Slide 1 Risperidone Binding Profile (high affinity for D2 receptors) a 1 antagonist a 2 antagonist Slide 2 Risperidone Prescribing Facts 2 8 mg/day for acute psychosis and bipolar disorder 0.5-2 mg /day for children and elderly patients 25-50 mg IM every two weeks Slide 3 Risperidone Prescribing Facts Tablets: 0.25mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 6 mg. Orally disintegrating tablets: 0,5 mg, 2 mg Liquid: 1 mg/ml, 30 ml bottle LAI: Risperidone microspheres for IM use. 25 mg, 37.5 mg, 50 mg Stahl, S M. The Prescriber's Guide. 4thd ed. New York: Cambridge University
Slide 4 Risperidone Clinical Profile Approved for use in children and adolescents: Schizophrenia, ages 13 and older Acute mania/mixed mania, ages 10 and older Autism related irritability in children, ages 5-16 LAI approved for maintenance treatment of bipolar 1 disorder Stahl, S M. The Prescriber's Guide. 4thd ed. New York: Cambridge University Slide 5 Risperidone Clinical Profile Weight gain: intermediate risk. Lower risk than olanzapine and clozapine Higher risk than aripiprazole and ziprasidone EPS risk is dose dependent. A PET study found that risperidone occupies 75-80% of striatal D2 receptors at a dose of 6mg/day. Prolactin elevation is a risk. Slide 6 Paliperidone Metabolite of risperidone: 9-hydroxylrisperidone Available as LAI: paliperidone palmitate
Slide 7 Paliperidone Binding Profile a 1 antagonist a 2 antagonist Slide 8 Paliperidone- Prescribing Facts 6 mg/day (up to 12 mg/day) Extended release tablets: 3 mg, 6 mg, 9 mg LAI - Paliperidone palmitate: 39 mg, 78 mg, 117 mg, 156 mg, 234 mg. INVEGA [package insert]. Accessed at http://invega.com : November 2012 Slide 9 Paliperidone - Clinical Profile First antipsychotic to be approved for schizoaffective disorder. Paliperidone and risperidone are the two SGAs associated with hyperprolactinemia.
Slide 10 Quetiapine Binding Profile - 5HT1A partial agonist - H1 antagonist a 1 antagonist Slide 11 Quetiapine Prescribing Facts 400-800 mg/day for schizophrenia and bipolar mania 300 mg / day for bipolar depression Tablets: 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg XR tablets: 200 mg, 300 mg, 400 mg Slide 12 Quetiapine Clinical Profile Approved for: Bipolar maintenance Bipolar depression Acute mania/mixed states Adjunctive treatment of MDD
Slide 13 Quetiapine Clinical Profile Adverse effects: Most common adverse effects: somnolence and dizziness. Orthostatic hypotension About 7% of patients Syncope is a possibility with rapid titration Weight gain: intermediate risk EPS: low risk Used in patients with Parkinson s disease and Lewy body dementia Schatzberg, AF., Cole, JO, and DeBattista, C. Manual of Clinical Psychopharmacology. 7th ed.american Psychiatric Publishing, 2010. Slide 14 Ziprasidone - Binding Profile - 5HT1A partial agonist - 5HT1D antagonist - 5HT2C antagonist - Low affinity for H1, M1 and a 1 receptors
Slide 15 Ziprasidone Prescribing Facts Schizophrenia: 40 200 mg/day Bipolar disorder: 80-160 mg/day Maximum daily IM dose: 40 mg Capsules: 20 mg, 40 mg 60 mg, 80 mg Injection: 20 mg/ml Slide 16 Ziprasidone Clinical Profile Associated with QT prolongation: Not dose dependent Careful with: Patients with CV conditions: uncompensated heart failure, cardiac arrhythmias Hypokalemia Hypomagnesemia Bradycardia Use of medications that prolong the QT interval Janicak, P G., Marder S R., and. Pavuluri M N. Principles and Practice of Psychopharmacotherapy. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2010. Slide 17 Ziprasidone Clinical Profile Very low risk of inducing weight gain Patients who are overweight or have metabolic disturbances Dose dependent sedation Janicak, P G., Marder S R., and. Pavuluri M N. Principles and Practice of Psychopharmacotherapy. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2010.
Slide 18 Aripiprazole Binding Profile - Partial D2/D3 agonist (pre and postsynaptic receptors) - 5HT2A antagonist - 5HT1A partial agonist - Modest affinity for H1, M1 and a 1 receptors Slide 19 Aripiprazole Prescribing Facts 15-30 mg/day Tablets: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg Orally disintegrating tablets: 10 mg, 15 mg Oral solution: 1mg/ml Injection: 9.75 mg/1.3 ml Slide 20 Aripiprazole Clinical Profile Approved as adjunctive treatment for MDD Low risk of causing weight gain Akathisia is a possibility