Comparison of Atypical Antipsychotics

(PL Detail-Document #281006: Page 4 of 6)Generic(Brand)/Cost bZiprasidone(Geodon,generics) i80 mg$248.99FDA-Approved Indications for Adultsand Usual or Target Adult DailyDosage Range (mg/day) a, *Schizophrenia: 40-160 mgBipolar disorder(acute manic or mixed episodes;maintenance [adjunct]):80-160 mg• Take with food.Metabolic Adverse Effects 1,14-17,21,24,aWeightgainLow ornoneDiabetesRiskDyslipidemiaQTProlonging a,n,18CYP3A4Metabolism a Sedation a,19None None Yes j Yes Lowa. Per FDA-approved product labeling and our PL Chart, Drug-induced Long QT Interval. 2-7,9-11,13,20 A “yes” in the QT column means, at minimum, QTprolongation has been reported in patients taking the medication, regardless of causality. Some of these medications have contraindications orrecommendations to avoid use related to QT prolongation (see footnotes).b. Wholesale Average Cost (WAC) of one-month supply of daily oral dose specified (lowest cost generic, when available).c. Aripiprazole is available as an IM formulation for agitation associated with schizophrenia or bipolar disorder (usual dose 9.75 mg [may consider 5.25 mg];may re-dose after two hours if needed; 30 mg maximum daily dose). 2d. Avoid use with medications that prolong the QT interval and in patients with risk factors for QT prolongation. 3,7-10e. Consider as second-line antipsychotic due to capacity to prolong QT interval. Avoid use with medications that prolong QT interval, and use caution andconsider dose reduction with drugs that inhibit its metabolism. Monitor potassium and magnesium in patients at risk of electrolyte disturbances. 5f. Olanzapine is available as a short-acting IM formulation (Zyprexa IntraMuscular) and a long-acting IM formulation (Zyprexa Relprevv). 6,27 ZyprexaIntraMuscular is indicated for agitation associated with schizophrenia or bipolar I mania. Usual dose is 10 mg (lower dose [2.5, 5, 7.5 mg] may be given).Max daily dose 30 mg (i.e., 10 mg two hours after first dose, and 10 mg four hours after second dose). 6 Zyprexa Relprevv is indicated for acute andmaintenance treatment of schizophrenia in patients with established tolerability to oral olanzapine. Give the first dose in a facility equipped to handlemedical emergencies. Monitor for sedation and delirium. During the first eight weeks of therapy, the usual dose is 210 mg every two weeks or 405 mgevery four weeks (corresponding to an oral dose of 10 mg once daily), or 300 mg every two weeks (corresponding to an oral dose of 15 to 20 mg oncedaily). Start with 150 mg every four weeks for elderly or debilitated patients, or patients who may have slower olanzapine metabolism or extra sensitivityto its effects, including hypotension. Maintenance doses of Zyprexa Relprevv are 150, 210, or 300 mg every two weeks (corresponding to oral doses of 10,15, or 20 mg once daily, respectively) or 300 or 405 mg every four weeks (corresponding to oral doses of 10 or 15 mg once daily, respectively). 27g. Paliperidone is available as an extended-release IM formulation (Invega Sustenna) for acute and maintenance treatment of schizophrenia in patients withestablished tolerability to paliperidone or risperidone. Initial dose is 234 mg, then 156 mg one week later, then 39 mg to 234 mg monthly. 8h. Risperidone is available as a long-acting IM formulation (Risperdal Consta) for schizophrenia and bipolar disorder (25 mg/dose every two weeks; 50 mgmaximum dose every two weeks). 12i. Ziprasidone is available as IM formulation for acute agitation in schizophrenic patients (10-20 mg/dose; Doses of 10 mg may be given every two hours.Doses of 20 mg may be given every four hours. 40 mg maximum daily dose). 13j. Consider as second-line antipsychotic due to capacity to prolong QT interval. Contraindicated in long QT syndrome, recent myocardial infarction,uncompensated heart failure, and with medications that prolong the QT interval. Avoid use in patients with bradycardia or arrhythmias. Check electrolytesat baseline and periodically in patients at risk for electrolyte disturbances. Ensure normal potassium and magnesium levels. 13Copyright © 2012 by Therapeutic Research CenterP.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249www.pharmacistsletter.com ~ www.prescribersletter.com ~ www.pharmacytechniciansletter.comMore. . .