Posted by Vince on November 22, 2002, at 23:27:32
I'm using olanzapine (Zyprexa)as a mood stablizer along with my AD. It really helps but I'm getting an endless appitite with endless weight gain,and some slight EPS, which worries me. I'm wondering if I should talk my pdoc into letting me try aripiprazole as a mood stablizer? It was just approved in the last week or two. I don't even know if it would work as a stablizer but it should since many of the AP's do. If it did do the job as a stablizer, from what I've read it has fewer side effects. People switched from Zyprexa to aripiprazole lost about a pound a week [see article below].
Any first hand experience? Any inside info or any opinions out there?
Here's an article that I read about it:
Aripiprazole May Change Schizophrenia Treatment
Laurie Barclay, MD
NEW YORK (MedscapeWire) May 29 — The investigational antipsychotic aripiprazole may change the treatment approach to schizophrenia, according to several studies presented on May 22-25 at the 155th annual meeting of the American Psychiatric Association in Philadelphia, Pennsylvania.
Aripiprazole has a different mechanism of action than traditional antipsychotics; it is a potent partial agonist of D2 receptors, a partial agonist of 5HT1A serotonin receptors, and an antagonist of 5HT2A receptors.In one study the drug was significantly better than placebo in preventing relapse, and in another, it was better tolerated and somewhat more effective than haloperidol. A third study showed that it was well tolerated with symptom improvement and reduction of adverse effects after schizophrenic patients were switched from a variety of different medications.
"One of the most difficult challenges in treating patients with schizophrenia is long-term adherence," Jeffrey Lieberman, MD, from the University of North Carolina at Chapel Hill, says in a news release. "Data from these studies suggest the potential for significant benefits of aripiprazole in the long-term treatment of schizophrenia."
In a 52-week study of 1294 patients diagnosed with acute relapse of schizophrenia, aripiprazole treatment was associated with improvements in positive, negative, and depressive symptoms that were maintained throughout the study. Patients treated with either aripiprazole or haloperidol had similar improvement of positive symptoms, but those treated with aripiprazole had greater improvement of negative and depressive symptoms from baseline to endpoint than did those treated with haloperidol. Significantly fewer patients treated with aripiprazole discontinued therapy for lack of efficacy or adverse events than did those treated with haloperidol (P<.001), and they had significantly fewer extrapyramidal symptoms including akathisia.
In a separate 26-week study of 310 patients with stable chronic schizophrenia, aripiprazole was significantly better than placebo in preventing relapse (P<.001). Time to relapse was twice as long with aripiprazole as with placebo (P<.001), and there was greater improvement in psychotic symptoms (P=.002). Weight changes and extrapyramidal symptoms associated with aripiprazole were similar to those in the placebo group.
In a third study, 311 patients with stable schizophrenia were safely switched from olanzapine, risperidone, or haloperidol to aripiprazole, with improvement in symptoms and a reduction in certain adverse effects.
"There is a very high rate of switching medications among patients with schizophrenia, and in many incidences the switching is driven by side effects," said Daniel E. Casey, MD, from the Portland VA Medical Center. "In this study, patients were successfully switched to aripiprazole from commonly used antipsychotics, and in many cases there were distinct benefits to that switch."
At the end of 8 weeks, patients switched to aripiprazole from olanzapine had a mean weight loss of 2.03 kg (P<.001), decreased prolactin levels, and improvement in extrapyramidal symptoms. Patients switched from risperidone to aripiprazole had decreased prolactin levels (P<.001), weight loss, and fewer extrapyramidal symptoms. Patients switched from haloperidol had improvement in extrapyramidal symptoms, decreased prolactin levels, and minimal weight change.
Specific differences in safety and tolerability parameters depended on prior antipsychotic treatment.
Bristol-Myers Squibb Co. and Otsuka Pharmaceuticals filed regulatory applications for aripiprazole for the treatment of schizophrenia in the United States and Europe in October and December 2001, respectively.
APA Annual Meeting. May 22-25, 2002.
Reviewed by Gary D. Vogin, MD
poster:Vince
thread:128860
URL: http://www.dr-bob.org/babble/20021122/msgs/128860.html