Ask the Pharmacist:NEW MEDICATIONS AND

NEW INDICATIONS

Presented by LARRY DIBELLO, R.Ph., forNAMI PA, Main Line,

an affiliate of the National Alliance on Mental Illness

Please view the final slide for NAMI PA, Main Line contact information and a list of all links embedded within this presentation.

Created November 2014

NEW DRUGS IN DEVELOPMENTFOR MENTAL ILLNESS

119 NEW DRUGS IN DEVELOPMENT: 36 FOR SCHIZOPHRENIA 29 FOR DEPRESSION 20 FOR SUBSTANCE ABUSE 19 FOR ADHD 15 FOR ANXIETY

SOURCE: PHARMACEUTICAL MANUFACTURERS ASSOCIATION

AUGMENTATION

Atypical antipsychotics are being used for augmentation of antidepressants

Bupropion Hcl is also used for augmentation of serotonin increasing antidepressants

Most atypical antipsychotics have augmentation approval from the FDA

Note: All atypical antipsychotics seem to work as well for augmentation.

LEVOMILANACIPRAN (FETZIMA, FOREST LABS)

Indicated for major depressive disorder Significant increaser of norepinephrine Also increases serotonin but 1/10 as much Dose 40, 80 and 120mg/Day sustained release

Note: discontinuation rate drug 9% and placebo 3%

VORTIOXETINE (BRINTELLIX, LUNBECK,TAKEDA)

Multimodal antidepressant activity Serotonin- increases 5HT and 5HT3 and

decreases 5HT1A Possibly affecting many other neurotransmitters Possibly lower side effects Long acting (lower withdrawal effect)

Dose – start 10mg/day , can increase to 15 or 20mg/day or decrease to 5mg/day (depending on

activity and or side effects)

ASENAPINE (SAPHRIS, FOREST)

Indicated for Schizophrenia: 5mg to 10mg Bipolar disorder: 10mg/d can reduce to 5mg/twice

daily Sublingual (lessens liver side effects)

Note: serious allergic reactions and neuromuscular side effects have been reported

LURASIDONE (LATUDA, SUNOVION PHARMA)

Indicated for schizophrenia and mania New indication is bipolar depression No muscarinic acetylcholine receptors Lower impairment of memory and learning vs.

other antipsychotics Dose: 40mg to 80mg once daily

BREXIPIPERAZOLE (ALZFORUM, LUNDBECK, OTSUKA) PHASE III

Dopamine partial agonist Add-on therapy for depression and schizophrenia Works well for agitation and other behavioral

symptoms in dementia 10% discontinuation rate, and less weight gain and

akathesia then other drugs Dose 1 to 3 mg./day

PIPAMPERONE(DIPEPERONE, JANSSEN)

Is available in Europe It is a weak antipsychotic Seems to work well for agitated patents It is an excellent antidepressant augmenter

Studies ongoing in a fixed combination with Celexa in the United States

OTHER MEDICATIONS

Ramelteon (Rozerem, Takeda Pharmaceuticals North America) - being studied in bipolar disorder

Rozerem sublingual is also being testedTasimelteon (Hetlioz or Vanda) - is indicated for

treatment of disorder of sleep wake cycle in people blind from birth

Provigil and Nuvigil being looked at for bipolar disorder and MDD

Intranasal pherines for social anxiety disorder - a synthetic neuroactive pherine targets nasal chromosensory receptors

OTHER MEDICATIONS

Stavzor - delayed release valproic acid ( easier on stomach); 125mg, 250mg, 500mg capsule twice daily

Pristiq- desvenlafaxine long-acting Effexor; 75mg, 152mg tablets once daily

Aplenzin- long acting Bupropion HBr 174, 348, 555mg tablets once daily

Oleptro - long acting trazodone initial dose 150mg. May be titrated to 375mg daily.

Silenor - low dose Doxepin 3mg, 6mg. At bedtime, lasts 8 hrs. Low side effects, no hangover.

Forfivo XL - long acting bupropion; 450mg tablet once daily

Abilify Maintena - injectable long-acting Abilify, lasts thirty days

TITRATION OF MEDICATIONS

Titration – start with low dose and increase the dose periodically

Reverse titration – decreasing dose periodically until discontinued

Crossover titration – changing medicationsDecreasing dose of first medication while adding a second medication at a low dose and increasing it while decreasing dose of the first medication until discontinued

Important- Medications are very potentFor context: A teaspoonful of sugar is 5,000 mg.

FOLIC ACID

Folic acid is a B vitamin that is helpful in the management of depression.Most experts feel that 1.2mgs/day helps(The normal amount of folic acid in multivitamins and B

complex vitamins is 0.4mgs)

Deplin (L-methylfolate 15mg) - A much more active form of folic acid and other B vitamins (expensive)

OMEGA 3 FATTY ACIDSFISH OR FLAX SEED OIL

The best fish oil is the 1400mg formulation(available at Walgreens and Walmart) Contains 647 mg of EPA and 250mg of DHA It is enteric coated (no aftertaste) Purified (no or minimal mercury) Side effects (oily stool, thinning blood?) EPA is not stored in the body and DHA is stored in

the body

BETA ENDORPHIN

A neurotransmitter found naturally in our bodies

Is produced when we exercise

It produces a mild euphoria and acts as an analgesic

WHERE TO FIND RELIEF FOR DRUG BILLS

Overview of Prescription Drug Assistance (government programs, non-profit programs, pharmaceutical companies):http://www.nami.org/Template.cfm?Section=Helpline1&Template=/ContentManagement/ContentDisplay.cfm&ContentID=156228

Needymeds.com www.NeedyMeds.com(Philadelphia-based nonprofit)

Together RX Access Card (drug discounts to the uninsured)www.Togetherrxaccess.Com or 1-800-444-4106

Simple Fill: 1-877-386-0206 Select Care: 1-800-858-9060 The RX Advocates: 1-866-949-7353 Partnership for Prescription Assistance: www.Pparx.Org

(information about drug company programs) PA Department of Aging: PACE or PACENET (depending on income), 1-

800-955-0989 NJ Department of Health and Senior Services:

PAAD, 1-800-792-9745

MOOD CHARTING RECOMMENDATIONS

Mood charting Provides a simple means of generating a graphic representation of illness

over the last month. Allows patients/caregivers to systemically bring together important pieces of

information: medication levels mood state major life events

Helps people see emerging patterns that otherwise might be difficult to discern.

Source: Bipolar Clinic & Research Program, Massachusetts General Hospital

Note: More information about Mood Charting and sample charts are available at: http://NAMIocala.org/Mood-Charting.php

IMPROVING COMMUNICATION WITH YOUR HEALTH CARE PROVIDER

Depression and Bipolar Support Alliance recommends: making a list of all experiences resulting from medication,

both good and bad; bringing a paper and pencil to the visit and take notes on

what the doctor tells you; helping your doctor make time for you by asking questions

that you have written down before the visit; bringing written feedback on your progress; (there are

many side effects to medications that you may not associate with the medication); and

learning all you can about your diagnosis.Remember it’s your body.

Presented by NAMI PA, Main Line an affiliate of the National Alliance on Mental Illness

www.namipamainline.orginfo@NAMIpaMainLine.org

Links and resources embedded within the presentation:• General Information about Prescription Drug Assistance Programs (government programs, non-profit organizations and pharmaceutical company relief programs): http://www.nami.org/Content/ContentGroups/Helpline1/Prescription_Drug_Patient_Assistance_Programs.htm• Needymeds.com: www.NeedyMeds.com • Together RX Access Card: www.Togetherrxaccess.com• Partnership for Prescription Assistance: www.Pparx.Org• More information about Mood Charting and sample charts are available at: http://NAMIocala.org/Mood-Charting.php

All information is current as of publication date; please let us know if you encounter broken hyperlinks.

Created November 2014