Atypical Antipsychotic Agent

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Contents 1 More Specific Terms 2 Indications 3 Dosage 4 Monitor 5 Adverse-effects 6 Notes 7 More General Terms 8 Additional Terms 9 References

More Specific Terms

• aripiprazole (Abilify)
• asenapine (Saphris)
• iloperidone (Fanapt)
• lurasidone (Latuda)
• LY2140023 (LY404039)
• olanzapine (Zyprexa, Zydis, Zyprexa, Relprevv)
• paliperidone (9-hydroxyrisperidone, Invega, Invega Sustenna)
• quetiapine (Seroquel)
• risperidone (Risperdal)
• sertindole (Serlect)
• ziprasidone (Zeldox, Geodon)

Indications

• treatment of psychosis
• both negative & positive symptoms may respond
• agitation
• aggressive behavior
• especially useful in the elderly ( antipsychotics of choice)

Dosage

• do not abruptly discontinue; taper antipsychotic to be discontinued while titrating new antipsychotic

Monitor

• weight at baseline, then 1, 2, & 3 months after starting or changing therapy, then every 3 months
• fasting blood glucose at baseline, 3 months, then annually
• blood pressure at baseline, 3 months, then annually
• fasting lipid panel at baseline, 3 months, then every 5 years (if normal)
• consider trying different antipsychotic if

• serum glucose or lipid profile worsen
• weight gain exceeds 5%
  

• monitor with atypical antipsychotic agents

Adverse-effects

• extrapyramidal symptoms
• urinary symptoms
• akathisia
• hyperglycemia; increased risk of diabetes [2] {may be all atypical antipsychotics} [2]
• dyslipidemia [3]
• weight gain [3]
• increased mortality in the elderly [4]

• number needed to harm [NNH], 87 [10]

• increased risk of stroke in patients receiving any antipsychotic [6]

• RR 23% higher in demented vs non demented patients
• RR* = 2.3 atypical antipsychotics
• RR* = 1.7 conventional antipsychotics

• * RR in demented patients
  

• drug adverse effects of antipsychotic agents
• drug adverse effects of atypical antipsychotic agents

Notes

• atypical antipsychotics may not be more effective than older agents in the treatment of schizophrenia
• all agents are discontinued more frequently than not [5]

More General Terms

• antipsychotic agent

Additional Terms

• Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE)

References

1. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
2. Prescriber's Letter 10(11):62 2003
3. Prescriber's Letter 11(3):13 2004 Detail-Document#: [1] (subscription needed) [2]
4. FDA Public Health Advisory Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances [3] [4]
5. Lieberman JA et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005 Sep 22; 353:1209-23. PMID: [5]
6. Douglas IJ and Smeeth L. Exposure to antipsychotics and risk of stroke: Self controlled case series study. BMJ 2008 Aug 28; 337:a1227. PMID: [6]
7. Prescriber's Letter 16(10): 2009 Comparison of Atypical Antipsychotics Detail-Document#: [7] (subscription needed) [8]
8. Prescriber's Letter 17(1): 2010 Atypical Antipsychotics in Kids Detail-Document#: [9] (subscription needed) [10]
9. Prescriber's Letter 17(2): 2010 Comparison of Atypical Antipsychotics Detail-Document#: [11] (subscription needed) [12]
10. Maher AR et al. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults. JAMA 2011 Sep 28; 306:1359 PMID: [13]
11. Prescriber's Letter 18(12): 2011 CHART: Off-Label Use of Atypical Antipsychotics in Adults CHART: Comparison of Atypical Antipsychotics Detail-Document#: [14] (subscription needed) [15]
12. National Guideline Clearinghouse Atypical antipsychotic medication poisoning: an evidence-based consensus guideline for out-of-hospital management. ngc-guideline: [16]

atypical antipsychotic agent