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OBJECTIVES
NEWER ATYPICAL Discuss new antipsychotics approved within the last five years
NOVEL IDEAS OR Recognize the clinical utility of new antipsychotic agents for
the treatment of schizophrenia
ME TOOS?
Sanaz Farhadian, Pharm.D., BCPP
Clinical Psychiatric Pharmacist
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Veterans Affairs Healthcare System, San Diego, CA
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* Available generically
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1 Mesolimbic 3 Nigrostriatal
2 Mesocortical 4 Tuberoinfundibular
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FANAPT
WHERE DO NEW AGENTS FIT IN? (ILOPERIDONE)
Oral tablet
APPROVAL DATE ANTIPSYCHOTIC BRAND
1mg, 2mg, 4mg, 6mg, 8mg, 10mg, 12mg
May 2009 Iloperidone Fanapt
July 2009 Paliperidone IM Invega Indication: acute treatment of schizophrenia
Injection Sustenna
August 2009 Asenapine SL Saphris Antagonist at 2C receptors
December 2009 Olanzapine IM Zyprexa
Injection Relprevv Twice daily dosing
October 2010 Lurasidone Latuda 95% protein bound
February 2013 Aripiprazole IM Abilify Well absorbed, peak plasma concentrations 2-4 hours post-dose
Injection Maintena Metabolized by CYP2D6 and CYP3A4 into P88 and P95
February 2013 Clozapine Oral Versacloz Elimination half-life: 18-33 hours for parent drug; 23-37 hours for
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Suspension metabolites
Fanapt package insert.
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Long-acting injection to paliperidone palmitate Hold syringe upright to de-aerate by moving plunger rod forward
If at steady state, initiate with maintenance dose q4 weeks 23 24
when next injection is due Inject entire contents IM slowly into selected muscle
Invega Sustenna package insert. Invega Sustenna package insert.
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Maximum dose: 20mg/day in divided doses Place under tongue and allow to
dissolve fully
Avoid eating or drinking for 10 minutes after administration
Reduces bioavailability Do not eat or drink for 10 minutes
post-administration
Dosage adjustments
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NOT recommended in severe hepatic impairment Slide tablet pack into case until it
Saphris package insert. clicks Saphris package insert.
Saphris package insert. Saphris package insert. Minassian et al. Expert Opin Pharmacother 2010;11:2107.
Bishara et al. Neuropsychiatr Dis Treat 2009;5:483. Citrome et al. Neuropsychiatr Dis Treat 2011;7:325.
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Orthostasis
Anticholinergic
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Somnolence
Take with food (at least 350 calories)
Dizziness
Dosage adjustments Low metabolic risk
CrCl 49ml/min - reduce 50%
Moderate hepatic impairment reduce 50% Nausea
Severe hepatic impairment initiate 20mg, max 40mg/day
Moderate CYP3A4 inhibitor reduce 50% 43
Dizziness 44
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