Prescription Atypical Antipsychotic List

ATYPICAL ANTIPSYCHOTICS

This article is about the family of pharmacological agents known as Atypical Antipsychotics, also sometimes referred to as "Second Generation Antipsychotics (SGA)."

Following a brief introduction, you will find a LIST of the currently available medications in this particularly category. These are all prescription medications, available in the U.S.

The very names "Atypical" and "Second Generation" presuppose an earlier class of drugs. This is true. Before the advent of these "atypical" products, the only antipsychotic medications we had were drugs like Haldol, Thorazine, Prolixin and Lithium. Although these medications were somewhat helpful, they had numerous side-effects. Additionally, at best they could treat what we would call the "negative" symptoms of schizophrenia or bipolar disorder. These include things like lack of energy, lack of desire, lack of appetite.

Then along came Clozapine in the 1970s. This was a breakthrough, and the first of the "atypical" antipsychotics were born. The advantage of this new class of medications was not merely a lower incidence of side effects compared to those seen in earlier drugs, but they also seemed to provide improvements in some of the "positive" symptoms associated with these diseases (such as hallucinations, hearing voices and delusions). As it turns out, Clozapine itself was far from perfect, and was discovered to sometimes cause a very serious side effect known as agranulocytosis. Although its use diminished, it opened the door for new exploration, and newer, safer alternatives with similar benefits have since been developed.

Uses: Atypical antipsychotics are approved to treat a variety of psychological conditions. They are NOT all approved to treat ALL the conditions listed below. However, I have chosen to list the types of conditions here, as the "approval" status for any given condition often changes. Additionally, it is not unusual to use an atypical antipsychotic for a condition which it has not "officially" been approved for yet. This is known as "off label" prescribing, and it is fairly common with these medications.

Approved indications include:

  • Autistic Disorder, including irritability
  • Bipolar I Disorder, & Adjunct Therapy
  • Major Depressive Disorder, & Adjunct Therapy
  • Schizoaffective Disorder
  • Schizophrenia

ABILIFY (aripiprazole)

Manufacturer: Bristol-Myers Squibb Company

Available Generically? No

Strengths & Dosage Forms Available:

  • Tablets: 2mg, 5mg, 10mg, 15mg, 20mg, 30mg
  • Discmelt (orally dissolving tablet): 10mg, 15mg
  • Oral Solution: 1mg/ml
  • Injection: 9.75mg/1.3ml

Usual Oral Dosage: ONCE DAILY DOSING

Initial doses are from 2mg to 15mg once daily depending on the diagnosis. Maximum daily dose is 30mg. The most common "target" dose is 15mg daily. Ideally dosage adjusments should be slow, about 5mg per week.

Notes: Abilify has been studied and used for several "off label" (i.e. not yet approved) indications such as the treatment of cocaine dependence, tourette syndrome and restless leg syndrome.


CLOZARIL (clozapine)

Manufacturer(s):

  • Clozaril (Novartis)
  • Clozapine (generic - various)
  • Fazaclo (Azur Pharma)

Available Generically? Yes

Strengths & Dosage Forms Available:

  • Clozaril Tablets: 25mg, 100mg
  • Clozapine (generic): Tablets 25mg, 50mg, 100mg, 200mg
  • Fazaclo Orally Dispersisble Tablets: 12.5mg, 25mg, 100mg, 150mg, 200mg


Usual Oral Dosage: Once or Twice Daily Dosing to start, then 2-3 times daily depending on dose

Initial therapy is usually begun with 12.5mg once or twice daily. This should be increased, as tolerated, by 25mg or 50mg daily with a goal of reaching 300mg to 450mg daily in 2 weeks. After this, dose increases should be no more than once weekly, in 50mg or 100mg increments.

Notes: Clozapine carries a special warning, known in pharmacy circles as the "Black Box Warning." This is an FDA mandaged warning for serious potential adverse reactions. In the case of clozapine, the most serious possible side effect is agranulocytosis. This is a potentially life-threatening drop in white blood cells (WBC). Due to this, clozapine patients must have their blood counts monitored regularly. The drug can only be administered through a system designed to ensure this blood work is done properly and monitered. Although it carries risks, some patients do very well on clozapine, and it is therefore a treatment option that some are willing to use. However, due to the risks, other Atypical Antipsychotics have become more popular.


FANAPT (Iloperidone)

Manufacturer: Novartis Pharmaceuticals

Available Generically? No

Strengths & Dosage Forms Available:

  • Tablets: 1mg, 2mg, 4mg, 6mg, 8mg, 10mg, 12mg

Usual Oral Dosage: Twice Daily Dosing

The dose of Fanapt must be slowly titrated up over the course of 1 week (typically) to avoid a particular side effect known as "orthostatic hypotention." Basically, this means that your blood pools in your lower extremities upon standing, you get dizzy, and could faint or fall.

Therefore, dosing typically begins with 1mg twice daily on the first day. This dose is increased, using each of the available strengths (2mg twice daily, 4mg twice daily, etc) every day. A conveninet "Titration Pack" is available so that patients can buy just 1 prescription to get started (as opposed to paying for a separate prescription for each strength needed). Symptom control will be delayed 1-2 weeks while the medication is being slowly tapered up.

The target dose is typically 6mg or 12mg twice daily.


Notes: Due to the many questions I received about Fanap, I wrote an entire article just on this one particular drug.

Find it here: What Is Fanapt?


GEODON (ziprasidone)

Manufacturer: Pfizer

Available Generically? YES (capsules only)

Strengths & Dosage Forms Available:

  • Capsules: 20mg, 40mg, 60mg, 80mg
  • Injection: 20mg

Usual Oral Dosage: TWICE daily dosing

The starting dose tends to be 20mg twice daily. Then, depending on the diagnosis, the dose will be increased up to 40mg-80mg twice daily.

Notes:

INVEGA (paliperidone)

Manufacturer: Janssen

Available Generically? No

Strengths & Dosage Forms Available:

  • Extended Release Tablet: 1.5mg, 3mg, 6mg, 9mg
  • IM Injection (Invega Sustenna): 39mg, 78mg, 117mg, 156mg, 234mg

Usual Oral Dosage: Once Daily Dosing

Titration is not usually necessary. Typical starting dose is 6mg daily. Some patients may need as much as 12mg daily (2 x 6mg tablets). For those under 17 years of age, 3mg daily is a typical dose.

Notes:

LATUDA (lurasidone)

Manufacturer: Sunovion

Available Generically? No

Strengths & Dosage Forms Available:

  • Tablets: 20mg, 40mg, 80mg

Usual Oral Dosage: Once Daily Dosing

Typical starting dosages are 40mg daily. Average maintenance doses are 40mg to 80mg daily.

Notes: Latuda should be taken with food. The manufacturer recommends at least 350 calories. Therefore, I advise taking Latuda with your evening meal every day. Taking Latuda with food helps ensure the medication is properly absorbed.


RISPERDAL (risperidone)

Manufacturer: Janssen

Available Generically? Yes (tablets only)

Strengths & Dosage Forms Available:

  • Tablets: 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg
  • M-tab (orally dissolving): 0.5mg, 1mg, 2mg, 3mg, 4mg
  • IM Injection (Risperdal Consta): 12.5mg, 25mg, 37.5mg


Usual Oral Dosage: Once or Twice daily dosing

Typical starting dosages are 2mg once or twice daily. Then, depending on diagnosis, the dose may be increased by no more than 1mg or 2mg daily, up to the target dose (usually 4mg to 8mg daily)

Notes: Due to the fact that Risperdal is available generically, many health plans require a TRIAL of risperidone prior to allowing one of the newer and more expensive atypical antipsychotics to be approved.


SAPHRIS (asenapine)

Manufacturer: Organon

Available Generically? No

Strengths & Dosage Forms Available:

  • Sub-lingual Tablets: 5mg, 10mg

Usual Oral Dosage: Twice Daily Dosing

Beginning dose is usually 5mg twice daily, followed by an increase to 10mg twice daily after 1 week, or as tolerated.

Notes: A sub-lingual dosage form (that dissolves under the tongue) is ideal in certain situations. Some patients have difficulty swallowing. Other patients are prone to "cheeking" the medication (that is, hiding it in their cheek to dispose of later). This form of the medication would cause the medication to be absorbed as long as it remains in the mouth long enough.

SEROQUEL (quetiapine)

Manufacturer: AstraZeneca

Available Generically? Yes (regular formula only, not XR)

Strengths & Dosage Forms Available:

  • Tablets: 25mg, 50mg, 100mg, 200mg, 300mg, 400mg
  • XR Tablets: 50mg, 150mg, 200mg, 300mg, 400mg

Usual Oral Dosage: Twice Daily for the original formulation, Once daily for XR

Target doses tend to be in the 400mg to 800mg daily range, depending on the diagnosis. Both formulations should be slowly tapered up, usually increasing by 100mg per day up to the target. The XR formulation is given once daily in the evening.

Notes:

SYMBYAX (olanzapine/fluoxetine)

Manufacturer: Eli Lilly

Available Generically? No

Strengths & Dosage Forms Available: (olanzapine/fluoxetine)

  • Capsules: 3mg/25mg, 6mg/25mg, 6mg/50mg, 12mg/25mg, 12mg/50mg

Usual Oral Dosage: Once daily dosing

Typical starting dosage is 6mg/25mg once daily in the evening. Dosage increases may gradually be done as tolerated and necessary.

Notes: Symbyax is a unique combination product containing BOTH an atypical antipsychotic and fluoxetine (an SSRI, also known as Prozac). It is used in situations where depression accompanies Bipolar disorder, or for depression when other treatments for depression have been unsuccessful.

ZYPREXA (olanzapine)

Manufacturer: Eli Lilly

Available Generically? Yes (tabs and Zydis versions)

Strengths & Dosage Forms Available:

  • Tablets: 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg
  • Zydis (orally dissolving tabs): 5mg, 10mg, 15mg, 20mg
  • IM Injection: 10mg (short acting formulation)
  • Zyprexa Relprevv: 210mg, 300mg, 405mg (long acting formulation, administered by deep IM gluteal injection every 2 to 4 weeks.


Usual Oral Dosage: Once Daily

Initial dose is usually 5mg-10mg daily. Maintenance dose is 10mg-20mg daily

Notes: "Off label" (not officially approved) uses for Zyprexa include treatment of OCD, Stuttering and Tourette Syndrome.

SIDE EFFECTS OF ATYPICALS

The Atypical Antipsychotic medications are not without possible side effects. As with any medication, the relatives risks and benefits need to be carefully and thoughtfully weighed.

Some side effects are more common with certain atypicals than others. But the following are some of the more common side effects that can be experienced:

  • Drowsiness
  • Dizziness
  • Constipation
  • Headache
  • Confusion

More Serious Side Effects which are possible, but not quite as common, include:

  • Weight Gain
  • Seizures
  • Extrapyramidal symptoms (uncontrolled movements)
  • Ophthalmic symptoms (worsening of glaucoma)
  • Diabetes
  • Agranulocytosis (a serious drop in white blood cell count)

References:

Related Article(s):

Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice



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Comments 5 comments

writer20 profile image

writer20 4 years ago from Southern Nevada

pharamcist, you really are a person putting all this information on H/P for followers to read.

Voted up useful and interesting.


Eric Calderwood profile image

Eric Calderwood 4 years ago from USA

Great idea using your professional expertise here on HubPages. You get asked so many questions everyday in your work that putting them and their answers in an easy to read online format is a great way to see the information you have collected go on to further use!


pharmacist profile image

pharmacist 4 years ago from Whitinsville, MA Author

@writer20: Thanks for the encouragement and for reading!

@Eric: Thank you kindly, it is a pleasure to interact with patients and their questions in this format; and often much easier than in the busy pharmacy setting.


Ome Ogbru 4 years ago

Nice work.


nurseleah profile image

nurseleah 3 years ago from West Virginia

Very informative, useful hub. Regarding Clozaril, it is very important that healthcare providers ensure patients and families understand the importance of blood tests and the reason for them. I once had a patient's mother call and ask me what kind of poison her son had been prescribed that required him to have weekly blood tests. She simply did not understand. Her son was a minor and his discharge education had not been quite thorough enough to ensure his mother understood the drug and its dangers.

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