I blithely wrote a post for my blogging day job on the atypical antipsychotics, cleverly (or so I thought at the time, at least) entitling it “The Atypical History of Atypical Antipsychotics,” and I covered what I considered the big guns among the atypicals: Clorazil, Zyprexa, Risperdal, Seroquel, Geodon, and Abilify.
Little did I know that I was years behind the times.
For though these drugs still hold the lion’s share of the atypical market, drug makers have been working doggedly to make atypical antipsychotics with better side effect profiles, and have been coming out with new ones–behind my back it seems–for years now.
Three in particular caught my eye–and if anyone is on them or has experience with them, I’d love to hear your input about these meds, that feel so foreign to me, after my years of being used to the Big 6, as I call them. In other words, I’d love to actually know what I’m talking about.
Let me start with the three that jumped out and bit me just the other week.
Invega was FDA approved in 2007 for schizophrenia, so it would be perfectly shameful that I know so little about it, except that it’s one of those ‘change a little thing and get a whole new patent’ evergreening jobbies, so it’s not like I missed a major shift in the pharmaceutical industry.
Put out by Janssen right as its Risperdal was losing patent, Invega contains the active compound of Risperdal, but allows for once a day dosing, vs the twice a day dosing of the older drug. Of course that’s connected to Janssen’s Consta, which is, again Risperdal, but can be given intramuscularly (and thus needed a whole new patent).
So perhaps for something a little more novel.
Saphris, made by a company I’ve surely never heard of called Catalent UK Swindon Zydis Ltd,  is marketed and distributed by one I have heard of–Schering Corporation–and was FDA approved in 2009 for both schizphrenia and bipolar disorder, the very first psychotropic drug ever to receive initial approval for both indications at the same time.
Saphris is the only antipsychotic delivered sublingually–and you can even get it in black cherry-flavor, which is a big sell in my book.
Clinical trials were not stellar, particularly, and were a bit hard to interpret since the data was released quite light, but there seems to be less weight gain associated with it than with Zyprexa, one of the drugs it went head to head with in the trials–although there still is weight gain, and dizziness and akathisia are also apparently common.
It is clearly a good choice for people with swallowing difficulties, as it’s the only atypical with sublingual distribution.
I’m quite interested in people’s experiences, and if anyone found it, indeed, more effective than one of the older atypicals.
Finally there’s Latuda, approved for schizophrenia in 2011.
Put out by Sunovian Pharmaceuticals, by the time Latuda made its arrival in drugstores, it had more than its fair share of competition, including a leading generic (Risperdal had already lost patent and morphed into risperidone, at a fraction of the original price), plus promises of more generics speedily on their way.
Well, as the strippers in ‘Gypsy’ knew, ‘you gotta have a gimmick,’ and Latuda’s got one that could make it a contender yet: It purportedly doesn’t have the weight gain associated with the atypicals, although the numbers supporting this assertion are small.
Fierce Pharma made a good point about that issue, which I update in brackets: “The company has priced Latuda at $14 per pill [it's $18.41 at the local CVS], or about $5,000 per year. In addition, Eli Lilly’s Zyprexa goes off [done deal--it went off] patent later this year, and AstraZeneca’s Seroquel loses exclusivity in early 2012 d. Both have been linked to weight gain, but will patients and payers be willing to pay the price for a new brand, on the promise that it won’t?”
Would you?
Have you?
Well, that’s enough for me for one day, of addressing drugs that just pop up with no warning.
But, you might say, what of the other atypicals you apparently never mentioned in your original post. What of Fanapt, what of Solian, what of Remoxipride, and more?
Well, I’m worn out for the moment by finding out about all these drugs sneaking onto the market without my knowledge. But I’d sure love to come back tomorrow and find a comment telling me I’d better get at it and check out one of them, since it’s the best thing since sliced bread.
Failing that–I’ll get around to it.
Sanford Finkel
September 22, 2012
Rhona,
This is brilliant—very informative, very well written, and with your touch of sly humor to boot.
I learned something too. Very well done.
Love,
Dad
Rhona Finkel (@Abitofthisand)
September 23, 2012
Gee, thanks, Dad. It’s great to have an objective family member rooting for you on your blog. I recommend it to everyone.
Sugel
September 24, 2012
Seroquel® (quetiapine fumarate), and other atypical antipsychotic medications, such as Zyprexa® (olanzapine), Risperdal® (risperidone), Clozaril® (clozapine), drugs commonly prescribed for the management of schizophrenia and bipolar disorder , often have the unwanted side effect of weight gain as well as an increased risk of diabetes. Does this mean patients are forced to choose between their mental and physical health?
candidaabrahamson
September 30, 2012
Doesn’t it–tragically–seem like all too often that’s true? I guess that’s why they keep coming out with new ones–and Geodon, Abilify and Latuda don’t have the weight gain side effect. But sometimes they don’t work as effectively for a person as, say, Cloazaril, which is still the gold standard for schizophrenia. It’s a very very difficult row to hoe.
DeeDee
September 29, 2012
I’ve heard of a few of these via PsychCentral – mostly people saying, “my doc put me on this new drug, does anyone know anything about it?”
I would pay a huge premium for a drug that would be less likely to lead to metabolic syndrome, though small numbers would make me extremely skeptical until I saw more patient reports to triangulate corporate claims. Call me paranoid, but more patients report aphasia side effects from quite a range of psych meds than manufacturer info would suggest, for example. Every last one of the drug companies reports aphasia as a “rare” side effect, but anecdotally, it seems way more prevalent than is claimed and shows up on way too many side effect lists.
Making people trade off physical health for mental health (inasmuch as these meds can achieve that end) is a horrible, horrible thing. It’s not just the weight gain, it’s the fact that these meds can actually make you diabetic. Irreparably, as I understand it, but that may not be accurate. And even if only temporary, drugs that can cause diabetes are still flat-out unacceptable.
But why are people whining about those prices? My generic Adderall XR costs $10/day, $3650/year, but I can’t function adequately without it – certainly not well enough to perform the job that includes the insurance that lets me get the drugs that allow me to perform the job! An atypical is much like that for someone who needs it; the price of going without is considerably higher than the price of the drug, and not just in direct dollars paid for medications.
But I’m soooooooo glad I don’t need antipsychotics!
candidaabrahamson
September 30, 2012
Yes–if Latuda comes through as a drug that can go head to head with the others, then it’s not causing the illnesses that go along with the already-upsetting weight gain will be a huge deal. I’m not sure it will happen, though. To this day, for schizophrenia, Clozapine is far and away the most superior drug. It’s also got the worst side effect profile. In fact, the other day I asked a psychiatrist why he still used it, and he said it’s just the best we’ve got.
So while it would be great if drugs with lesser side effects could knock out the worse of the mental instability, I’m not putting all my eggs in one basket.
Additionally, while it’s true that the price in terms of human suffering is higher than the cost of any med, there simply are people who can’t afford it. The price of Latuda, before my patient’s doctor got it covered, was $15,000 a year. And I believe Abilify is even more. It becomes hard to talk about costs like that by just saying, ‘well, you’ve got to have it, right?’ although that’s true. The issue is how in the world can people be expected to pay for it, when some are out of work, some do have insurance, but, like my patient, the insurance denies the claim, and many can’t take on the second job that would be required to cover this–and that’s just one med. Many patients are on a panoply. We really do have a problem–I don’t have the solution, but the antipsychotics are extremely high-priced, and often extremely necessary.