Psychotropic Medications: What s New?

Transcription

1 Psychotropic Medications: What s New? Stacie L Penkova, PharmD, MHSA, BCPS Acclaim Pharmacy Benefits Manager Connected Care Partners Project Manager Outcomes Conference August 2016

2 Disclosures I, Stacie L. Penkova, PharmD, MHSA, BCPS, do not have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. Special thanks to Hillary Hardwick for assisting me in compiling and condensing the material for this and my other presentations you will see today and tomorrow.

3 Objectives Review various psychotropic medications and what AEs to watch for in your patients Discuss safety measures associated with psychotropic medications

4 2015 Beer s Criteria Related to Psychotropics Clinically important DDIs Antidepressants (i.e. TCAs, SSRIs) + 2 other CNS active drugs = increased risk of falls Antipsychotics + 2 other CNS active drugs = increased risk of falls Benzodiazepines and non-benzodiazepine, benzodiazepine receptor agonist hypnotics + 2 other CNS active drugs = increased risk of falls

5 2015 Beer s Criteria Related to Psychotropics Dose adjustments of drugs to avoid based on kidney function: Neurontin (CrCl <60) CNS AEs unless you reduce dose = mg BID = mg QDay 15 = mg QDay <15 = proportionally to CrCl (HD = mg supplement, PD no supplement) Keppra (CrCl 80) CNS AEs unless you reduce dose = mg BID = mg BID <30 = mg BID HD = mg QDay mg supplement PD = mg QDay & no supplement

6 2015 Beer s Criteria Related to Psychotropics Non-benzodiazepine benzodiazepine receptor agonist hypnotics (i.e. eszoplicone, zaleplon, zolpidem) added to the list of drugs to avoid in elderly patients with dementia or cognitive impairment Avoid using antipsychotic drugs as first-line for delirium due to lack of evidence for efficacy and increased risk of AEs in elderly

7 Antidepressant Safety There may be a reduced risk of MI with SSRIs, especially fluoxetine A study of 238,963 patients with depression in the UK looked at the association between antidepressants and CV events (i.e. AMI, CVA or TIA) ~88% of patients received antidepressant therapy with SSRIs (most common), TCAs, or another antidepressant There were no significant associations for stroke or transient ischemic attack of any of the drug classes (timeline of follow-up=5 years) Similar results for arrhythmias and MIs, including with the use of citalopram, which has been associated with QT prolongation Further analysis needed for sufficient results

8 Antidepressant Safety GI bleeding and antidepressant use Long term use with SSRIs associated with risk of upper and lower GI bleeding Increased risk when SSRIs used with NSAIDs Nationwide cohort study conducted on 48,765 patients to estimate risk of upper and lower GI bleeding with use of SSRIs and SNRIs 39,012 control participants 5-year follow-up showed an increased risk of both upper and lower GI bleeding in SSRIs but not SNRIs

9 Chantix & Alcohol Interaction Chantix (varenicline) is a prescription medication to facilitate smoking cessation FDA is warning of increased intoxicating effects of alcohol Aggressive behavior Amnesia Rare cases of seizures Recommendation: Stop taking Chantix if the patient experiences agitation, hostility, aggressive behavior, depressed mood or develops atypical behavioral changes or suicidal ideation. Decrease alcohol consumption until he/she knows its effects with Chantix Stop taking Chantix if seizure activity occurs and have the patient seek medical attention

10 Zyprexa Relprevv Two patients deaths have caused FDA to look into the use of Zyprexa Relprevv (olanzapine pamoate) since both patients died 3 to 4 days after receiving these injections No changes made, but continue to follow REMS requirements and current label recommendations: Prescriber, health care facility, patient and pharmacy enrolled in the Zyprexa Relprevv Patient Care Program Zyprexa Relprevv injections administered at a REMS-certified health care facility with easy access to emergency response services Constantly monitor patients at the REMS-certified health care facility for at least 3 hours after IM injection Patients receiving Zyprexa Relprevv must have someone with them at the healthcare facility

11 Daytrana Patch & Chemical Leukoderma Permanent loss of skin color caused by repeated exposure of chemical compounds in methylphenidate transdermal system Irreversible loss of color on up to 8 inches of skin diameter Do not stop using this medication without first talking to provider

12 Brintillex and Brilinta Name Confusion Similar brand names causing prescribing and/or dispensing errors Brintillex (vortioxetine) is a SSRI that treats major depressive disorder Brilinta (ticagrelor) is an antiplatelet drug used to decrease the risk of MI or other related heart problems caused by blood clotting FDA has approved a brand name change for the antidepressant Brintellix (vortioxetine) to Trintellix to decrease the risk of prescribing and dispensing errors resulting from name confusion

13 Clozapine and Severe Neutropenia Clozapine is an antipsychotic medicine used to treat schizophrenia in those who have not had success with other antipsychotic therapy. It is also used for patients with schizophrenia or schizoaffective disorders having suicidal ideations. Severe neutropenia is a dangerously low number of white blood cells (neutrophils) that can be life threatening due to the inability to fight off infections The prescribing information for clozapine has been revised to improve monitoring and management of severe neutropenia from clozapine.

14 Clozapine and Severe Neutropenia Requirements to monitor, prescribe, dispense, and receive clozapine are covered in the new Clozapine REMS Program. All patients currently receiving clozapine will be entered into the REMS Program. As of October 12, 2015, all pharmacies and prescribers must be certified in the Clozapine REMS Program to either dispense or prescribe clozapine.

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