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Tic Disorders and Tourette Syndrome
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
Valerie Brandt, Samuele Cortese
The pharmacological treatment is one of the components of the multimodal treatment of tics. To date, the most comprehensive evidence synthesis on the pharmacological treatment is provided by the network meta-analysis (NMA, an advanced meta-analytic approach allowing the comparison of two or more treatments even when they have not been compared head-to-head in individual trials) conducted by Yang et al. (2019). The authors included 60 RCTs, for a total of 4,077 participants (aged 2–65 years) with a clinical diagnosis of tic disorders as per the Diagnostic and Statistical Manual of Mental Disorders-3 (DSM-3), DSM-4, or DSM-4-Text Revision, the International Classification of Diseases-10 (ICD-10) or the Chinese Classification and Diagnostic Criteria of Mental Disorders (CCMD). Haloperidol (standardised mean difference, SMD = –3.20, 95% CI [ –6.52, –0.14]), olanzapine (SMD = –6.11, –11.86, 0.55), ziprasidone (SMD = –5.57, –11.15, –0.048), risperidone (SMD = –3.47, –6.87, –0.37), aripiprazole (SMD = –4.74, –8.67, –1.06) and quetiapine (SMD = –12.32, –19.09, –5.63) were significantly more efficacious than placebo in improving tic severity. Quetiapine was significantly more efficacious than haloperidol, pimozide, risperidone, tiapride, aripiprazole and penfluridol. Aripiprazole was significantly more efficacious than tiapride. Unfortunately, this NMA did not report comparative tolerability of drugs and did not conduct subgroups analyses in children/adolescents only. Therefore, the reader should interpret with caution the overall findings of this meta-analysis and refer to guidelines based on evidence and expert consensus as well.
Review: Chlorpromazine Versus Penfluridol for Schizophrenia
Published in Issues in Mental Health Nursing, 2018
Front-line treatment to manage the symptoms of schizophrenia involves the use of anti-psychotic medications, such as chlorpromazine and penfluridol; however, patient compliance can be problematic due to the adverse side effects of the drugs and/or lack of insight in to their illness (Nikvarz et al., 2017). Chlorpromazine is recognised as benchmark anti-psychotic drug against which others are measured (Adams, Awad, Rathbone, Thornley, & Sores-Weiser, 2014). Its use is associated with a wide range of side effects, including extrapyramidal, anti-cholinergic and anti-histaminergic effects, for example dry mouth, blurred vision, urinary retention and tremors (Adams et al., 2014). Penfluridol is a long-acting anti-psychotic drug with similar side effects to chlorpromazine, however has the advantage of being able to be administered weekly.
New approaches to antipsychotic medication adherence – safety, tolerability and acceptability
Published in Expert Opinion on Drug Safety, 2022
Sharon Taub, Amir Krivoy, Eromona Whiskey, Sukhi S. Shergill
Antipsychotic compounds are traditionally considered as long acting when their therapeutic effect extends a week or more after administration [51]. Long-acting oral antipsychotics (LAOA) potentially present substantial advantages over LAI and daily oral medications. Similar to LAI, the frequency of administration could be prolonged; however, unlike LAI, the LAOA allow less-invasive consumption of medication. Though these features make it easier to maintain treatment and supervise ingestion with LAOA, they are still underprescribed [52]. LAOA include penfluridol and pimozide, which are among the diphenylbutylpiperidines group of tertiary amines. Another oral antipsychotic worth mentioning is cariprazine. Cariprazine is a partial D3/D2 dopamine agonist [53] approved for the treatment of schizophrenia in 2015 by the FDA [54]. Cariprazine’s unique pharmacokinetic properties includes two equipotent active metabolites, and although administrated once daily [55], it is distinguished from other antipsychotic agents by longer half- life of 2–5 days [53] and delayed incidence of relapse after treatment discontinuation [56]. We will focus on penfluridol, the archetypal LAOA, a highly potent FGA compound, recently regaining interest. It is characterized by the pharmacological properties of traditional FGA, with relatively specific dopamine antagonist activity [57]. Regimen protocols of penfluridol requires weekly oral doses of 20–120 mg [57], in which penfluridol 60 mg per week is equivalent to haloperidol 15 mg per day [58]. Following oral ingestion, the compound is distributed into fatty tissues from which it is slowly released, resulting in a sustained release mode of action (1-week action with a plasma half-life of 70 hours) and primarily excreted unchanged [57]. Penfluridol is known as an effective antipsychotic formulation since 1970 [51] and approved for this purpose in many countries; however, it is not licensed in UK [52]. A recent UK cohort study aimed to evaluate the current effectiveness of penfluridol [59]. A sample of 17 subjects, most of them outpatients, was prescribed oral weekly penfluridol. All participants were diagnosed with psychotic disorders, known to be nonadherent to treatment (daily oral treatment or long-acting injections), and most of them had symptoms that were considered as treatment refractory. Penfluridol was administered with dosing ranging between 20 and 40 mg per week. Following 1 year of treatment, more than half (53%) of the patients remained adherent to penfluridol treatment, much like to continuation rates under long-acting injections. These comparable rates are supported by data from a large Dutch retrospective cohort study recently published [60], which assessed the impact of the antipsychotic formulations on time to treatment discontinuation during 4-year follow-up. The results demonstrated similar patterns for oral-weekly and depot formulation, with 17% of the oral-weekly group and 12% of the depot group receiving the same treatment at the end of the study. When hospital admissions (frequency and duration) were compared to the previous year before penfluridol, a nonsignificant reduction was observed [59]. The authors concluded that penfluridol might provide useful antipsychotic treatment.