Schizophrenia: Latest Drug Treatments
This SharePost is the first of a series devoted to schizophrenia treatment and it focuses specifically on some of the newer drugs used to control the symptoms of this illness.
Disclaimer: This information is for educational purposes only. Speak to your psychiatrist for any medical advice you have concerning a particular drug. Taken from the prescribing information with links to the drug Web sites at the end of this article. Not every side effect or detail about the drug is described here.
As with all SZ drugs, the risks should be weighed against the benefits in making any decision about which drug to take. All the drugs cited are used to treat the positive symptoms of schizophrenia like delusions, hallucinations (hearing voices or seeing things) and paranoia.
Invega, or paliperidone is a small tablet that comes in four dose strengths and each tablet strength is a different color. The dosages are 1.5 mg, 3 mg, 6 mg, and 9 mg. The medicine is released over a 24-hour period and should be taken at the same time every day to get the steady effect throughout the day. You can take it with or without food and take it with a liquid.
Invega can cause weight gain and cardiovascular/cerebrovascular risks such as high blood sugar and diabetes. It can change your heart rhythm.
The most common side effects with Invega in the treatment of schizophrenia in adults were abnormal muscle movements (including tremor - shaking), shuffling, uncontrolled involuntary movements and abnormal movements of the eyes and fast heartbeat. In the treatment of schizoaffective disorder in adults the common side effects were abnormal muscle movements (including tremor - shaking), shuffling, uncontrolled involuntary movements, and abnormal movements of the eyes, sleepiness, heartburn, constipation, weight increase and sore throat.
According to drugs.com Invega could pose risks during pregnancy:
"Paliperidone has been assigned to pregnancy category C by the FDA. Animal studies have revealed increased pre- and post-implantation loss, a slightly decreased number of live embryos, and decreases in serum testosterone, sperm motility and sperm concentration. There are no controlled data in human pregnancy. Use of first generation antipsychotic drugs during the last trimester of pregnancy has been associated with extrapyramidal symptoms in the neonate. Paliperidone should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus."
Do not breast feed while taking Invega as it is excreted in human milk.
Fanapt or ilopderidone tablets come in dosage strengths of 1 mg, 2 mg, 4 mg, 6 mg, 8 mg, 10 mg and 12 mg tablets. The recommended target dosage is 12 to 24 mg/day administered twice daily. This ideal dose is achieved by daily dose adjustments over a seven-day period starting with 1 mg twice daily.
It can be taken with or without food.
Common side effects were dizziness, dry mouth, fatigue, nasal congestion, orthostatic hypotension, somnolence, tachycardia, and weight gain. This drug prolongs QT interval and may be associated with arrhythmia and sudden death. The prescribing information tells you to consider using other antipsychotics first. Do not use with other drugs that have demonstrated QT prolongation.
Use only if clearly needed during pregnancy. Breast feeding is not possible when a woman takes Fanapt.
Latuda or lurasidone HCL tablets come in 40 mg and 80 mg strengths. It is recommended to start at a dose of 40 mg once daily. Initial dose titration is not required. The maximum recommended dose is 80 mg once daily. Latuda should be taken with food.
Common side effects include somnolence, akathisia, nausea, parkinsonism and agitation. Latuda is thought to have a less risky metabolic profile though this drug can possibly cause weight gain too.
It was priced at $14 per pill-the highest cost of the SZ meds-and this comes out to about $5,000 per year.
No adequate and well-controlled studies exist of Latuda in pregnant woman and breast feeding should be considered only if the potential benefit justifies the potential risk to the child. Latuda was excreted in milk of rats during lactation. It is not known whether Latuda or its metabolites are excreted in human milk.
A newer older atypical is Geodon or ziprasidone HCL capsules.
The oral doses must be taken with food. Taking the drug with food increases the absorption of Geodon up to two-fold. The dose strengths are 20 mg, 40 mg, 60 mg and 80 mg.
It is not to be used in patients with a known history of QT prolongation or in patients with recent acute myocardial infarction. It is also not to be used in patients with uncompensated heart failure. Do not use with other drugs that have demonstrated QT prolongation.
Common side effects included somnolence and respiratory tract infection. Geodon should be used during pregnancy only if the potential benefit outweighs the potential risk. Women taking this drug should not breast feed.
It is the least likely to cause weight gain yet the reality is some people do gain weight on Geodon just like on the other atypicals.
The last of the newer drugs I'll talk about here is Abilify or aripiprazole.
Oral doses are administered once daily with or without food. The tablets comes in 2 mgt, 5 mg, 10 mg, 15 mg, 20 mg and 30 mg strengths. Can be taken with or without food.
Common side effects included akathisia in adult patients with schizophrenia. It is not known if Abilify is associated with the increased risk of hyperlgycemia and diabetes mellitus the way the other atypicals are.
According to the prescribing information:
There are no adequate and well-controlled studies in pregnant women. It is not known whether aripiprazole can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Neonates exposed to antipsychotic drugs during the third trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery. There have been reports of agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress and feeding disorder in these neonates. These complications have varied in severity; while in
some cases symptoms have been self-limited, in other cases neonates have required intensive care unit support and prolonged hospitalization.
Abilify should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Breast feeding is not recommended.
The first SharePost in August will look at the older atypicals in detail. After that I'll talk about the latest drug treatments in the pipeline in research to bring to market.