Antipsychotics - Newer Is Not Always Better

This study was reported in NEJM. A total of 1500 patients with chronic schizophrenia were randomly assigned to receive different antipsychotic medications. Seventy-forty percent of patients discontinued the medications within 18 months.

Zyprexa (olanzapine) was the most effective antipshycotic in the study but the news is not all good for Zyprexa because it was associated with the greatest weight gain and increases in glucose and lipids.

The efficacy of the conventional antipsychotic perphenazine was similar to that of the newer agents - quetiapine, risperidone, and ziprasidone.

What about the incidence of extrapyramidal side effects (EPS)?

Patients taking the older medication perphenazine had more EPS but that was not statistically significant.

A month's supply of perphenazine costs $60, compared with $520 for Zyprexa, $450 for Seroquel, $250 for Risperdal and $290 for Geodon.

The new generation of atypical antipsychotic drugs was introduced 12 years ago, and now 90% of schizophrenia prescriptions are for one of those six drugs (WebMD).

References:
Study Finds Little Advantage in New Schizophrenia Drugs - NYTimes
Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia - NEJM 9/05
Atypical Antipsychotics and the Risk for New-Onset Diabetes
Schizophrenia Drug Face-Off: No Clear Winner - WebMD
Tough Choices in Treating Schizophrenia - NPR
Why New Drugs Don't Live Up to the Hype - Time
Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Stefan Leucht et al. The Lancet, Volume 373, Issue 9657, Pages 31 - 41, 3 January 2009.

Updated: 01/02/2009

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