Atypical drugs

Many are inhibited by various drugs or their metabolic products, providing another cause of drug interactions Some exhibit genetic polymorphisms, which can result in atypical drug metabolism... 

Health-care decision-makers may be required not only to make economic choices between conventional and atypical drugs, but also between individual atypical agents. There are few direct comparisons of atypical drugs. This is probably a result of the marketing aims of pharmaceutical manufacturers each has sought to establish the cost-effectiveness of their product compared with conventional... 

There is certainly evidence that whereas typical neuroleptics are equally active in mesolimbic/cortical areas as well as the striatum, the atypical drugs are much less effective in the latter. This has been shown by (1) increased DA turnover through DOPAC and HVA production in vitro, (2) augmented DA and DOPAC release by microdialysis in vivo and (3) increased c-fos- ike, expression. 

Whether the amelioration of negative symptoms results from an action in the cortex and, in particular, the prefrontal cortex requires further study. The fact that clozapine, the atypical drug that is currently most effective in this respect, has actions there which are not shown by other compounds is encouraging even though the precise mechanism by which it works remains to be elucidated. 

Of the antipsychotic drugs prescribed, 72% were typical antipsychotics, which included haloperidol, chlorpromazine, levomepromazine, sulpiride, trifluoperazine, fluphenazine, flupentixol, and bromperidol. Use of typical drugs was associated with longer hospitalization, male gender, and clinical reports of violence or aggression. Atypical drugs only accounted for 28% of antipsychotic drugs... 

For approximately 70% of patients with schizophrenia, and probably for a similar proportion of patients with bipolar disorder with psychotic features, typical and atypical antipsychotic drugs are of equal efficacy for treating positive symptoms. However, the evidence favors atypical drugs for benefit for negative symptoms and cognition, for diminished risk of tardivedyskinesia and other forms of EPS, and for lesser increases in prolactin levels. 

Antipsychotic drugs include the older phenothiazines and butyrophenones, as well as newer atypical drugs. All of these can cause CNS depression, seizures, and hypotension. Some can cause QT prolongation. The potent dopamine D2 blockers are... 

Hyperlipidemia associated with antipsychotic drugs has been reviewed (SEDA-29, 64). Haloperidol and the atypical antipsychotic drugs ziprasidone, risperidone, and aripiprazole would be associated with lower risks of hyperlipidemia, whereas chlorpromazine, thioridazine, and the atypical drugs quetiapine, olanzapine, and clozapine would be associated with higher risks. However, severe clozapine-induced hypercholesterolemia and hypertriglyceridemia has been reported in a patient taking clozapine (55). 

Additionally, three other epidemiological studies have identified a higher risk of diabetes associated with olanzapine (Sernyak 777,778). The first of these studies included out-patients with schizophrenia treated over 4 months in 1999 (Sernyak 561). When patients who had taken atypical drugs (n = 22 648) were compared with... 

Zhou H. Pharmacokinetic strategies in deciphering atypical drug absorption pr.d>ClesPharmacol, 2003 ... 

Traditional agents are also somewhat less predictable, and there tends to be more patient-to-patient variability in the beneficial (antipsychotic) effects of these medications.18 Newer atypical drugs may be somewhat safer and more predictable, and these agents are described next. 

The discovery of the antidepressant effect of medications was coincidental to their use for other disorders. Initial work published in 1952 reported that iproniazid (originally used for the treatment of tuberculosis) could elevate mood. Although the use of iproniazid was discontinued due to toxicity, many other additional medications have been tested and approved for the treatment of depression. These include monoamine oxidase inhibitors, tricyclics, selective serotonin reuptake inhibitors, and a heterogeneous class of atypical drugs. 

The DSM-IV-TR observes that atypical antipsychotic drugs are less likely to cause akathisia than the new atypical drugs but that it does occur. In my experience, so-called atypicals like Risperdal and Zyprexa are equally likely to cause akathisia when given in doses equivalent to those used for the older drugs. 

Drug interactions can be dangerous or fatal and should be avoided. Patients individual concerns and health needs must be taken into account when selecting a drug. The atypical drugs, it is said, would be better first-line drugs for patients with specific health concerns. 

Obsessive-compulsive symptoms have been described with both typical neuroleptic drugs (for example chlor-promazine) and atypical drugs (for example clozapine and risperidone) (SEDA-19, 51 SEDA-20, 47 407,410). 

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