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Ask the Pharmacist: New Medications and New Indications


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Presentation details new medications and indications for managing mental illness, as well as information about obtaining relief from the costs of prescription drugs. Also, the presentation features slides relating to Mood Charting and resources for effectively implementing that tool.

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Ask the Pharmacist: New Medications and New Indications

  1. 1. Ask the Pharmacist: NEW MEDICATIONS AND NEW INDICATIONS Presented by LARRY DIBELLO, R.Ph., for NAMI 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
  3. 3. 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.
  4. 4. 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%
  5. 5. VORTIOXETINE (BRINTELLIX, LUNBECK,TAKEDA)  Multimodal antidepressant activity  Serotonin-increases 5HT and 5HT3 and decreases5HT1A  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)
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. OTHER MEDICATIONS Ramelteon(Rozerem, Takeda Pharmaceuticals North America) -being studied in bipolar disorder Rozerem sublingual is also being tested Tasimelteon (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 pherinetargets nasal chromosensory receptors
  11. 11. 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 HBr174, 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. ForfivoXL -long acting bupropion; 450mg tablet once daily AbilifyMaintena-injectable long-acting Abilify, lasts thirty days
  12. 12. TITRATION OF MEDICATIONS Titration –start with low dose and increase the dose periodically Reverse titration –decreasing dose periodically until discontinued Crossover titration –changing medications Decreasing 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 potent For context: A teaspoonful of sugar is 5,000 mg.
  13. 13. 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)
  14. 14. 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 notstored in the bodyand DHAis stored in the body
  15. 15. BETA ENDORPHIN  A neurotransmitter found naturally in our bodies  Is produced when we exercise  It produces a mild euphoria and acts as an analgesic
  16. 16. WHERE TO FIND RELIEF FOR DRUG BILLS  Overview of Prescription Drug Assistance (government programs, non-profit programs, pharmaceutical companies):  nonprofit)  Together RX Access Card (drug discounts to the uninsured) www.Togetherrxaccess.Comor 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
  17. 17. 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:
  18. 18. 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.
  19. 19. Presented by NAMI PA, Main Line an affiliate of the National Alliance on Mental Illness Links and resources embedded within the presentation: • General Information about Prescription Drug Assistance Programs (government programs, non-profit organizations and pharmaceutical company relief programs): • • Together RX Access Card: • Partnership for Prescription Assistance: www.Pparx.Org • More information about Mood Charting and sample charts are available at: All information is current as of publication date; please let us know if you encounter broken hyperlinks. Created November 2014