Misc. info about atypical antipsychotics

by D.J. Jaffe (of AMI/FAMI) - see web site at: http://www.schizophrenia.com/ami

The following is taken from a speech by Dr. Lewis Opler at the AMI/NYS annual
convention. The following is written from my notes, but should not substitute
for a consultation with your doctor)

According to Dr.Lewis Opler, we are entering the war of antipsychotics. Four
different companies are fighting with clozaril, respiridol, olanzapine, and
sertindol. This presents opportunities and problems. The opportunity is
that a lot of money is involved so the pharmaceutical companies are receptive
to forking over dollars to AMI groups. The problem is that misleading info
and marketing ploys that benefit the companies at the expense of the consumer
are now widespread.

For example, respiridol is the best selling antypsychotic without any proof
it is better than clozaril. And there is little clinical evidence that a
weekly blood test is needed for clozril after one-year. But if Sandoz, the
maker of clozaril, were to have the FDA approve this, the market for clozaril
would explode at a time Sandoz no longer has a patent. This would make it
worthwhile for generic manufacturers to enter the market, and hurt Sandoz.
So in the interim, consumers continue to go through a weekly blood draw long
after it's needed.

Setindole, the newest antipsychotic to soon enter the market has some
interesting characteristics: it is good on both neg. and positive symptoms,
and does not elevate prolactin production. OTOH, it does cause some mild
(supposedly not dangerous) cardiac irregularities.

Olanzapine has an advantage over clozaril in that it can be started at an
effective dose (10mg), while people starting on clozaril must start on a
lesser dose and work up to a therapeutic level. The makers of olanzapine
(Lilly) are exploiting the fact that it does not cause heart beat
irregularities. This is there way of digging at Sertindole, even though the
cardiac arhythmeia problem caused by sertindole is minor.

It should be noted that olanzapine, respiridol, and sertindole, all can cause
TD, but at a much much lower rate than haldol (1% vs. 5%). Only clozril does
not cause any TD. In order for Clozaril to be effective the individual
should have at least 350nanogram per millileter in blood or in won't work.
Unfortunately doctors rarely check the blood to make sure a therapeutic does
is present. This test is different than the weekly white blood cell count.
As an advocate, you might want to insist if your relative is on clozaril
that they periodically receive this serum test.

One questioner at the conference asked Dr. Opler about the fact that many
people on clozaril appear to develop obsessive-compulsive-like symptoms.
Many in the audience, shook their heads, indicating they too had experienced
this, even though it has not 'officially' been reported. Since clozaril is a
serotonin blocker, and the meds that help OCD (anafranil, zoloft, prozac)
increase serotonin, it is not counter-intuitive to conclude that clozaril
could exacerbate or lead to the development of OCD like symptoms. One
potential way to counteract this, according to Dr. Opler, might be to add an
SSRI like prozac or zoloft to a clozaril regiment. He did not suggest using
anafranil, since it's side effects are too similar to clozaril and therefore
these meds should probably not be used together. However, for an individual
on respiridol, adding a low nightly dose (25-50mg) of pimozide may help
counteract the OCD symptoms that may be associated (but not reported) with

I asked the doctor how a family can decide whether to try a different (newer)
med if someone is on clozaril, but the family thinks the consumer can do
better. According to the doctor, there are no studies comparing the atypical
antipsychotics, so there is no 'scientific' evidence suggesting changing meds
is a good approach (except when side-effects make continuation on clozaril
impossible). However, many family members (who IMHO often know more than
doctors) know that some meds are good for some people and others work for
other people.

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