Neurologic drug–psychotropic drug update (original) (raw)
Related papers
Psychotropic drug versus psychotropic drug—update
General Hospital Psychiatry, 2004
Psychotropic drugs are not necessarily the drugs of psychiatry. Seventy percent of antidepressants, and 90% of anxiolytics are prescribed by nonpsychiatric physicians. Since psychotropic medications are so frequently employed by nonpsychiatric physicians, e.g., neurologists, primary care physicians, internists, and because large numbers of their patients are concurrently on medical drugs for somatic reasons, the interactions of psychotropic versus medical drugs and psychotropic versus psychotropic drugs as listed below must be understood before primary care physicians or psychiatrists prescribe psychotropic medications, especially to the medically ill. Seventy commonly prescribed psychotropic drugs were examined for their interactions with other psychotropic medications using six reference tools: 1) MEDLINE (PubMed) employing the first generic psychotropic drug name, the second generic psychotropic drug name, and the term "interaction;" 2) Information [5]; and 6) Food and Drug Administration (MedWatch) (Dear Doctor Letters and new labeling) (www.fed.gov/medwatch for (1999, 2000, and 2001). The authors recognized that all of the above sources do not necessarily cover the entire information database regarding drug-drug interactions. (Citations regarding children, reports in foreign languages or concerning food, animals, in vitro experiments, analgesics, and naturalistic-herbal or natural products-treatment interactions were excluded).
Comparison of three methods for identifying medical drug-psychotropic drug interactions
General Hospital Psychiatry, 2002
Three methods for examining drug-drug interactions were compared to understand advantages and disadvantages of each: ePocrates; Interact; The Mount Sinai multiple source for the evaluation of drug-drug interactions (MS). ePocrates is a commonly employed software system utilized in a hand held computer, the PalmPilot. Interact is on a CD-ROM, and promoted by the American Psychiatric Association Press. The MS system was developed by the authors and utilizes six separate references sources to ascertain the presence and significance of drug-drug interactions. Commonly prescribed neurology and psychotropic medication interactions were compared using the three systems. ePocrates did not list the significance level of the interaction, e.g., (major, moderate, minor), often did not include a mechanism of action, and several commonly employed medications were not included. It did permit examining several drugs at the same time, and was easily carried on the person of the physician. Interact often contained old references, several drugs were not included, was not adapted to a hand held computer format, and had no update since 1999. The MS system listed level of significance, provided mechanism of action , and advice to the practitioner including recommendations. It is not portable, requiring a laptop or desk top computer or hard copy, and only searches one drug at a time. It is hoped that the advantages of each of these three systems may be incorporated into systems of the future.
Neuropsychopharmacotherapy: Guidelines
NeuroPsychopharmacotherapy
express biased opinions. They are often not read or followed because of poor quality or because of barriers to implementation due to either lack of agreement or ambiguity. We briefly review practice guidelines for the treatment of schizophrenia, major depression, and bipolar disorder.
Editorial Opinion: Principles of Prescribing Practice in Psychiatry and Neuropsychiatry
Journal of Psychology & Clinical Psychiatry, 2016
III. There are alwayssubtle ethicospirituobiopsychofamiliosocioethnicocultural systems 1 [1] of influence, and each of these components, in turn, impact on each other. IV. Multiple factors impact pharmacological choices, responsiveness to medications and safety issues. Prescription is not just pharmacological. V. We need to prescribe for the correct duration and this necessitates evaluating all relevant factors, and appropriate follow-up. The obvious components written on all patient prescriptions include, hopefully the following appropriate, correct details: a. The dose for that patient: this is specific to the circumstances at that time; b. The duration of the prescription; c. The frequency of the drug. But there are some major principles that facilitate success in our management of the patient's condition after performing the
FOCUS, 2006
Most drugs are prescribed for several illnesses, but it took several years for psychotropic drugs to have multiple clinical indications. Our search for serotonergic drugs in affective illnesses and related disorders led to new off-label indications for fluoxetine, sertraline, tryptophan, clonazepam, alprazolam, tomoxetine, buproprion, duloxetine, risperidone and gabapentin. Various clinical trial designs were used for these proof-of-concept studies. Novel therapeutic uses of benzodiazepines, such as in panic disorder and mania, were found with the introduction of 2 high-potency benzodiazepines, clonazepam and alprazolam, which were thought to have serotonergic properties. Our initial clinical trials of fluoxetine and sertraline led to their approved indications in the treatment of obsessive-compulsive disorder, and our trials of gabapentin led to new indications in anxiety disorders (generalized anxiety, panic attack and social phobia) and sleep disorders (insomnia). La plupart des médicaments sont prescrits pour plusieurs maladies, mais il a fallu plusieurs années pour que les psychotropes aient de multiples indications cliniques. Notre recherche de médicaments sérotoninergiques contre des maladies affectives et des troubles connexes est à l'origine de nouveaux emplois non conformes des médicaments suivants : fluoxétine, sertraline, tryptophan, clonazépam, alprazolam, tomoxétine, buproprion, duloxétine, rispéridone et gabapentine. On a utilisé divers concepts d'essais cliniques pour ces études de validation du principe. On a trouvé de nouvelles utilisations thérapeutiques pour les benzodiazépines, comme dans des cas de trouble panique et de manie, avec l'arrivée sur le marché de deux benzodiazépines de haute puissance, le clonazépam et l'alprazolam, qui semblaient avoir des propriétés sérotoninergiques. Nos premières études cliniques sur la fluoxétine et la sertraline ont débouché sur l'approbation de leurs indications dans le traitement du trouble obsessif compulsif, et nos études sur la gabapentine sont à l'origine de nouvelles indications contre les troubles de l'anxiété (anxiété généralisée, crise de panique et phobie sociale) et du sommeil (insomnie).
British Journal of Clinical Pharmacology, 2001
To describe the psychiatric indications of neuroleptics (especially the relative share of schizophrenic and other psychotic disorders) and the usage patterns of these drugs (dose, duration, coprescriptions). Methods A one-day national cross-sectional survey in a random sample of 723 French psychiatrists was carried out in 1996. Each psychiatrist was asked to complete a standardized questionnaire for the first three patients seen the day of the survey to whom at least one neuroleptic was prescribed (initiated or renewed). Results One thousand seven hundred and fifty-four questionnaires were returned. Three quarters of the patients (74%) were psychotic (664 with schizophrenia, and 636 other psychosis), 19.3% were depressive and 6.7% had other psychiatric disorders. Phenothiazines were the most often prescribed (40.8%), followed by butyrophenones (22.5%), benzamides (15.8%), other neuroleptics (14.8%) and thioxanthenes (6.1%). Among schizophrenic subjects, an average number of 1.54 (95% CI: 1.50-1.60) neuroleptics were prescribed per patient, compared with 1.4 (95% CI: 1.32-1.41) and 1.2 (95% CI: 1.14-1.23) in other psychotic and depressive subjects, respectively. Regardless of the indication, non-neuroleptic psychotropic drugs were coprescribed in 75.4%, mainly benzodiazepines (75.7%). Adjuvant drugs used in prevention or treatment of side-effects were coprescribed in 46.7%, mostly anticholinergic antiparkinsonians (86.1%). Conclusions Neuroleptics are mainly prescribed for psychotic disorders and especially schizophrenia. However, current recommendations are not always followed.
An Overview of Psychotropic Drug-Drug Interactions
Psychosomatics, 2005
The psychotropic drug-drug interactions most likely to be relevant to psychiatrists' practices are examined. The metabolism and the enzymatic and P-glycoprotein inhibition/induction profiles of all antidepressants, antipsychotics, and mood stabilizers are described; all clinically meaningful drug-drug interactions between agents in these psychotropic classes, as well as with frequently encountered nonpsychotropic agents, are detailed; and information on the pharmacokinetic/pharmacodynamic results, mechanisms, and clinical consequences of these interactions is presented. Although the range of drug-drug interactions involving psychotropic agents is large, it is a finite and manageable subset of the much larger domain of all possible drug-drug interactions. Sophisticated computer programs will ultimately provide the best means of avoiding drug-drug interactions. Until these programs are developed, the best defense against drug-drug interactions is awareness and focused attention to this issue.