Psychiatric Medications: What you need to know
[Pages:27]Psychiatric Medications: What you need to know
Lindsay J. McCoy, Pharm.D., BCPP
13 April 2019
Disclosures
Lindsay McCoy has nothing to disclose.
Objectives
Discuss the prescribing considerations with recently approved drug therapies in the treatment of mood disorders.
Recognize and manage potential drug-drug and drug-disease interactions.
Atypical Antipsychotics
Aripiprazole Brexpiprazole Cariprazine Lurasidone
Comparing binding profiles
Frankel, J. S., & Schwartz, T. L. (2017). Brexpiprazole and cariprazine: distinguishing two new atypical antipsychotics from the original dopamine stabilizer aripiprazole. Therapeutic Advances in Psychopharmacology, 29?41.
Stephen R. Saklad (2017) Graphic representation of pharmacology: Development of an alternative model. Mental Health Clinician: September 2017, Vol. 7, No. 5, pp. 201-206.
Aripiprazole
Indications/dosing (adult):
Schizophrenia ? 10-15 mg/day (max 30mg) Bipolar mania ? monotherapy ? 15 mg/day (max 30mg) Bipolar mania ? adjunct to lithium or valproate ? 15 mg/day (max
30mg) Major depressive disorder ? adjunct to antidepressant ? 5-10 mg/day
(max 15mg)
Common side effects: akathisia, tremor, extrapyramidal symptoms, somnolence, insomnia
Mechanism of action: D2 and 5-HT1A partial agonist; 5-HT2A antagonist
Abilify(R) [package insert]. Rockville, MD: Otsuka America Pharmaceutical; 2014
Aripiprazole [drug interactions]
Strong CYP450 2D6 and 3A4 inhibitors Strong CYP450 3A4 inducers Known 2D6 poor metabolizers Antihypertensive medications Benzodiazepines Known 2D6 poor metabolizer AND 3A4 inhibitor Strong 3A4 inhibitor with 2D6 inhibitor
Reduce usual dose by half Double usual dose over 1-2 weeks Reduce usual dose by half Monitor BP closely; adjust if necessary Monitor sedation, BP; adjust if necessary Reduce usual dose to ?
Reduce usual dose to ?
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