Older Antipsychotic Drugs As Effective As Newer Ones

(November 20, 2006) -- People newly diagnosed with schizophrenia should be prescribed a less-expensive, older antipsychotic drug first before more costly newer drugs are tried, according to the latest report from Consumer Reports Best Buy Drugs. The report echoes recent research findings that the older drugs work just as well for many people, and at far lower cost.

Most of the newer drugs are five to 10 times more expensive than an older generation of antipsychotics, now available as generics. The newer medicines have been heavily marketed in recent years and their sales have soared to more than $10 billion.

In particular, the report chooses generic perphenazine as a Best Buy and recommends that doctors consider prescribing it for newly diagnosed patients and for patients who are currently taking a newer drug but not doing well on it. Perphenazine proved as effective as several newer drugs in one recent major comparison study of antipsychotic drugs.

The choice of perphenazine – if a patient responds well to it – could save $200 to $500 a month ($2,400 to $6,000 a year) compared to the frequently prescribed newer drugs Zyprexa and Risperdal, for example, the report says.

However, the report cautions that (a) not all people with schizophrenia will do well on perphenazine; (b) it poses more risk of certain side effects than other antipsychotic drugs and patients must be monitored closely; and (c) people with schizophrenia whose disease is well-controlled on any antipsychotic drug (an older or newer one) should, in general, not be switched to another drug.

The report, available free at www.CRBestBuyDrugs.org, is the 16th in a series helping consumers find effective and safe medicines that give them the most value for their health care dollar. Other reports compare drugs to treat depression, high blood pressure, high cholesterol, asthma, allergies, migraines, insomnia, and overactive bladder.

In general, antipsychotic drugs (old and new) play a significant role in helping people with schizophrenia live more meaningful, stable lives with fewer, and sometimes no, periods of hospitalization. But they are a highly problematic class of medicines, too. A sizeable percentage of people with schizophrenia get little or no benefit from them, others get only a minor reduction in symptoms, and a high rate of side effects (some quite serious) pose a major barrier to continuous use. In studies, for example, three of every four people stopped taking an antipsychotic or switched to a different one within 18 months.

Some 3 million Americans have schizophrenia. Hallmark symptoms are disjointed and illogical thinking, fearfulness, agitation, hallucinations, and delusions.

Antipsychotics are also approved to treat people with bipolar depression (also called manic depression), which afflicts about 5 million Americans. While helpful in calming “mania” symptoms such as severe agitation, the report advises doctors and consumers to exercise more caution in the routine use of antipsychotics to treat people with bipolar depression in light of recent studies indicating the risks of these medicines.

The report also notes that recent research shows that both older and newer antipsychotic drugs present significant risks when used to reduce some symptoms in people with Alzheimer’s disease. In many – if not most – of such patients, the risk of the drugs outweigh the benefits.

Taking effectiveness, safety, side effects, patient variability, dosing convenience, and cost into account, the following Best Buy Drugs were chosen.

Generic perphenazine – as initial treatment for people newly diagnosed with schizophrenia and for people with schizophrenia who have failed on a second-generation drug and whose doctor thinks perphenazine is worth a try. Patients taking perphenazine should be closely monitored for muscle tremors and spasms.

Olanzapine (Zyprexa) – for certain people with schizophrenia who take perphenazine first and get no or minimal benefit and/or experience intolerable side effects. For people who are overweight, have blood sugar abnormalities, diabetes, or heart disease, Zyprexa is not a good option.

Risperidone (Risperdal) – for people with schizophrenia who take perphenazine first and get minimal benefit and/or experience intolerable side effects.

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Generic clozapine – for people with moderate to severe schizophrenia who have not responded at all to two or more other antipsychotics and have had little reduction in symptoms.

Consumer Reports Best Buy Drugs combines a review of the scientific evidence on the effectiveness and safety of medicines with pricing information. Every report is peer-reviewed by medical experts. The project is independently administered by Consumers Union and Consumer Reports with support from the Engelberg Foundation, a private philanthropy, and the National Library of Medicine.

By Jean Egan
Source: www.HealthNewsDigest.com

Last updated: 11/06

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