atypical antipsychotic agent; second generation antipsychotic
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Indications
- treatment of psychosis
- both negative & positive symptoms may respond
- agitation
- especially useful in the elderly (antipsychotics of choice)
- aggressive behavior
- autism[12]
- depression, bipolar disorder, mania[12]
Benefit/risk
- treatment of agitation demented patients
- increased risk for mortality (NNH = number needed to harm)
- risperidone, NNH = 27
- olanzapine, NNH = 40
- quetiapine, NNH = 50[18]
- increased risk for mortality (NNH = number needed to harm)
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
- melatonin 5 mg QD may attenuate weight gain[14]
- 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%
Adverse effects
- extrapyramidal symptoms
- risk of tardive dyskinesia less than that with conventional antipsychotics[13]
- see tardive dyskinesia for management of extrapyramidal symptoms
- urinary symptoms
- akathisia
- hyperglycemia; increased risk of diabetes[2] {may be all atypical antipsychotics}[2]
- dyslipidemia[3]
- weight gain[3]
- melatonin 5 mg QD may attenuate weight gain[14]
- increased mortality in the elderly[4]
- RR = 1.54
- number needed to harm [NNH], 87[10], 50-100[20]
- increased risk of mortality in Parkinson's disease (RR=2.35)[19]
- 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
- worsening of cognitive impairment[15]
- increased risk of falls & fractures in the elderly, especially in the 1st 90 days[17]
- acute renal failure in the 1st few months of use in the elderly (1%, RR=1.6)[16]
- hypotension[16]
- hyperprolactinemia (see antipsychotic)
- black box warning
- increased risk of stroke
- increased mortality in patients with dementia
- drug adverse effects of antipsychotic agents
- drug adverse effects of atypical antipsychotic agents
- drug adverse effects of psychotropic 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
More specific terms
- amisulpride (Solian, Deniban, Barhemsys)
- aripiprazole (Abilify)
- asenapine (Saphris)
- brexpiprazole (Rxulti)
- cariprazine (Vraylar)
- iloperidone; hoperidone (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)
- zotepine (Losizopilon, Lodopin, Setous, Zoleptil)
Additional terms
- atypical vs conventional antipsychotics in the elderly
- Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE)
References
- ↑ UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 2.0 2.1 2.2 Prescriber's Letter 10(11):62 2003
- ↑ 3.0 3.1 3.2 Prescriber's Letter 11(3):13 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200306&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 FDA Public Health Advisory Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances http://www.fda.gov/cder/drug/advisory/antipsychotics.htm http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#atypical
Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA. 2005 Oct 19;294(15):1934-43. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16234500 - ↑ 5.0 5.1 Lieberman JA et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005 Sep 22; 353:1209-23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16172203
- ↑ 6.0 6.1 Douglas IJ and Smeeth L. Exposure to antipsychotics and risk of stroke: Self controlled case series study. BMJ 2008 Aug 28; 337:a1227. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18755769
- ↑ Prescriber's Letter 16(10): 2009 Comparison of Atypical Antipsychotics Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=251010&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Prescriber's Letter 17(1): 2010 Atypical Antipsychotics in Kids Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260102&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Prescriber's Letter 17(2): 2010 Comparison of Atypical Antipsychotics Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260206&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 10.0 10.1 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: https://www.ncbi.nlm.nih.gov/pubmed/21954480
- ↑ Prescriber's Letter 18(12): 2011 CHART: Off-Label Use of Atypical Antipsychotics in Adults CHART: Comparison of Atypical Antipsychotics Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=271207&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 12.0 12.1 12.2 Deprecated Reference
- ↑ 13.0 13.1 Jeste DV. Tardive dyskinesia rates with atypical antipsychotics in older adults. J Clin Psychiatry. 2004;65 Suppl 9:21-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15189108
- ↑ 14.0 14.1 14.2 Romo-Nava F et al. Melatonin attenuates antipsychotic metabolic effects: An eight-week randomized, double-blind, parallel-group, placebo- controlled trial. Bipolar Disord 2014 Mar 17 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24636483 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/bdi.12196/abstract
- ↑ 15.0 15.1 Vigen CL, Mack WJ, Keefe RS et al Cognitive effects of atypical antipsychotic medications in patients with Alzheimer's disease: outcomes from CATIE-AD. Am J Psychiatry. 2011 Aug;168(8):831-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21572163
- ↑ 16.0 16.1 16.2 Hwang YJ, Dixon SN, Reiss JP et al Atypical Antipsychotic Drugs and the Risk for Acute Kidney Injury and Other Adverse Outcomes in Older Adults: A Population-Based Cohort Study. Ann Intern Med. 2014;161(4):242-248 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25133360 <Internet> http://annals.org/article.aspx?articleid=1897100
- ↑ 17.0 17.1 Fraser LA et al. Falls and fractures with atypical antipsychotic medication use: A population-based cohort study. JAMA Intern Med 2015 Jan 12 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25581312 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=2089230
- ↑ 18.0 18.1 Maust DT, Kim HM, Seyfried LS et al. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: Number needed to harm. JAMA Psychiatry 2015;72(5):438-445. Mar 18; PMID: https://www.ncbi.nlm.nih.gov/pubmed/25786075
- ↑ 19.0 19.1 Weintraub D et al. Association of antipsychotic use with mortality risk in patients with Parkinson disease. JAMA Neurol 2016 Mar 21 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26999262
- ↑ 20.0 20.1 Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
- ↑ Peuskens J, Pani L, Detraux J, De Hert M. The effects of novel and newly approved antipsychotics on serum prolactin levels: a comprehensive review. CNS Drugs. 2014 May;28(5):421-53. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24677189 Free PMC Article
- ↑ Rognoni C, Bertolani A, Jommi C. Second-generation antipsychotic drugs for patients with schizophrenia: systematic literature review and meta-analysis of metabolic and cardiovascular side effects. Clin Drug Investig. 2021;41:303-319. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33686614