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Top 5 Topics Posted on Forum (July-Aug 2015)
Here is the list of top five topics posted on forum based on post reach and engagement:
1. Antidepressants + NSAID use = increased risk of intracranial hemorrhage in first 30 days, especially in men.
Source: BMJ 2015;351:h3517
Full PDF: http://www.bmj.com/content/351/bmj.h3517.full.pdf+html
2. Patient with schizophrenia is admitted to inpatient psychiatry unit for recent worsening of paranoia, disorganized behavior and inability to care for self. She is found to be 1 month pregnant on laboratory exam.
Which of the following medication is considered to have lowest rates of placental passage?
(d) All have same rate of placental passage
Answer: (C) Quetiapine.
Thanks everyone for participating.
I have a patient currently on my service with above clinical presentation. This is what I found after reviewing the literature:
Rates of Placental Passage:
Olanzapine > Risperidone > Quetiapine
Quetiapine is a reasonable first choice when a new atypical antipsychotic is indicated for a pregnant patient. In clinical trials, quetiapine had lower rates of placental passage compared with risperidone and olanzapine.
Source: Am J Psychiatry. 2007;164( :1214-1220.
Prospective studies show no increase in fetal malformations or adverse neonatal health outcomes with quetiapine.
Postmarketing surveillance data suggest risperidone has no major teratogenic effect. However, in some cases withdrawal-emergent syndrome is noted with risperidone. Also the risk of hyperprolactinemia with risperidone.
In postmarketing surveillance studies and case reports, there have been have anecdotal cases of fetal malformations related to olanzapine use during pregnancy. Also increased risk of neonatal withdrawal syndrome, gestational diabetes and macrocephaly with olanzapine.
Source: Current Psychiatry 2013 July;12(7):12-18.
3. European Medicines Agency Released New Recommendations for Hydroxyzine (27 March 2015).
(1) Hydroxyzine has the potential to block hERG channels and other types of cardiac channels, resulting in a potential risk of QT interval prolongation and cardiac arrhythmia events (confirmed by clinical and post-marketing data)
(2) The potential risk of QT interval prolongation and torsades de pointes can therefore be adequately minimised through measures targeting the identified risk factors and restricting the use of hydroxyzine to the lowest effective dose for the shortest possible duration.
(3) The maximum dose in adults should be a total of 100 mg daily; in the elderly, if use cannot be avoided the maximum daily dose should be 50 mg.
(4) The maximum daily dose in children up to 40 kg in weight should be 2 mg/kg/day;
children over 40 kg should be given the adult dose.
(5) Use of hydroxyzine is contraindicated in patients with known acquired or congenital QT interval prolongation, or with a known risk factor for QT interval prolongation such as cardiovascular disease, significant electrolyte imbalance (hypokalaemia, hypomagnesaemia), family history of sudden cardiac death, significant bradycardia, or concomitant use of drugs known to prolong the QT interval and/or induce torsades de pointes.
(6) Use is not recommended in elderly patients, due to reduced elimination of hydroxyzine in these patients and greater vulnerability to anticholinergic effects and other adverse reactions.
(7) The medicine should be used with caution in patients with bradycardia, or who are taking hypokalaemia-inducing medicines.
( Care is also required when hydroxyzine is co-administered with drugs known to be potent inhibitors of alcohol dehydrogenase or CYP3A4/5.
4. REXULTI® (BREXPIPRAZOLE) Approved for Schizophrenia and Adjunctive treatment for Major Depression Disorder.
Announced by Otsuka Pharmaceutical Co., Ltd. (Otsuka) and H. Lundbeck A/S (Lundbeck) on July 11, 2015. This approval is supported by four completed placebo-controlled clinical phase III studies.
* Partial agonist activity at serotonin 5-HT1A and dopamine D2 receptors.
* Antagonist activity at serotonin 5-HT2A receptors.
* High affinity for noradrenaline alpha1B/2C receptors.
Dosage Instruction: It is given in a once-daily oral dose with a well defined titration schedule that can be taken with or without food.
• MDD: Initiate treatment at 0.5 mg or 1 mg once daily. Titrate at weekly intervals to 1 mg once daily, then up to the target dosage of 2 mg once daily based on the patient’s clinical response and tolerability.
• Schizophrenia: Initiate treatment at 1 mg once daily for the first 4 days. Titrate to 2 mg once daily on Day 5 through Day 7, then to 4 mg on Day 8 based on the patient’s clinical response and tolerability.
REXULTI will become available to patients in the U.S. in early August 2015.
5. SSRI Induced Indifference/ SSRI Induced Apathy
Definition: Low insight in the afflicted, particularly in children and adolescents, with regard to behavioral symptoms (i.e., low motivation)
Course: Delayed or insidious onset
Etiology: Related to SSRI dosing, with higher doses being more likely to precipitate the syndrome
Treatment: Completely resolvable with a lowering and/or discontinuation of the SSRI.
Full PDF: http://www.ncbi.nlm.nih.gov/…/articles/P…/pdf/PE_7_10_14.pdf
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