ask the pharmacist: new medications and new indications
DESCRIPTION
Presentation details new medications and indications for managing mental illness, as well as information about obtaining relief from the costs of prescription drugs. Also, the presentation features slides relating to Mood Charting and resources for effectively implementing that tool.TRANSCRIPT
Ask the Pharmacist:NEW MEDICATIONS AND
NEW INDICATIONS
Presented by LARRY DIBELLO, R.Ph., forNAMI PA, Main Line,
an affiliate of the National Alliance on Mental Illness
Please view the final slide for NAMI PA, Main Line contact information and a list of all links embedded within this presentation.
Created November 2014
NEW DRUGS IN DEVELOPMENTFOR MENTAL ILLNESS
119 NEW DRUGS IN DEVELOPMENT: 36 FOR SCHIZOPHRENIA 29 FOR DEPRESSION 20 FOR SUBSTANCE ABUSE 19 FOR ADHD 15 FOR ANXIETY
SOURCE: PHARMACEUTICAL MANUFACTURERS ASSOCIATION
AUGMENTATION
Atypical antipsychotics are being used for augmentation of antidepressants
Bupropion Hcl is also used for augmentation of serotonin increasing antidepressants
Most atypical antipsychotics have augmentation approval from the FDA
Note: All atypical antipsychotics seem to work as well for augmentation.
LEVOMILANACIPRAN (FETZIMA, FOREST LABS)
Indicated for major depressive disorder Significant increaser of norepinephrine Also increases serotonin but 1/10 as much Dose 40, 80 and 120mg/Day sustained release
Note: discontinuation rate drug 9% and placebo 3%
VORTIOXETINE (BRINTELLIX, LUNBECK,TAKEDA)
Multimodal antidepressant activity Serotonin- increases 5HT and 5HT3 and
decreases 5HT1A Possibly affecting many other neurotransmitters Possibly lower side effects Long acting (lower withdrawal effect)
Dose – start 10mg/day , can increase to 15 or 20mg/day or decrease to 5mg/day (depending on
activity and or side effects)
ASENAPINE (SAPHRIS, FOREST)
Indicated for Schizophrenia: 5mg to 10mg Bipolar disorder: 10mg/d can reduce to 5mg/twice
daily Sublingual (lessens liver side effects)
Note: serious allergic reactions and neuromuscular side effects have been reported
LURASIDONE (LATUDA, SUNOVION PHARMA)
Indicated for schizophrenia and mania New indication is bipolar depression No muscarinic acetylcholine receptors Lower impairment of memory and learning vs.
other antipsychotics Dose: 40mg to 80mg once daily
BREXIPIPERAZOLE (ALZFORUM, LUNDBECK, OTSUKA) PHASE III
Dopamine partial agonist Add-on therapy for depression and schizophrenia Works well for agitation and other behavioral
symptoms in dementia 10% discontinuation rate, and less weight gain and
akathesia then other drugs Dose 1 to 3 mg./day
PIPAMPERONE(DIPEPERONE, JANSSEN)
Is available in Europe It is a weak antipsychotic Seems to work well for agitated patents It is an excellent antidepressant augmenter
Studies ongoing in a fixed combination with Celexa in the United States
OTHER MEDICATIONS
Ramelteon (Rozerem, Takeda Pharmaceuticals North America) - being studied in bipolar disorder
Rozerem sublingual is also being testedTasimelteon (Hetlioz or Vanda) - is indicated for
treatment of disorder of sleep wake cycle in people blind from birth
Provigil and Nuvigil being looked at for bipolar disorder and MDD
Intranasal pherines for social anxiety disorder - a synthetic neuroactive pherine targets nasal chromosensory receptors
OTHER MEDICATIONS
Stavzor - delayed release valproic acid ( easier on stomach); 125mg, 250mg, 500mg capsule twice daily
Pristiq- desvenlafaxine long-acting Effexor; 75mg, 152mg tablets once daily
Aplenzin- long acting Bupropion HBr 174, 348, 555mg tablets once daily
Oleptro - long acting trazodone initial dose 150mg. May be titrated to 375mg daily.
Silenor - low dose Doxepin 3mg, 6mg. At bedtime, lasts 8 hrs. Low side effects, no hangover.
Forfivo XL - long acting bupropion; 450mg tablet once daily
Abilify Maintena - injectable long-acting Abilify, lasts thirty days
TITRATION OF MEDICATIONS
Titration – start with low dose and increase the dose periodically
Reverse titration – decreasing dose periodically until discontinued
Crossover titration – changing medicationsDecreasing dose of first medication while adding a second medication at a low dose and increasing it while decreasing dose of the first medication until discontinued
Important- Medications are very potentFor context: A teaspoonful of sugar is 5,000 mg.
FOLIC ACID
Folic acid is a B vitamin that is helpful in the management of depression.Most experts feel that 1.2mgs/day helps(The normal amount of folic acid in multivitamins and B
complex vitamins is 0.4mgs)
Deplin (L-methylfolate 15mg) - A much more active form of folic acid and other B vitamins (expensive)
OMEGA 3 FATTY ACIDSFISH OR FLAX SEED OIL
The best fish oil is the 1400mg formulation(available at Walgreens and Walmart) Contains 647 mg of EPA and 250mg of DHA It is enteric coated (no aftertaste) Purified (no or minimal mercury) Side effects (oily stool, thinning blood?) EPA is not stored in the body and DHA is stored in
the body
BETA ENDORPHIN
A neurotransmitter found naturally in our bodies
Is produced when we exercise
It produces a mild euphoria and acts as an analgesic
WHERE TO FIND RELIEF FOR DRUG BILLS
Overview of Prescription Drug Assistance (government programs, non-profit programs, pharmaceutical companies):http://www.nami.org/Template.cfm?Section=Helpline1&Template=/ContentManagement/ContentDisplay.cfm&ContentID=156228
Needymeds.com www.NeedyMeds.com(Philadelphia-based nonprofit)
Together RX Access Card (drug discounts to the uninsured)www.Togetherrxaccess.Com or 1-800-444-4106
Simple Fill: 1-877-386-0206 Select Care: 1-800-858-9060 The RX Advocates: 1-866-949-7353 Partnership for Prescription Assistance: www.Pparx.Org
(information about drug company programs) PA Department of Aging: PACE or PACENET (depending on income), 1-
800-955-0989 NJ Department of Health and Senior Services:
PAAD, 1-800-792-9745
MOOD CHARTING RECOMMENDATIONS
Mood charting Provides a simple means of generating a graphic representation of illness
over the last month. Allows patients/caregivers to systemically bring together important pieces of
information: medication levels mood state major life events
Helps people see emerging patterns that otherwise might be difficult to discern.
Source: Bipolar Clinic & Research Program, Massachusetts General Hospital
Note: More information about Mood Charting and sample charts are available at: http://NAMIocala.org/Mood-Charting.php
IMPROVING COMMUNICATION WITH YOUR HEALTH CARE PROVIDER
Depression and Bipolar Support Alliance recommends: making a list of all experiences resulting from medication,
both good and bad; bringing a paper and pencil to the visit and take notes on
what the doctor tells you; helping your doctor make time for you by asking questions
that you have written down before the visit; bringing written feedback on your progress; (there are
many side effects to medications that you may not associate with the medication); and
learning all you can about your diagnosis.Remember it’s your body.
Presented by NAMI PA, Main Line an affiliate of the National Alliance on Mental Illness
Links and resources embedded within the presentation:• General Information about Prescription Drug Assistance Programs (government programs, non-profit organizations and pharmaceutical company relief programs): http://www.nami.org/Content/ContentGroups/Helpline1/Prescription_Drug_Patient_Assistance_Programs.htm• Needymeds.com: www.NeedyMeds.com • Together RX Access Card: www.Togetherrxaccess.com• Partnership for Prescription Assistance: www.Pparx.Org• More information about Mood Charting and sample charts are available at: http://NAMIocala.org/Mood-Charting.php
All information is current as of publication date; please let us know if you encounter broken hyperlinks.
Created November 2014