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Dr. Bob is Robert Hsiung, MD,
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Posted by JLM on June 12, 2003, at 5:06:34
In reply to Re: Abilify (aripiprazole) cost is PROHIBITIVE! » JLM, posted by JLM on June 12, 2003, at 4:51:34
I guess I better toss this in for good measure too:
https://www.family.org/physmag/issues/a0024894.html
Drug Rep Evangelism
By Paul C. Reisser, M.D.
A little humility goes a long way.--------------------------------------------------------------------------------
On Dec. 17, 2002, a study in the following day?s edition of JAMA became a prominent story on all three national network evening news broadcasts. The massive Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, otherwise known as ALLHAT, had demonstrated (among other things) that the lowly thiazide diuretic chlorthalidone outperformed an ACE inhibitor (lisinopril), a calcium channel blocker (amlodipine) and an alpha-blocker (doxazocin). Why all the news coverage? Because, as Lawrence J. Appel, M.D., of Johns Hopkins noted in JAMA, ?The most effective therapy was also the least expensive. . . . The ALLHAT results provide compelling evidence that thiazide diuretics should be the initial drug of choice for patients with hypertension, especially compared with those agents that were directly tested in this trial.?That is precisely what we were told to do 25 years ago. So why did most of us depart from this standard operating procedure? For one thing, the diuretic doses we once used were too high, leading to brisk sales of potassium supplements. Also, some patients didn?t care for the increased urine output, and more than a few experienced changes in insulin resistance and glucose levels. But no doubt we were also affected by learning about the latest ?hot? anti-hypertensive?and receiving those all-important samples?from our friendly pharmaceutical representatives.
Recently, a number of observers have raised concerns about who actually sets the prescribing agendas for the average physician. In the United States, in 2000?the last year for which statistics are available?the pharmaceutical industry spent some $15.7 billion (up 43 percent from 1997) promoting their products to physicians, not to mention another $2.5 billion advertising them directly to the public. We see their ubiquitous ads in both prestigious journals and throwaways, wade through dozens of advertisements arriving in the mail every week, and sometimes marvel at the creative ways in which products are paraded before us. The pens, Post-its, clocks, calculators and clipboards, while useful, can easily make an office resemble a stockcar bedecked with ads from its sponsors.
Equally (if not more) influential are the 80,000 representatives deployed to our offices and clinics. Along with their detail pieces,
presentations and samples, they offer good cheer, appreciation and invitations to pleasant experiences. In bygone days their offers included sports events, live theater, a round of golf, even a weekend at a plush resort. More recently, under tighter guidelines promoted by the AMA and others, these have been toned down to more modest educational lunches or dinners (minus spouses), though usually presented at upscale restaurants and occasionally accompanied by consulting fees offered in exchange for feedback about the company?s current advertising campaigns.A growing body of research confirms that interactions with drug reps, especially those that involve gifts and other pleasantries, affect the prescribing habits of residents and seasoned physicians alike, and some observers worry that this can compromise objective decision-making. After all, how can anyone on the receiving end of such favors not feel obliged, or at least be influenced, to recommend the medications that have been highlighted? Are patients helped or hindered when we reach for samples of the new product we just heard about, especially if the next issue of the Medical Letter dispassionately points out that it shows no superiority to far less expensive predecessors? Are some of us in danger of inhabiting a parallel universe of CME provided by speakers hired by pharmaceutical companies who are informative, but whose presentations may filter the current literature through a grid favorable to those who are picking up the tab?
A few critics insist that the best response to these issues is for physicians to detach themselves completely and abstain from any interaction with drug companies and their representatives.
While everyone must draw his or her own boundaries on this issue, I find this approach a bit extreme. Instead, a little discernment, skepticism and common sense can go a long way in weighing drug company overtures. I generally take a drug representative?s claims of product superiority with a grain or two of salt, knowing that a competitor?s rep will show up with an equally compelling claim. I also periodically reassess my interactions with the pharmaceutical industry, including a reality check on my own motives and potential blind spots. Are my treatment strategies driven by objectivity and an overriding concern for a patient?s clinical and financial welfare?or by the samples currently on my shelves? When a representative pays a visit, however, I do gain some insight into another arena of my life that is far more important: the way I represent my faith to others. I realize that a decision to prescribe a particular medication and a decision to follow Christ are light-years apart in significance. But in a very real sense we are ?reps? for our God (see 2 Corinthians 5:20), entrusted with presenting the most important message on the planet in the most attractive way possible. We need to be prepared, to take the initiative, to ?know our stuff? without flaunting it, to avoid talking too long (or too loud), to listen, and to present His case (not ours) without being pushy.
Several months ago I attended a dinner presentation on lipid-lowering therapy during which the speaker demonstrated a formidable command of hundreds of statistics from the current literature on this subject. His was also the most slanted medical presentation I had ever heard, insinuating that the sponsor?s product was the only rational choice in its class, based on current evidence. I left the meeting feeling insulted and humiliated.
Since I use a number of products in this class of drugs, I obviously must be one of those dumb slugs in the trenches who doesn?t have the time to master this particular topic. I retaliated by refusing to prescribe the sponsor?s product for several weeks, and when I finally ventilated to the rep who had organized the meeting he was mortified to hear that I had been alienated rather than won over by the presentation.
One thing I gained from this experience was a reminder that no one wins any converts by overpowering them intellectually (or any other way) and that the primary fruits of such effort are resistance and resentment. ?Always be prepared to give an answer to everyone who asks you to give the reason for the hope that you have,? exhorted the apostle Peter. ?But do this with gentleness and respect? (1 Peter 3:15). The gospel is not a sales pitch or an argument to be won; rather, it is good news, first and last, spread by one grateful beggar telling another where he has found food, clothing and shelter.
Posted by Dr. Bob on June 12, 2003, at 18:10:58
In reply to Re: Abilify (aripiprazole) cost is PROHIBITIVE! » JLM, posted by JLM on June 12, 2003, at 5:06:34
> Drug Rep Evangelism...
I'd like discussion of the pharmaceutical industry to be redirected to Psycho-Social-Babble, thanks.
Bob
PS: And discussion of posting policies to be redirected to Psycho-Babble Administration.
Posted by nsaw on June 14, 2003, at 10:22:18
In reply to Re:sleep and physical anxiety, posted by Vanidosa on January 20, 2003, at 9:47:01
My brother was on Abilify for a 6-week trial, and he had trouble falling asleep also. He would stay up very late and get maybe 3 hours of sleep a night. He is back on Abilify, as of yesterday, and we're again experiencing the same problems. His sleep has been fine on all his other medications: including Risperadone and Olanzapine.
I was thinking yesterday that maybe Abilify has something that keeps you awake? Should he not be taking it at night? Does anyone know anything about taking Abilify at night? Please help.
> I've had a very hard time staying asleep. I wake up sometimes at three or four, no matter when I've gone to bed, and I feel like I have to go running or something like that to calm the physical anxiety and sleeplessness. I've been on abilify for a little over four weeks now. There is really no information out there except for PR from the pharmaceutical companies. Does anyone have any other research or medical journals to recommend?
Posted by CouchPup on June 16, 2003, at 22:57:30
In reply to Re:sleep and physical anxiety, posted by nsaw on June 14, 2003, at 10:22:18
Hi nsaw,
I just now started taking Abilify six days ago. At first no side effects, except I would feel sleepier and get to bed earlier. Now I am beginning to feel some physical anxiety, making it hard (but not impossible) for me to sit at the computer for an extended time. As time goes by, I am finding that I am awakening a little more frequently in the middle of the night, and have to stay in bed longer to get the sleep I need.
I keep running into the word "Akathisia."
In reading through this thread, I've seen others mention problems with sleep and physical anxiety (like the one you quote).
There are two particularly relevant posts, "Abilify and Akathisia" by River1924, at
http://www.dr-bob.org/babble/20030125/msgs/137555.html , and
http://www.dr-bob.org/babble/20030125/msgs/137556.html .The latter refers to "Extrapyramidal Symptoms and the Elderly", by B.V. Borders-Hemphill, PharmD
http://www.ascp.com/public/pubs/cc/1998/supp4a.shtml .I'm on a 2-week trial, which a coupon is taking care of, blessedly; otherwise I'd be paying $126, because I've no insurance. Ugh! After this two weeks, I don't know what I am going to do.... My Dr. said "Try it anyway," when I called him astonished at the price.
Good luck, and hope this helped, nsaw.
-CouchPup> My brother was on Abilify for a 6-week trial,
> and he had trouble falling asleep also. He
> would stay up very late and get maybe 3 hours
> of sleep a night. He is back on Abilify, as of
> yesterday, and we're again experiencing the
> same problems. His sleep has been fine on all
> his other medications: including Risperadone
> and Olanzapine.
>
> I was thinking yesterday that maybe Abilify has
> something that keeps you awake? Should he not
> be taking it at night? Does anyone know
> anything about taking Abilify at night? Please
> help.
>
>
Posted by Dr. Bob on June 17, 2003, at 9:03:02
In reply to Redirect: pharmaceutical industry, posted by Dr. Bob on June 12, 2003, at 18:10:58
> I'd like discussion of the pharmaceutical industry to be redirected to Psycho-Social-Babble, thanks.
Here's a link:
http://www.dr-bob.org/babble/social/20030617/msgs/234522.html
Bob
Posted by sisterfriend on June 17, 2003, at 11:45:24
In reply to Re:sleep and physical anxiety, posted by Vanidosa on January 20, 2003, at 9:47:01
My husband has been taking Abilify for 3 weeks now and has the same restlessness-- his Dr. prescribed Lorazipam (Ativan) to take at bedtime which seems to be working perfectly. He can take up to 3 a day, in quarters or halves depending on the situation (feeling jumpy or nervous) and he takes one or two of those three before bedtime and is asleep within a half an hour. Hope that helps.
> I've had a very hard time staying asleep. I wake up sometimes at three or four, no matter when I've gone to bed, and I feel like I have to go running or something like that to calm the physical anxiety and sleeplessness. I've been on abilify for a little over four weeks now. There is really no information out there except for PR from the pharmaceutical companies. Does anyone have any other research or medical journals to recommend?
Posted by clusterfscked on June 20, 2003, at 13:07:03
In reply to Re:sleep and physical anxiety, posted by sisterfriend on June 17, 2003, at 11:45:24
Not only am I new to this board, but I'm new to Abilify as well. I was taking 800 mg of Tegretol alongside 400 mg of Wellbutrin SR, but the Tegretol didn't seem to be doing much more for me than a placebo. So, my psychiatrist decided to put me on Abilify and after taking it only one time -- admittedly perhaps a bit too soon to judge -- I am wondering if that was a wise move.
I took my first dose (15 mg) yesterday at about 10:30a and began going downhill from there. Within about an hour, I was so tired that it felt like I had been up for at least a week. I went and layed down but was only able to sleep for approximately 2 hours because I kept tossing and turning. After waking up, my stomach felt like it was being shifted around by one of those taffy machines at that fair and it also felt like someone was sticking an icepick into my stomach. My whole body also felt shakey, as though my legs were too weak to hold me and my hands / arms couldn't hold anything heavier than a piece of paper.
I managed to make it through the afternoon and evening though and longed for a good night's sleep. WRONG! I woke up at least every hour and spent all of the night shifting around in bed. In fact, it seemed as though I was acting my dreams out IN bed, that's how significant my shifting was. This is what I say -- I can handle the sleep issue, that's not a real big deal. I cannot however handle the nausea and icepick feeling that I experienced.
I've noticed from these threads that it's pretty much a hit and miss type of situation. Some people have been able to wait the symptoms out and finally experience the good attributes of this drug, while others didn't really see it happening. I have Bipolar Disorder / Anxiety Disorder / Depression and so far the drugs I have taken (Depakote, Lithium, Paxil, Celexa, Lexapro, Tegretol, Ativan, Zyprexa) have not been worth much to me. I hope that these symptoms are merely initial symptoms because I absolutely cannot function with how I felt yesterday.
Posted by kotsunega on June 20, 2003, at 15:46:14
In reply to New to Abilify, posted by clusterfscked on June 20, 2003, at 13:07:03
I think if it was me, I'd be calling my doctor and explaining what I am experiencing. I know others have posted that they've had some nasty effects from Abilify. I have not had any problem with it.
Sorry you're having a difficult time
-kotsunega
Posted by bbmod on June 21, 2003, at 16:48:55
In reply to Re: Abilify , posted by HOFW on January 29, 2003, at 1:36:17
My husband is taking 15 mg of Abilify and has experienced similar tremor problems at night. I perceive them as similar to seizures involving his entire body. He doesn't waken during the episode and has no memory of it in the a.m.
He seems very groggy the next day. Like you, I recognize the positive results from Abilify but feel grave concern for this side effect.
> My wife has been taking abilify for 5 weeks, she started at 15mg, reduced to 10 mg and currently at7.5 mg.
>
> The main side effects are restlessness (akasthasia), shaking/tremors/movement of hands in sleep and blurred vision.
>
> The doc has added cogenitin to suppress the side effects and that helps with the restlessness but the other side effects remain.
>
> Has anyone experienced the shaking/movements/tremors in sleep??
>
> I think Abilify helped her on lot of positive/negative symptoms, ability to think logically, clearly, participate in conversations etc.
>
> Let me know If anyone needs additional info.
Posted by bbmod on June 22, 2003, at 9:46:38
In reply to Re: New to Abilify, posted by kotsunega on June 20, 2003, at 15:46:14
I appreciate your concern and HAVE talked to the doctor about the tremors. Last night was his upper body, trunk, not extremities, and lasted about one minute. The psychiatrist doesn't know what they are, suggests it might be a restless leg syndrome. I'm not sure what to do next.
He's on several other meds and I don't feel like we have a sense of which is causing what....I'm new to this board so it's very interesting to see the responses to some of the other meds he's on, all of which seem to have pretty complex side effects (lithium, lamictal, strattera, klonopin, in addition to abilify)
Feeling pretty frustrated....don't know how to help him.....
Posted by Sebastian on June 22, 2003, at 17:38:32
In reply to New to Abilify, posted by clusterfscked on June 20, 2003, at 13:07:03
clusterfscked
How was the Zyprexa? I had all the same side-effects as you on the Abilify. Zyprexa is the only thing that works, for me. What dose were you on, did you take any AD's with it?
Sebastian
Posted by cybercafe on June 22, 2003, at 18:36:46
In reply to Re: New to Abilify » clusterfscked, posted by Sebastian on June 22, 2003, at 17:38:32
> clusterfscked
>
> How was the Zyprexa? I had all the same side-effects as you on the Abilify. Zyprexa is the only thing that works, for me. What dose were you on, did you take any AD's with it?
>
> Sebastian
hey sebastian, what made you quit abilify, was it akathisia or insomnia ?
did you try taking any other meds to help with that?
i wonder if it might be possible to take zyprexa and abilify at the same time
Posted by kotsunega on June 22, 2003, at 21:52:57
In reply to Re: Abilify , posted by bbmod on June 22, 2003, at 9:46:38
> I appreciate your concern and HAVE talked to the doctor about the tremors. Last night was his upper body, trunk, not extremities, and lasted about one minute. The psychiatrist doesn't know what they are, suggests it might be a restless leg syndrome. I'm not sure what to do next.
> He's on several other meds and I don't feel like we have a sense of which is causing what....I'm new to this board so it's very interesting to see the responses to some of the other meds he's on, all of which seem to have pretty complex side effects (lithium, lamictal, strattera, klonopin, in addition to abilify)
> Feeling pretty frustrated....don't know how to help him.....I recollect reading a post on this board that suggested taking benedryl or another prescription antihistamine to combat side effects. Here's the post: http://www.dr-bob.org/babble/20030125/msgs/137494.html It's just a couple of lines. I don't know if you should do this without your doctor's advice, of course, but wanted to let you know this may be an option. Best wishes for everything working out.
-kotsunega
Posted by bbmod on June 23, 2003, at 0:24:06
In reply to Re: Abilify , posted by kotsunega on June 22, 2003, at 21:52:57
Thank you kotsunega! I'm gathering info for doc this week and will share your suggestion.
Posted by Sebastian on June 23, 2003, at 22:36:44
In reply to Re: New to Abilify, posted by cybercafe on June 22, 2003, at 18:36:46
I took both at the same time, no good, I didn't like the effects. Maybe I should have taken the full dose of Zyprexa like the doc suggested.
Major insomina, every night up later and sleeping less. Think I just don't function without my 10mg dose (Zyprexa that is). Anyways I've lost almost all the weight, 50 lbs, I still want to lose another 10 and be at 166 again. I take Wellbutrin now and that motivates me so I'm not as tired. I've even cut my smoking in half, wish I could quit that.
So have you switched to Abilify, and totaly off the Zyprexa?
Sebastian
Posted by Sebastian on June 23, 2003, at 22:57:40
In reply to Re: New to Abilify, posted by cybercafe on June 22, 2003, at 18:36:46
Yes I had Akathisia too, but at the same time it was like I was being robbed of energy?
Posted by cybercafe on June 23, 2003, at 23:48:26
In reply to Re: New to Abilify » cybercafe, posted by Sebastian on June 23, 2003, at 22:36:44
> I took both at the same time, no good, I didn't like the effects. Maybe I should have taken the full dose of Zyprexa like the doc suggested.
wow.. so even with zyprexa you still couldn't sleep? hmmmm... without meds do you tend towards insomnia or over sleeping? ... myself i tend to sleep too much so i wonder if abilify might be just right for me
> So have you switched to Abilify, and totaly off the Zyprexa?
nope abilify isn't available here yet... :(
Posted by cybercafe on June 23, 2003, at 23:49:14
In reply to Re: New to Abilify » cybercafe, posted by Sebastian on June 23, 2003, at 22:57:40
> Yes I had Akathisia too, but at the same time it was like I was being robbed of energy?
was the akathisia worse than the insomnia? ....
Posted by Rhiannonpa on June 24, 2003, at 5:46:57
In reply to Re: New to Abilify, posted by kotsunega on June 20, 2003, at 15:46:14
I agree...call the doctor FAST. It sounds like you are experiencing some very Serious Adverse Events. The weakness in your legs really caught my attention.
Good luck & Brighter Blessings with your meds.
Rhiannon
>
> I think if it was me, I'd be calling my doctor and explaining what I am experiencing. I know others have posted that they've had some nasty effects from Abilify. I have not had any problem with it.
>
> Sorry you're having a difficult time
>
> -kotsunega
Posted by HOFW on June 25, 2003, at 3:24:57
In reply to Re: Abilify » HOFW, posted by bbmod on June 21, 2003, at 16:48:55
The doctor added cogenitin(benzatropin) to control the side effects (tremor in sleep, shaking of lips, akasthasia etc.), it seems to reduce the side effects to a good degree, let me know If you need additional info. Thanks
> My husband is taking 15 mg of Abilify- and has experienced similar tremor problems at night. I perceive them as similar to seizures involving his entire body. He doesn't waken during the episode and has no memory of it in the a.m.
> He seems very groggy the next day. Like you, I recognize the positive results from Abilify but feel grave concern for this side effect.
> > My wife has been taking abilify for 5 weeks, she started at 15mg, reduced to 10 mg and currently at7.5 mg.
> >
> > The main side effects are restlessness (akasthasia), shaking/tremors/movement of hands in sleep and blurred vision.
> >
> > The doc has added cogenitin to suppress the side effects and that helps with the restlessness but the other side effects remain.
> >
> > Has anyone experienced the shaking/movements/tremors in sleep??
> >
> > I think Abilify helped her on lot of positive/negative symptoms, ability to think logically, clearly, participate in conversations etc.
> >
> > Let me know If anyone needs additional info.
>
>
Posted by bbmod on June 25, 2003, at 9:47:55
In reply to Re: Abilify:bbmod, posted by HOFW on June 25, 2003, at 3:24:57
Good info. Thank you. I printed it off to show the doctor. Tremors are continuing (upper trunk, too). Wow. Could I relate to the shaking lips!
> The doctor added cogenitin(benzatropin) to control the side effects (tremor in sleep, shaking of lips, akasthasia etc.), it seems to reduce the side effects to a good degree, let me know If you need additional info. Thanks
>
> > My husband is taking 15 mg of Abilify- and has experienced similar tremor problems at night. I perceive them as similar to seizures involving his entire body. He doesn't waken during the episode and has no memory of it in the a.m.
> > He seems very groggy the next day. Like you, I recognize the positive results from Abilify but feel grave concern for this side effect.
> > > My wife has been taking abilify for 5 weeks, she started at 15mg, reduced to 10 mg and currently at7.5 mg.
> > >
> > > The main side effects are restlessness (akasthasia), shaking/tremors/movement of hands in sleep and blurred vision.
> > >
> > > The doc has added cogenitin to suppress the side effects and that helps with the restlessness but the other side effects remain.
> > >
> > > Has anyone experienced the shaking/movements/tremors in sleep??
> > >
> > > I think Abilify helped her on lot of positive/negative symptoms, ability to think logically, clearly, participate in conversations etc.
> > >
> > > Let me know If anyone needs additional info.
> >
> >
>
>
Posted by lynn3 on June 25, 2003, at 22:02:22
In reply to Re: Abilify , posted by bbmod on June 25, 2003, at 9:47:55
I had akathesia and insomnia with the abilify 12.5 mg /day. My doc added 50mg of Seroquel at bedtime and it took the symptoms away.
Posted by Sebastian on June 26, 2003, at 9:25:01
In reply to Re: New to Abilify, posted by cybercafe on June 23, 2003, at 23:49:14
>wow.. so even with zyprexa you still couldn't sleep? hmmmm... without meds do you tend towards insomnia or over sleeping? ... myself i tend to sleep too much so i wonder if abilify might be just right for me
Ya, I can't sleep without the Zyprexa, I tried once with just the Celexa and had a simmilar problem as with the Abilify. The Wellbutrin prevents me from over sleep. Totaly without meds, insomnia.
>nope abilify isn't available here yet... :(
Are you in Canada?
>was the akathisia worse than the insomnia? ....
Insomnia was the worst.
Posted by cybercafe on June 27, 2003, at 21:56:04
In reply to Re: New to Abilify » cybercafe, posted by Sebastian on June 26, 2003, at 9:25:01
thanks for replying bro, your insight is INVALUABLE!> >wow.. so even with zyprexa you still couldn't sleep? hmmmm... without meds do you tend towards insomnia or over sleeping? ... myself i tend to sleep too much so i wonder if abilify might be just right for me
>
> Ya, I can't sleep without the Zyprexa, I tried once with just the Celexa and had a simmilar problem as with the Abilify. The Wellbutrin prevents me from over sleep. Totaly without meds, insomnia.I know most people report insomnia on abilify but a lot of them might be insomniacs to begin with i think.....! i sleep quite a bit so maybe i won't have problems.... or ! why not just take zyprexa + abilify?
> >nope abilify isn't available here yet... :(
>
> Are you in Canada?yeah.... maybe i'll drive down to buffalo to get some. i wonder if it's gone down in price at all... $13 US a pill? that's quite a lot
> >was the akathisia worse than the insomnia? ....
>
> Insomnia was the worst.great! i was really worrying about akathisia ....
did you try anything to treat the insomnia?
Posted by cybercafe on June 27, 2003, at 21:58:37
In reply to Re: New to Abilify, posted by kotsunega on June 20, 2003, at 15:46:14
Hey kots how is the abilify working for you?
Does it help with ADD symptoms like inattention and impatience?
good luck bro
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Dr. Bob is Robert Hsiung, MD,
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