AD) is the most common cause
of dementia, but cognitive loss is also associated with
other neurological conditions such as Parkinson's disease,
dementia with Lewy bodies, and...
Alzheimer's disease (AD) is the most common cause
of dementia, but cognitive loss is also associated with
other neurological conditions such as Parkinson's disease,
dementia with Lewy bodies, and vascular
dementia. Mild cognitive impairment (MCI) is generally
defined as cognitive decline greater than expected
for an individual's age and educational level, but not
interfering with activities of daily living; it may be a
transitional state between the cognitive changes of
normal aging and dementia.
Drugs for Psychiatric Disorders
The Medical Letter on Drugs and Therapeutics • June 1, 2013; (Issue 130)
Drugs are not the only treatment for psychiatric illness.
Psychotherapy remains an important component
in the management of these disorders, and cognitive
behavioral therapy (CBT) can be used for many...
Drugs are not the only treatment for psychiatric illness.
Psychotherapy remains an important component
in the management of these disorders, and cognitive
behavioral therapy (CBT) can be used for many of
them as well. Electroconvulsive therapy (ECT) has a
long history of efficacy and safety when drugs are
ineffective or cannot be used.
Long-Acting Injectable Aripiprazole (Abilify Maintena) for Schizophrenia
The Medical Letter on Drugs and Therapeutics • April 29, 2013; (Issue 1415)
An extended-release injectable formulation of the
second-generation antipsychotic aripiprazole
(Abilify) has been approved by the FDA (Abilify
Maintena – Otsuka/Lundbeck) for once-monthly treatment of...
An extended-release injectable formulation of the
second-generation antipsychotic aripiprazole
(Abilify) has been approved by the FDA (Abilify
Maintena – Otsuka/Lundbeck) for once-monthly treatment of schizophrenia. It is the fourth second-generation
antipsychotic to become available in a
long-acting parenteral formulation. Long-acting parenteral
antipsychotics, given at intervals of 2-4
weeks, are generally used for patients with a history
of relapse due to poor adherence to oral maintenance
therapy.
Drugs for Insomnia
The Medical Letter on Drugs and Therapeutics • July 1, 2012; (Issue 119)
Pharmacological treatment of insomnia includes prescription
drugs, non-prescription medications and
"natural" remedies. Behavioral changes are often
needed as...
Pharmacological treatment of insomnia includes prescription
drugs, non-prescription medications and
"natural" remedies. Behavioral changes are often
needed as well.
Quetiapine (Seroquel) and QT-Interval Prolongation
The Medical Letter on Drugs and Therapeutics • October 3, 2011; (Issue 1374)
The FDA has required the manufacturer of the secondgeneration
antipsychotic quetiapine (Seroquel) to add a
warning to the labeling saying that use of the drug should
be avoided in combination with other...
The FDA has required the manufacturer of the secondgeneration
antipsychotic quetiapine (Seroquel) to add a
warning to the labeling saying that use of the drug should
be avoided in combination with other drugs that prolong
the electrocardiographic QTc interval (Table 1). The
warning is based only on postmarketing reports of QT-interval
prolongation in patients who overdosed on the
drug, had concomitant illness, or were taking other drugs
known to cause electrolyte imbalances or increase the
QT interval. QT prolongation can lead to torsades de
pointes, a potentially fatal cardiac arrhythmia.
Adjunctive Antipsychotics for Major Depression
The Medical Letter on Drugs and Therapeutics • September 19, 2011; (Issue 1373)
Augmentation with a second-generation (atypical) antipsychotic is a treatment option for patients with major
depressive disorder (MDD) whose symptoms persist following antidepressant monotherapy. Aripiprazole...
Augmentation with a second-generation (atypical) antipsychotic is a treatment option for patients with major
depressive disorder (MDD) whose symptoms persist following antidepressant monotherapy. Aripiprazole (Abilify), olanzapine in a fixed-dose combination with fluoxetine (Symbyax), and extended-release quetiapine (Seroquel XR) have been approved by the FDA for such use.
Lurasidone (Latuda) for Schizophrenia
The Medical Letter on Drugs and Therapeutics • February 21, 2011; (Issue 1358)
The FDA has approved lurasidone (Latuda - Sunovion), a new second-generation antipsychotic,
for oral treatment of schizophrenia in...
The FDA has approved lurasidone (Latuda - Sunovion), a new second-generation antipsychotic,
for oral treatment of schizophrenia in adults.
Drugs for Parkinson's Disease
The Medical Letter on Drugs and Therapeutics • January 1, 2011; (Issue 101)
Parkinson’s disease (PD) is caused primarily by progressive
degeneration of dopamine-containing neurons
in the substantia nigra. Dopamine itself cannot be
used to treat PD because it does not cross the...
Parkinson’s disease (PD) is caused primarily by progressive
degeneration of dopamine-containing neurons
in the substantia nigra. Dopamine itself cannot be
used to treat PD because it does not cross the blood-brain
barrier.
Drugs for Psychotic Disorders
The Medical Letter on Drugs and Therapeutics • August 1, 2010; (Issue 96)
The antipsychotic drugs listed in Table 1 on the next page are more effective for treating the “positive symptoms” of schizophrenia (hallucinations and delusions) than the “negative symptoms” (apathy,...
The antipsychotic drugs listed in Table 1 on the next page are more effective for treating the “positive symptoms” of schizophrenia (hallucinations and delusions) than the “negative symptoms” (apathy, social withdrawal, and blunted affect). Some symptoms of schizophrenia and acute psychoses may improve rapidly after treatment with antipsychotic drugs, but chronic schizophrenia improves slowly over many weeks and some patients may continue to improve for months. Most patients with chronic schizophrenia require prolonged maintenance therapy, but the risk of tardive dyskinesia and adverse metabolic effects must be kept in mind.
Drugs for Depression and Bipolar Disorder
The Medical Letter on Drugs and Therapeutics • May 1, 2010; (Issue 93)
Drugs are not the only treatment for mood disorders. Psychotherapy remains an important component in the management of these disorders, and electroconvulsive therapy (ECT) has a long history of efficacy and...
Drugs are not the only treatment for mood disorders. Psychotherapy remains an important component in the management of these disorders, and electroconvulsive therapy (ECT) has a long history of efficacy and safety
when drugs are ineffective, poorly tolerated or cannot be used. Some drugs are recommended here for indications that have not been approved by the FDA.
L-Methylfolate (Deplin) for Depression and Schizophrenia
The Medical Letter on Drugs and Therapeutics • April 19, 2010; (Issue 1336)
L-methylfolate (Deplin — Pamlab) is a “medical food” marketed for adjunctive use in depression or schizophrenia in patients with suboptimal folate levels. It is available only by...
L-methylfolate (Deplin — Pamlab) is a “medical food” marketed for adjunctive use in depression or schizophrenia in patients with suboptimal folate levels. It is available only by prescription.
Drugs for Cognitive Loss and Dementia
The Medical Letter on Drugs and Therapeutics • March 1, 2010; (Issue 91)
Alzheimer’s disease (AD) is the most common form of dementia, but cognitive loss is also associated with
other neurological conditions such as Parkinson’s disease, dementia with Lewy bodies or vascular...
Alzheimer’s disease (AD) is the most common form of dementia, but cognitive loss is also associated with
other neurological conditions such as Parkinson’s disease, dementia with Lewy bodies or vascular dementia.
Mild cognitive impairment (MCI) has been defined as cognitive decline greater than expected for an individual’s age and educational level, but not interfering with activities of daily living; it may be a transitional state between the cognitive changes of normal aging and dementia.
Iloperidone (Fanapt) - Another Second-Generation Antipsychotic
The Medical Letter on Drugs and Therapeutics • February 22, 2010; (Issue 1332)
The FDA has approved the marketing of iloperidone (Fanapt – Vanda), a second-generation antipsychotic, for treatment of schizophrenia. Iloperidone is chemically related to risperidone (Risperdal, and...
The FDA has approved the marketing of iloperidone (Fanapt – Vanda), a second-generation antipsychotic, for treatment of schizophrenia. Iloperidone is chemically related to risperidone (Risperdal, and others).
Asenapine (Saphris) Sublingual Tablets for Schizophrenia and Bipolar Disorder
The Medical Letter on Drugs and Therapeutics • February 8, 2010; (Issue 1331)
Asenapine (Saphris - Schering-Plough), a dibenzo-oxepino pyrrole, has been approved by the FDA in a sublingual tablet formulation for acute treatment of schizophrenia and manic or mixed episodes associated with...
Asenapine (Saphris - Schering-Plough), a dibenzo-oxepino pyrrole, has been approved by the FDA in a sublingual tablet formulation for acute treatment of schizophrenia and manic or mixed episodes associated with bipolar disorder. It is the sixth second-generation antipsychotic approved by the FDA for use in bipolar disorder.
In Brief: Injectable Paliperidone Palmitate for Schizophrenia
The Medical Letter on Drugs and Therapeutics • November 2, 2009; (Issue 1324)
Paliperidone palmitate (Invega Sustenna – Ortho-McNeil Janssen) has been approved by the FDA as a once-monthly injection for acute and maintenance treatment of schizophrenia in adults. An extended-release...
Paliperidone palmitate (Invega Sustenna – Ortho-McNeil Janssen) has been approved by the FDA as a once-monthly injection for acute and maintenance treatment of schizophrenia in adults. An extended-release oral formulation (Invega) has been available since 2006.1 Long-acting injections of antipsychotic drugs typically are used to treat patients who cannot adhere to an oral regimen.2,3 Paliperidone is the primary active metabolite of risperidone (Risperdal), which is also available as a long-acting (every 2 weeks) injection. It is unclear whether either risperidone or paliperidone is a better choice for long-term treatment of schizophrenia than a first-generation drug such as haloperidol, which can also be injected once a month and costs much less.4
1. Paliperidone (Invega) for schizophrenia. Med Lett Drugs Ther 2007; 49:21.
2. JC West et al. Use of depot antipsychotic medications for medication non-adherence in schizophrenia. Schizophr Bull 2008; 34:995.
3. D Hough et al. Safety and tolerability of deltoid and gluteal injections of paliperidone palmitate in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1022.
4. Drugs for psychiatric disorders. Treat Guidel Med Lett 2006; 4:35.
Download: U.S. English
1. Paliperidone (Invega) for schizophrenia. Med Lett Drugs Ther 2007; 49:21.
2. JC West et al. Use of depot antipsychotic medications for medication non-adherence in schizophrenia. Schizophr Bull 2008; 34:995.
3. D Hough et al. Safety and tolerability of deltoid and gluteal injections of paliperidone palmitate in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1022.
4. Drugs for psychiatric disorders. Treat Guidel Med Lett 2006; 4:35.
Download: U.S. English
In Brief: Cardiac Risks of Antipsychotic Drugs
The Medical Letter on Drugs and Therapeutics • February 23, 2009; (Issue 1306)
A recently published retrospective cohort study in patients 30-74 years old has led to headlines in the media warning that use of atypical antipsychotic drugs doubles patients’ risk of sudden cardiac death....
A recently published retrospective cohort study in patients 30-74 years old has led to headlines in the media warning that use of atypical antipsychotic drugs doubles patients’ risk of sudden cardiac death. Typical antipsychotics have long been associated with this risk. In this study, however, the incidence of sudden cardiac death was similar with typical and atypical antipsychotics: about 1 in 340 person-years among the patients who took typical (first generation) antipsychotics such as haloperidol (Haldol, and others) and 1 in 360 personyears among those who took atypical (second-generation) drugs such as olanzapine (Zyprexa), compared to 1 in 700 patient-years among otherwise similar nonusers of antipsychotic drugs. The risk increased with the dose of the drug and also with the age of the patient; the authors state that they did not include patients younger than 30 because sudden cardiac death is very rare in the younger age group.1
Second-generation drugs are less likely than first generation drugs to cause extrapyramidal symptoms, tardive dyskinesia and neuroleptic malignant syndrome, but more likely to cause weight gain and other metabolic abnormalities.2 Aripiprazole (Abilify)3 is least likely to prolong the QT interval, which is one of the mechanisms that could be responsible for the small increase in the absolute risk of sudden death among patients who take antipsychotic drugs.
In a patient with a good indication for its use, the consequences of not taking an antipsychotic drug may be greater than the risks of taking one.
1. WA Ray et al. Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009; 360:225.
2. Drugs for psychiatric disorders. Treat Guidel Med Lett 2006; 4:35.
3. Second-generation antipsychotics — aripiprazole revisited. Med Lett Drugs Ther 2005; 47:81.
Download: U.S. English
Second-generation drugs are less likely than first generation drugs to cause extrapyramidal symptoms, tardive dyskinesia and neuroleptic malignant syndrome, but more likely to cause weight gain and other metabolic abnormalities.2 Aripiprazole (Abilify)3 is least likely to prolong the QT interval, which is one of the mechanisms that could be responsible for the small increase in the absolute risk of sudden death among patients who take antipsychotic drugs.
In a patient with a good indication for its use, the consequences of not taking an antipsychotic drug may be greater than the risks of taking one.
1. WA Ray et al. Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009; 360:225.
2. Drugs for psychiatric disorders. Treat Guidel Med Lett 2006; 4:35.
3. Second-generation antipsychotics — aripiprazole revisited. Med Lett Drugs Ther 2005; 47:81.
Download: U.S. English
Tetrabenazine (Xenazine) for Huntington's Chorea
The Medical Letter on Drugs and Therapeutics • January 26, 2009; (Issue 1304)
Tetrabenazine (Xenazine - Ovation Pharmaceuticals), an old drug first synthesized 50 years ago for treatment of schizophrenia, was recently approved by the FDA for the treatment of chorea associated with...
Tetrabenazine (Xenazine - Ovation Pharmaceuticals), an old drug first synthesized 50 years ago for treatment of schizophrenia, was recently approved by the FDA for the treatment of chorea associated with Huntington's disease. It has been available in other countries for decades.
Diet, Drugs and Surgery for Weight Loss
The Medical Letter on Drugs and Therapeutics • April 1, 2008; (Issue 68)
Losing even a small amount of weight and increasing physical activity can prevent some of the complications of obesity, particularly type 2 diabetes. Diet and exercise are the preferred methods for losing...
Losing even a small amount of weight and increasing physical activity can prevent some of the complications of obesity, particularly type 2 diabetes. Diet and exercise are the preferred methods for losing weight but are associated with high long-term failure rates. Drugs may help some patients, but all currently available drugs for weight reduction have drawbacks. Gastric surgery can produce marked weight loss in the severely obese, but long-term data on safety are limited.
Drugs for Parkinson's Disease
The Medical Letter on Drugs and Therapeutics • October 1, 2007; (Issue 62)
ParkinsonÆs disease (PD) is caused primarily by progressive degeneration of dopamine-containing neurons in the substantia nigra. Dopamine itself cannot be used to treat PD because it does not cross the...
ParkinsonÆs disease (PD) is caused primarily by progressive degeneration of dopamine-containing neurons in the substantia nigra. Dopamine itself cannot be used to treat PD because it does not cross the bloodbrain barrier.
Drugs for Cognitive Loss and Dementia
The Medical Letter on Drugs and Therapeutics • February 1, 2007; (Issue 54)
Alzheimer's disease (AD) is the most common form of dementia, but cognitive loss is also associated with other neurological conditions such as Parkinson's disease, dementia with Lewy bodies, or vascular...
Alzheimer's disease (AD) is the most common form of dementia, but cognitive loss is also associated with other neurological conditions such as Parkinson's disease, dementia with Lewy bodies, or vascular dementia. Mild cognitive impairment (MCI) has been defined as cognitive decline greater than expected for an individual's age and educational level, but not interfering with activities of daily living; it may be a transitional state between the cognitive changes of normal aging and the earliest stages of dementia.1 In longitudinal studies, the rate of progression from MCI to clinically diagnosable AD is 10-15% per year.
Drugs for Psychiatric Disorders
The Medical Letter on Drugs and Therapeutics • June 1, 2006; (Issue 46)
Drugs are not the only treatment for psychiatric illness. Psychotherapy remains an important component in the management of these disorders, and cognitive behavioral therapy (CBT) is used for many of them as...
Drugs are not the only treatment for psychiatric illness. Psychotherapy remains an important component in the management of these disorders, and cognitive behavioral therapy (CBT) is used for many of them as well. Electroconvulsive therapy (ECT) has a long history of efficacy and safety when drugs are ineffective or cannot be used.
Second-Generation Antipsychotics - Aripiprazole Revisited
The Medical Letter on Drugs and Therapeutics • October 10, 2005; (Issue 1219)
Aripiprazole (Abilify - Bristol-Myers Squibb/Otsuka), a second-generation (atypical) antipsychotic drug, was approved by the FDA in 2002 for treatment of schizophrenia and more recently for bipolar disorder as...
Aripiprazole (Abilify - Bristol-Myers Squibb/Otsuka), a second-generation (atypical) antipsychotic drug, was approved by the FDA in 2002 for treatment of schizophrenia and more recently for bipolar disorder as well. It has been promoted as causing fewer adverse effects than other antipsychotics, without sacrificing efficacy.
Atypical Antipsychotics in the Elderly
The Medical Letter on Drugs and Therapeutics • August 1, 2005; (Issue 1214)
The FDA has reported that 5106 elderly patients with dementia treated with atypical (second generation) antipsychotics in 17 randomized controlled trials had a higher mortality rate (4.5% vs. 2.6%) than those...
The FDA has reported that 5106 elderly patients with dementia treated with atypical (second generation) antipsychotics in 17 randomized controlled trials had a higher mortality rate (4.5% vs. 2.6%) than those receiving placebo. Most of the deaths were due to cardiovascular and infectious causes (such as pneumonia). The drugs used in the trials were aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal). As the increase in mortality was considered a class effect, the FDA advisory also included ziprasidone (Geodon), clozapine (Clozaril) and the olanzapine/fluoxetine combination (Symbyax). The manufacturers of all of these drugs will be required to add a "black box" warning to their labeling.
Drugs for Parkinson's Disease
The Medical Letter on Drugs and Therapeutics • June 1, 2004; (Issue 22)
Parkinson's disease is caused by progressive degeneration of dopamine-containing neurons in the substantia nigra. Dopamine itself cannot be used to treat Parkinson's disease because it does not cross the...
Parkinson's disease is caused by progressive degeneration of dopamine-containing neurons in the substantia nigra. Dopamine itself cannot be used to treat Parkinson's disease because it does not cross the blood-brain barrier.
Olanzapine/Fluoxetine (Symbyax) for Bipolar Depression
The Medical Letter on Drugs and Therapeutics • March 15, 2004; (Issue 1178)
The fixed-dose combination of olanzapine and fluoxetine (Symbyax - Lilly) has been approved by the FDA for treatment of depressive episodes associated with bipolar disorder. Olanzapine alone (Zyprexa), which is...
The fixed-dose combination of olanzapine and fluoxetine (Symbyax - Lilly) has been approved by the FDA for treatment of depressive episodes associated with bipolar disorder. Olanzapine alone (Zyprexa), which is mainly used as an antipsychotic (Medical Letter 2003; 45:102), is FDA-approved for treatment of acute manic episodes and for maintenance treatment of bipolar disorder. Fluoxetine alone (Prozac, and others), which is mainly used as an antidepressant (Medical Letter 2003; 45:93), has no specific approval for use in bipolar disorder.
Choice of an Antipsychotic
The Medical Letter on Drugs and Therapeutics • December 22, 2003; (Issue 1172)
A recent supplement to the Journal of Clinical Psychiatry, titled "The Expert Consensus Guideline Series: Optimizing Pharmacologic Treatment of Psychotic Disorders," concluded that most experts endorsed use of...
A recent supplement to the Journal of Clinical Psychiatry, titled "The Expert Consensus Guideline Series: Optimizing Pharmacologic Treatment of Psychotic Disorders," concluded that most experts endorsed use of second-generation (atypical) antipsychotics rather than first-generation drugs, with risperidone (Risperdal - Janssen) the top choice for first episodes, multiple episodes or switches from another drug (JM Kane et al, J Clin Psychiatry 2003; 64 suppl 12:5). The supplement was sponsored by Janssen.
Drugs for Psychiatric Disorders
The Medical Letter on Drugs and Therapeutics • July 1, 2003; (Issue 11)
The number of drugs marketed for psychiatric indications has increased sharply in recent years. The recommendations in this article are based on the results of controlled trials and on the experience and...
The number of drugs marketed for psychiatric indications has increased sharply in recent years. The recommendations in this article are based on the results of controlled trials and on the experience and opinions of Medical Letter consultants. Interactions with other drugs can be found in The Medical Letter Handbook of Adverse Drug Interactions, 2003.
Aripiprazole (Abilify) for Schizophrenia
The Medical Letter on Drugs and Therapeutics • February 17, 2003; (Issue 1150)
Aripiprazole (Abilify - Bristol-Myers Squibb/Otsuka), a quinolinone derivative, has been approved by the FDA for treatment of...
Aripiprazole (Abilify - Bristol-Myers Squibb/Otsuka), a quinolinone derivative, has been approved by the FDA for treatment of schizophrenia.
Drugs that may cause Cognitive Disorders in the Elderly
The Medical Letter on Drugs and Therapeutics • November 27, 2000; (Issue 1093)
Older patients are especially susceptible to drug-induced cognitive impairment. They are more likely to be taking multiple drugs, to have higher blood levels of those drugs because of renal or hepatic...
Older patients are especially susceptible to drug-induced cognitive impairment. They are more likely to be taking multiple drugs, to have higher blood levels of those drugs because of renal or hepatic dysfunction, and to have pre-existing cognitive problems that make it difficult to detect the role of drugs causing new symptoms or making old ones worse.
Hypnotic Drugs
The Medical Letter on Drugs and Therapeutics • July 5, 1996; (Issue 978)
Superseded by Drugs of Choice HandbookInsomnia is a commom complaint, particularly among the elderly. Many drugs are approved by the US Food and Drug Administration (FDA) for treatment of insomnia, including...
Superseded by Drugs of Choice Handbook
Insomnia is a commom complaint, particularly among the elderly. Many drugs are approved by the US Food and Drug Administration (FDA) for treatment of insomnia, including five benzodiazepines and zolpidem (Ambien), a non-benzodiazepine that binds to benzodiazepine receptors in the brain. Some drugs marketed for other indications, such as antihistamines, antidepressants and antipsychotics, are also used as hypnotics. For many patients, nonpharmacological treatment of insomnia may be more effective than drugs, especially in the long term (CM Morin et al, Am J Psychiatry, 151:1172, 1994).
Insomnia is a commom complaint, particularly among the elderly. Many drugs are approved by the US Food and Drug Administration (FDA) for treatment of insomnia, including five benzodiazepines and zolpidem (Ambien), a non-benzodiazepine that binds to benzodiazepine receptors in the brain. Some drugs marketed for other indications, such as antihistamines, antidepressants and antipsychotics, are also used as hypnotics. For many patients, nonpharmacological treatment of insomnia may be more effective than drugs, especially in the long term (CM Morin et al, Am J Psychiatry, 151:1172, 1994).
Oral Hypnotic Drugs
The Medical Letter on Drugs and Therapeutics • March 10, 1989; (Issue 787)
Three benzodiazepines and 16 other compounds are marketed in the USA for treatment of insomnia. Many authorities believe that insomnia is overdiagnosed and overtreated (MK Erman, ed, Sleep Disorders,...
Three benzodiazepines and 16 other compounds are marketed in the USA for treatment of insomnia. Many authorities believe that insomnia is overdiagnosed and overtreated (MK Erman, ed, Sleep Disorders, Psychiatr Clin North Am, Volume 10, Dec 1987).