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Rao RR, Pisay M, Kumar S, Kulkarni S, Pandey A, Kulkarni VI, Mutalik S. Medium and large scale preparation of Nanostructured Lipid Carriers of asenapine maleate: Quality-by-design based optimization, production, characterization and performance evaluation. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Cope ZA, Kenton JA, Minassian A, Martin MV, Perry W, Bundgaard C, Arnt J, van Enkhuizen J, Geyer MA, Young JW. Chronic antipsychotic treatment exerts limited effects on the mania-like behavior of dopamine transporter knockdown mice. Behav Brain Res 2021; 405:113167. [PMID: 33577882 PMCID: PMC10729608 DOI: 10.1016/j.bbr.2021.113167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bipolar disorder is a life-threatening disorder linked to dopamine transporter (DAT) polymorphisms, with reduced DAT levels seen in positron emission tomography and postmortem brains. AIMS The purpose of this study was to examine the effects of approved antipsychotics on DAT dysfunction-mediated mania behavior in mice. METHODS DAT knockdown mice received either D2-family receptor antagonist risperidone or asenapine and mania-related behaviors were assessed in the clinically-relevant behavioral pattern monitor to assess spontaneous exploration. RESULTS Chronic risperidone did not reverse mania-like behavior in DAT knockdown mice. Chronic asenapine reduced mania behavior but this effect was more pronounced in wild-type littermates than in DAT knockdown mice. CONCLUSION Taken together, these findings suggest that while acute antipsychotic treatment may be beneficial in management of bipolar mania, more targeted therapeutics may be necessary for long-term treatment. Specific investigation into DAT-targeting drugs could improve future treatment of bipolar mania.
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Affiliation(s)
- Zackary A Cope
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, United States
| | - Johnny A Kenton
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, United States
| | - Arpi Minassian
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, United States; Center of Excellence for Stress and Mental Health and Research Service, VA San Diego Healthcare System, United States
| | - Maureen V Martin
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, United States
| | - William Perry
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, United States
| | - Christoffer Bundgaard
- H. Lundbeck A/S. Neuroscience Research, Ottiliavej 9, DK-2500, Copenhagen, Valby, Denmark
| | - Jørn Arnt
- Sunred Pharma Consulting, Solrød Strand, Denmark
| | - Jordy van Enkhuizen
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, United States
| | - Mark A Geyer
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0804, La Jolla, CA, 92093-0804, United States; Research Service, VA San Diego Healthcare System, San Diego, CA, United States.
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Căpățînă OO, Micluția IV, Fadgyas-Stănculete M. Current perspectives in treating negative symptoms of schizophrenia: A narrative review (Review). Exp Ther Med 2021; 21:276. [PMID: 33603883 PMCID: PMC7851661 DOI: 10.3892/etm.2021.9707] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022] Open
Abstract
The negative symptoms of schizophrenia are an unmet treatment target as currently approved treatments mostly control positive symptoms. The persistence of these symptoms holds back the patient's reinstatement in society, making them incapable of fulfilling their social, professional, or family roles. There is overwhelming research evidence suggesting that the negative symptoms of schizophrenia are associated with poorer functioning and lower quality of life than positive symptoms, confirming the need for developing new treatments for this particular category of symptoms. This present review aims to review clinical trials addressing novel pharmacological approaches addressing primary negative symptoms of schizophrenia. We overview both monotherapies, first-generation and second-generation antipsychotics, and add-on therapies, including psychostimulants, anti-inflammatory drugs, antidepressants, molecules targeting glutamatergic, cholinergic or serotonergic systems and hormones. Our findings suggest that the primary negative symptoms of schizophrenia may be mitigated by adjunctive therapies, and we highlight the pharmacological agents that have proven superior efficacy. Novel compounds such as cariprazine and MIN-101, to date, show promising results, but large clinical trials are needed to test their efficacy and safety.
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Affiliation(s)
- Octavia O Căpățînă
- Department of Neurosciences, 'Iuliu Haţieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ioana V Micluția
- Department of Neurosciences, 'Iuliu Haţieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Mihaela Fadgyas-Stănculete
- Department of Neurosciences, 'Iuliu Haţieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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Matsuzaki H, Hatano M, Iwata M, Yamada S. Treatment Continuation of Asenapine or Olanzapine in Japanese Schizophrenia Patients: A Propensity Score Matched Study. Neuropsychiatr Dis Treat 2021; 17:3655-3661. [PMID: 34934318 PMCID: PMC8684434 DOI: 10.2147/ndt.s343840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/01/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Asenapine is a second-generation antipsychotic agent that is classified as a multi-acting receptor-targeted antipsychotic and is similar to olanzapine. Our study aimed to compare the treatment continuation rate and reason for discontinuation of asenapine or olanzapine in schizophrenia using real-world data. METHODS This design was a retrospective study. The primary endpoint was Kaplan-Meier estimates of the continuation rate at six months, with the propensity score method applied to adjust for potential confounders. RESULTS A total of 95 patients were analyzed in this study (asenapine, n = 46; olanzapine, n = 49). Matched data were adjusted to consider six covariates (age, sex, chlorpromazine equivalent, diazepam equivalent, history of clozapine use, and history of modified electro convulsive therapy). The continuation rate at six months was 27.3% (95% CI, 15.6-47.6) in the asenapine group and 50.8% (95% CI, 34.3-75.3) in the olanzapine group (hazard ratio, 0.41; 95% CI, 0.21-0.82; P = 0.0088 by the Log rank test) in matched data. Cases of discontinuation because of the lack of efficacy were almost as frequent for asenapine (13.0%) as for olanzapine (10.2%). Discontinuation due to bitter taste (6.5%) and burden of the dosing method (6.5%) were observed only with asenapine, whereas anticholinergic side effects such as dry mouth (4.1%) and constipation (2.0%) were observed only with olanzapine. CONCLUSION The low continuation rate of asenapine in real-world data may be related to specific factors such as bitter taste and burden of the dosing method.
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Affiliation(s)
- Haruna Matsuzaki
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Masakazu Hatano
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.,Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Miko Iwata
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Shigeki Yamada
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Gupta H, Panchal R, Acharya N, Mehta PJ. Controlled Parenteral Formulations: An Efficacious and Favourable Way to Deliver the Anti-psychotic Drugs. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216666191226143446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The current paradigm of pharmaceutical formulations is focused on the controlled &
sustained delivery of a drug for the management of chronic impairments. Since these diseases need
daily and multiple intakes of the drug (i.e., twice or thrice a day) and missing a single dose, leads to
the poor therapeutic window which governs unpleasant pharmacological response and ultimately
patient in-compliance. All over the world, millions of patients are suffering from life-threatening
diseases; one of which is “psychosis”, which immensely requires prolong and sustain release of the
drug. Moreover, mainstay lacuna with antipsychotic medication is the reoccurrence of the symptoms,
and patient adherence on the therapy has been observed. These issues attract scientists to formulate
the Controlled Parenteral Antipsychotic (CPA). As per the literature search, significant work
has been performed on the development of Novel Controlled Parenteral Formulations (CPFs) for the
treatment of psychosis and especially focus has been given to microsphere, esterification, nanoformulation,
and salt-based formulation. Reports revealed that all of the above-mentioned formulations
have shown enormous potential to enhance the duration of a drug in the body for a longer period in a
controlled manner. The development of a drug in any form has shown a great impact on the patient’s
life, with tremendous productivity in the Pharma Market. As well as, this has raised the hope to get
more efficacious results of both the categories i.e., typical & atypical antipsychotics and limiting the
drawbacks of conventional antipsychotic drug delivery. Controlled formulations have also shown
the prominent solutions to handle one of the major obstacles that arises due to the Biopharmaceutical
Classification System (BCS). Drugs belonging to any of the BCS class can be utilized now with the
idea of CPF. In this context, the current paper relies on CPA’s strengths, weaknesses, opportunities,
and challenges followed by a compilation of attempt made by scientists on its formulations (microspheres,
salt-based, and nanoformulation) which will be one-stop-shop for the researchers working
globally in this field to make better improvement on the existing options for psychosis. In summary,
this review explains the concept of CPA as a promising option to treat psychosis.
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Affiliation(s)
- Harshita Gupta
- Department of Pharmaceutical Analysis, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India
| | - Rutu Panchal
- Department of Pharmaceutical Analysis, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India
| | - Niyati Acharya
- Department of Pharmaceutical Analysis, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India
| | - Priti Jignesh Mehta
- Department of Pharmaceutical Analysis, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India
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Suresh A, Narayan R, Nayak UY. Recent advances in the development of asenapine formulations. Expert Opin Drug Deliv 2020; 17:1377-1393. [PMID: 32633149 DOI: 10.1080/17425247.2020.1792439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Asenapine maleate (AM) is an atypical antipsychotic agent, that has been widely prescribed for the management of schizoaffective disorders. However, the bioavailability of AM is extremely poor due to the extensive first-pass metabolism. With the advancement in pharmaceutical technologies, significant strides have been made to create novel formulations to address the bioavailability problem of AM. AREAS COVERED This review article provides an insight into all the formulation approaches undertaken by researchers to increase the bioavailability of AM encompassing the works utilizing ultrasound mediated transdermal delivery, nose to brain delivery, intestinal lymphatic system targeting, in situ implants, etc. All the patents associated with AM formulation have also been discussed and summarized. EXPERT OPINION Numerous studies have been carried out on AM formulations over the recent years, many of these studies have shown significant improvement in bioavailability. We have also mentioned the unexplored domains which can be exploited for further enhancing the bioavailability of AM. Nonetheless, most of these studies are still limited to the research laboratory level and face multiple hurdles before making into the market. Attaining controllability and reproducibility for the production of novel formulations is needed to enable its transition from bench to bedside.
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Affiliation(s)
- Akhil Suresh
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education , Manipal, India
| | - Reema Narayan
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education , Manipal, India
| | - Usha Y Nayak
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education , Manipal, India
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YU X, CORRELL CU, XIANG YT, XU Y, HUANG J, YANG F, WANG G, SI T, KANE JM, MASAND P. Efficacy of Atypical Antipsychotics in the Management of Acute Agitation and Aggression in Hospitalized Patients with Schizophrenia or Bipolar Disorder: Results from a Systematic Review. SHANGHAI ARCHIVES OF PSYCHIATRY 2016; 28:241-252. [PMID: 28638198 PMCID: PMC5434280 DOI: 10.11919/j.issn.1002-0829.216072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Acute agitation and aggression are common symptoms in patients with bipolar disorder and schizophrenia. In this review, we discuss the prevalence, clinical assessment strategies, treatment options, and current Western and Chinese guidelines for the management of acute agitation and aggression in patients with bipolar disorder or schizophrenia. Among available approaches, we discuss in detail recent evidence supporting the use of intramuscular (IM) antipsychotics and some recently approved oral atypical antipsychotics for the management of acute aggression and agitation in hospitalized patients with bipolar disorder or schizophrenia presenting with acute agitation or aggression, highlighting some differences between individual antipsychotic agents.
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Affiliation(s)
- Xin YU
- Peking University Institute of Mental Health (the sixth hospital), Huayuanbeilu 51#, Haidian District, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders & the Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Christoph U. CORRELL
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, 75-59 263rd St, Glen Oaks, NY 11004, USA
- Hofstra Northwell School of Medicine, 500 Hofstra University, Hempstead, NY 11549 USA
- The Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY 11030, USA
| | - Yu-Tao XIANG
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, E12 Avenida da Universidade, Taipa, Macao SAR, China
| | - Yifeng XU
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China
| | - Jizhong HUANG
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China
| | - Fude YANG
- Beijing Huilongguan Hospital, Beijing, China
| | - Gang WANG
- Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Center of Depression, Beijing Institute for Brain Disorders & China Clinical Research Center for Mental Disorders, Beijing, China
| | - Tianmei SI
- Peking University Institute of Mental Health (the sixth hospital), Huayuanbeilu 51#, Haidian District, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders & the Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - John M. KANE
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, 75-59 263rd St, Glen Oaks, NY 11004, USA
- Hofstra Northwell School of Medicine, 500 Hofstra University, Hempstead, NY 11549 USA
- The Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY 11030, USA
| | - Prakash MASAND
- Duke-NUS Medical School, Academic Medicine Education Institute, Singapore
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Abstract
The aim of this review is to provide information for interpreting outcome results from monitoring of antipsychotics in biological samples. A brief overview of the working mechanisms, pharmacological effects, drug interactions, and analytical methods of classical and atypical antipsychotics is given. Nineteen antipsychotics were selected based on their importance in the worldwide market as follows: amisulpride, aripiprazole, asenapine, bromperidol, clozapine, flupenthixol, haloperidol, iloperidone, lurasidone, olanzapine, paliperidone, perphenazine, pimozide, pipamperone, quetiapine, risperidone, sertindole, sulpiride, and zuclopenthixol. A straightforward relationship between administered dose, plasma or serum concentration, clinical outcome, or adverse effects is often lacking. Nowadays, focus lies on therapeutic drug monitoring and individualized therapy to find adequate treatment, to explain treatment failure or nonresponse, and to check patient compliance. However, extensive research in this field is still mandatory.
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Levine M, Ruha AM. Overdose of atypical antipsychotics: clinical presentation, mechanisms of toxicity and management. CNS Drugs 2012; 26:601-11. [PMID: 22668123 DOI: 10.2165/11631640-000000000-00000] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Historically, treatment for schizophrenia focused on sedation. The advent of the typical antipsychotics resulted in treatment aimed specifically at the underlying disease, but these agents were associated with numerous adverse effects, and were not particularly effective at treatment of the negative symptoms of schizophrenia. As a result, numerous atypical agents have been developed over the past 2 decades, including several agents within the past 5 years. Overdose of antipsychotics remains quite common in Western society. In 2010, poison control centres in the US received nearly 43,000 calls related to atypical antipsychotics alone. Due to underreporting, the true incidence of overdose with atypical antipsychotics is likely much greater. Following overdose of an atypical antipsychotic, the clinical effects observed, such as CNS depression, tachycardia and orthostasis are largely predictable based on the unique receptor binding profile of the agent. This article, which focuses on the atypical antipsychotics commonly used in the treatment of schizophrenia, discusses the features commonly encountered in overdose. Specifically, agents that result in QT prolongation and the corresponding potential for torsades de pointes, as well as unique features encountered with the various medications are discussed. The diagnosis of this overdose is largely based on history. Routine use of drug screens is unlikely to be beneficial. The primary goal of management is aggressive supportive care. Patients with significant CNS depression with associated loss of airway reflexes and respiratory failure need advanced airway management. Hypotension should be treated first with intravenous fluids, with the use of direct acting vasopressors reserved for persistent hypotension. Benzodiazepines should be used for seizures, with barbiturates used for refractory seizures. Intravenous magnesium can be administered for patients with a corrected QT interval exceeding 500 milliseconds.
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Affiliation(s)
- Michael Levine
- Section of Medical Toxicology, Department of Emergency Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Atypical antipsychotics: trends in analysis and sample preparation of various biological samples. Bioanalysis 2012; 4:961-80. [DOI: 10.4155/bio.12.55] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Atypical antipsychotics are increasingly popular and increasingly prescribed. In some countries, they can even be obtained over-the-counter, without a prescription, making their abuse quite easy. Although atypical antipsychotics are thought to be safer than typical antipsychotics, they still have severe side effects. Intoxications are not rare and some of them have a fatal outcome. Drug interactions involving atypical antipsychotics complicate patient management in clinical settings and the determination of the cause of death in fatalities. In view of the above, analytical strategies that can efficiently isolate atypical antipsychotics from a variety of biological samples and quantify them accurately, sensitively and reliably, are of utmost importance both for the clinical, as well as for the forensic toxicologist. In this review, we will present and discuss novel analytical strategies that have been developed from 2004 to the present day for the determination of atypical antipsychotics in various biological samples.
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