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Treatment Guidelines
from The Medical Letter
Published by The Medical Letter, Inc. 145 Huguenot Street, New Rochelle, NY 10801 A Nonprofit Publication
Volume 11 (Issue 130) June 2013
www.medicalletter.org
Take CME exams
Tables
1. Drugs for Depression
2. SSRI and SNRI Drug Interactions
3. Oral Drugs for Bipolar Disorder
4. Antimanic and Anticonvulsant Drug Interactions
5. Parenteral Antipsychotics
6. Oral Antipsychotics
7. Relative Adverse Effects of Second-Generation
Antipsychotics
8. Second-Generation Antipsychotic Drug Interactions
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58
59
60
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Federal copyright law prohibits unauthorized reproduction by any means and imposes severe fines.
53
Celexa (Forest)
Escitalopram generic
Lexapro (Forest)
Fluoxetine generic
Prozac (Lilly)
delayed release generic
Prozac Weekly
Paroxetine hydrochloride generic
Paxil (GSK)
extended release generic
Paxil CR
Paroxetine mesylate Pexeva (Noven)
Sertraline generic
Zoloft (Pfizer)
SNRIs
Desvenlafaxine succinate Pristiq (Pfizer)
Desvenlafaxine generic (Alembic)
Duloxetine Cymbalta (Lilly)
Venlafaxine generic
extended release generic
Effexor XR (Pfizer)
TCAs
Amitriptyline generic
Desipramine generic
Norpramin (Sanofi)
Imipramine generic
Tofranil (Mallinckrodt)
Imipramine pamoate generic
Tofranil PM
Nortriptyline generic
Pamelor (Mallinckrodt)
MAOIs
Isocarboxazid Marplan (Validus)
Phenelzine generic
Nardil (Pfizer)
Selegiline Emsam (Somerset)
Tranylcypromine generic
Parnate (Covis)
Other
Bupropion generic
Wellbutrin (GSK)
extended release (12 hour) generic
Wellbutrin SR
Aplenzin (Sanofi)
extended release (24 hour) generic
Wellbutrin XL
Forfivo XL (Edgemont)
Mirtazapine generic
Remeron (Organon)
orally disintegrating generic
Remeron SolTab
Nefazodone6 generic
Trazodone generic
extended release Oleptro (Labopharm)
Vilazodone Viibryd (Forest)
Some Available
Formulations
Initial Adult
Dosage1
Usual Adult
Dosage1
20 mg once/d
40 mg once/d3
$4.004
145.00
10 mg once/d
10-20 mg once/d
10-20 mg once/d
20 mg once/d
90 mg 1x/wk
90 mg 1x/wk
20 mg once/d
20 mg once/d
12.5-25 mg once/d
25 mg once/d
10 mg once/d
25-50 mg once/d
20 mg once/d
50-100 mg once/d
50 mg once/d
50 mg once/d
30-60 mg once/d
50-100 mg once/d
50-100 mg once/d
or divided
25-50 mg once/d
75 mg once/d
75-100 mg once/d
10 mg tabs
15 mg tabs
10 mg bid
15 mg tid
6, 9, 12 mg/24 hr patches
10 mg tabs
6 mg/24 hr
10 mg once/d
6, 9, 12 mg/24 hr
20-30 mg bid
100 mg bid
100 mg tid
150 mg once/d
150 mg bid
174 mg once/d
150 mg once/d
348 mg once/d
300 mg once/d
450 mg ER tabs
7.5, 15, 30, 45 mg tabs
15, 30, 45 mg tabs
15, 30, 45 mg ODT
See footnote 5
15 mg once/d at hs
450 mg once/d
30-45 mg once/d
100 mg bid
75 mg bid
150 mg once/d
10 mg once/d
200 mg bid
300 mg divided bid
150-375 mg once/d
40 mg once/d
Cost2
7.00
143.00
4.004
211.00
110.00
145.00
4.004
121.00
91.00
128.00
204.00
5.00
141.00
25 mg tid
37.5 mg once/d
50 mg once/d
50 mg once/d
60 mg once/d or
divided bid
75 mg tid
225 mg once/d
161.00
139.00
199.00
64.00
240.00
522.00
150 mg once/d
or divided
150 mg once/d
or divided
100-150 mg once/d
or divided
150 mg once/d
or divided
150 mg once/d
or divided
5.00
151.00
205.00
20.00
349.00
348.00
549.00
14.00
1399.00
260.00
72.00
132.00
594.00
323.00
673.00
63.00
266.00
37.00
233.00
395.00
38.00
319.00
135.00
20.00
130.00
57.00
104.00
35.00
16.00
96.00
138.00
54
Treatment Guidelines from The Medical Letter Vol. 11 ( Issue 130) June 2013
CYP450
Comments
Citalopram
Escitalopram
Fluoxetine
Low potential for interactions; dose adjustments may be needed with 2C19
inhibitors; may prolong the QT interval
May decrease efficacy of tamoxifen; may increase concentrations of 2D6 substrates;
long half-life is a problem when interactions occur
Paroxetine
Sertraline
Venlafaxine
Desvenlafaxine
Duloxetine
1. Primary pathway
Treatment Guidelines from The Medical Letter Vol. 11 ( Issue 130) June 2013
55
PREGNANCY Both untreated maternal depression and use of SSRIs in pregnancy have been associated with delayed fetal development, preterm birth
and low birth weight.8,9 Taking SSRIs in the third
trimester has been associated with a self-limited
neonatal behavioral syndrome, treatment in a neonatal
intensive care unit, and a possible risk of persistent
pulmonary hypertension.10,11 Paroxetine is classified
as category D (positive evidence of human fetal risk)
for use during pregnancy because of an increased risk
of cardiovascular and other malformations in infants
born to mothers taking it in the first trimester.12 The
safety of other SSRIs in the first trimester has also
been questioned13,14; all except paroxetine are classified as pregnancy category C (adverse fetal effects in
animals or no animal reproductive studies, and no
adequate human studies). Overall, the risk of congenital malformations after taking an SSRI during pregnancy appears to be very low.15,16 One study that controlled for maternal characteristics found no increase
in perinatal mortality among a cohort of women treated with SSRIs.17
Pregnancy studies with SNRIs are limited,13 but exposure during the third trimester may cause a self-limited
neonatal behavioral syndrome. TCA use in late pregnancy has been associated with jitteriness and convulsions in newborns. MAOIs are classified as category C
for use during pregnancy, but because of the risk of drug
interactions or foods causing a hypertensive crisis, some
56
Treatment Guidelines from The Medical Letter Vol. 11 ( Issue 130) June 2013
Treatment Guidelines from The Medical Letter Vol. 11 ( Issue 130) June 2013
57
Some Available
Formulations
Initial Adult
Dosage1
Usual Adult
Dosage1
900-1800 mg
divided tid or qid
900-1800 mg
divided bid or tid
900-1200 mg
divided tid or qid
900-1200 mg
divided bid or tid
200-600 mg
divided tid-qid
600-1200 mg
divided bid or tid
Cost2
Antimanic Agent
Lithium carbonate3,4 generic
extended release generic
Lithobid (Noven)
Anticonvulsants
Carbamazepine generic6
Tegretol (Novartis)6
extended release generic6
Equetro (Validus)3,9
Carbatrol (Shire)6
Tegretol XR (Novartis)6
Lamotrigine generic4
Lamictal (GSK)4
Lamictal ODT4
extended release generic6
Lamictal XR6
Valproate12
Valproic acid generic
Depakene6 (Abbott)
delayed release Stavzor3(Noven)
Divalproex sodium generic
Depakote3 (Abbott)
Depakote Sprinkle6
extended release Depakote ER 3
Second-Generation Antipsychotics
Aripiprazole3,4,9 Abilify (BMS/Otsuka)
Abilify Discmelt
Asenapine Saphris (Merck)3,9
Olanzapine3,4,9 generic
Zyprexa (Lilly)
orally disintegrating generic
Zyprexa Zydis
Quetiapine generic
Seroquel (AstraZeneca)3,4,16
extended release Seroquel XR3,4,9,16
Risperidone3,9 generic
Risperdal (Janssen)
orally disintegrating generic
Risperdal M-Tab
Ziprasidone generic
Geodon (Pfizer)3,4,9
Combination
Olanzapine/fluoxetine16 generic
Symbyax (Lilly)
$15.00
24.00
240.00
9.008
236.00
200-600 mg
divided bid
200 mg bid
200-600 mg
divided bid
25 mg once/d11
200 mg once/d
25 mg once/d11
200 mg once/d
250 mg tid
1500-2000 mg
divided bid
125 mg cap
250, 500 mg tabs
25 mg/kg once/d13
67.00
607.00
227.00
29.00
214.00
479.00
25-40 mg/kg once/d13 412.00
15 mg once/d
15-30 mg once/d
10 mg bid
10-15 mg once/d
5-10 mg bid
5-20 mg once/d
50-100 mg once/d
or divided bid
50-300 mg once/d
2-3 mg once/d
300-800 mg
divided bid
300-800 mg once/d
4-6 mg once/d
40 mg bid
40-80 mg bid
6/25 mg once in
the evening
600-1200 mg
divided bid
89.00
138.00
106.00
120.00
12.00
252.00
248.00
350.00
416.00
669.00
797.00
690.00
29.00
367.00
226.00
397.00
89.00
754.00
497.00
38.00
513.00
373.00
616.00
237.00
543.00
58
Treatment Guidelines from The Medical Letter Vol. 11 ( Issue 130) June 2013
hepatic transaminases are common; fatal hepatotoxicity has occurred rarely, particularly in young children
and with use of multiple anticonvulsants. Polycystic
ovary syndrome has been reported. Rare idiosyncratic
reactions include hemorrhagic pancreatitis, hyperammonemic encephalopathy and agranulocytosis.
Adverse effects of carbamazepine include rash, dizziness, diplopia, nausea, somnolence, headache, hyponatremia, elevated transaminases and, rarely, StevensJohnson syndrome, agranulocytosis and aplastic anemia. Han Chinese may have a ten-fold increased risk
of Stevens-Johnson syndrome because of genetic vulnerability.30 Eosinophilia and hepatic toxicity
(DRESS Syndrome) have been reported.31 Because
of the many drug interactions that occur with carbamazepine, oxcarbazepine, which causes less induction
of hepatic enzymes, may be used instead.
Adverse effects of lamotrigine include nausea, dizziness and somnolence. About 10% of patients develop
mild rash; severe, life-threatening rash, including
Stevens-Johnson syndrome and toxic epidermal
necrolysis, has occured rarely. Very gradual up-titration of the dose may minimize the risk of rash.32
Carbamazepine is not recommended for use during pregnancy, unless no alternatives exist, because of an increased
risk of major malformations, including neural tube
defects, low birth weight, and fetal and neonatal vitamin K
deficiency, which can lead to neonatal hemorrhage.
Second-generation antipsychotics can cause somnolence, weight gain, diabetes, extrapyramidal symptoms, QT prolongation and elevated prolactin levels
(see Table 7).
Data on use of second-generation antipsychotics during pregnancy are limited; increased birth weight has
been reported.34
CHOICE OF DRUGS Lithium is generally the
drug of choice for maintenance treatment of bipolar
disorder. Lamotrigine may be used to prevent recurrent depressive episodes. Lithium, valproate, and second-generation antipsychotics are similarly effective
for treatment of mania. Quetiapine or a combination
of olanzapine and fluoxetine are effective for treatment of depression in patients with bipolar disorder.
Lamotrigine may also be effective for treatment of
bipolar depression.
Comments
Carbamazepine
Carbamazepine is a strong inducer of multiple hepatic enzymes, including 3A4; increase in dosage of 3A4
substrates may be required. It is also a 3A4 substrate; dosage adjustments may be required with strong 3A4
inducers and inhibitors.
Diuretics, ACE inhibitors, and NSAIDs (except aspirin) reduce renal clearance of lithium; reduce dosage of
lithium. Carbamazepine increases the risk of neurotoxicity; a reduction in dosage of lithium may be required.
Valproate is a moderate inhibitor of 2C9; reduction in dosage of 2C9 substrates may be required. Phenytoin,
carbamazepine, phenobarbital, and rifampin increase renal clearance of valproate; increase dosage of
proate. Use with lamotrigine increases the risk of Stevens-Johnson syndrome; reduce dosage of lamotrigine.
Lithium
Valproate
Treatment Guidelines from The Medical Letter Vol. 11 ( Issue 130) June 2013
59
PSYCHOTIC DISORDERS
The oral antipsychotic drugs used for treatment of schizophrenia, schizoaffective disorder, delusional disorder
and other manifestations of psychosis or mania are listed
in Table 6. Adverse effects such as movement disorders
and metabolic effects, cost, and lack of access to nonpharmacological services (rehabilitation, psychotherapy,
education and intensive case management) can interfere
with patient adherence to these medications.
EFFECTIVENESS Antipsychotic drugs are generally more effective for treating the positive symptoms
of schizophrenia (agitation, hallucinations and delusions) than the negative symptoms (apathy, social
withdrawal and blunted affect).35 Some symptoms of
schizophrenia and acute psychoses may improve rapidly after treatment with antipsychotic drugs, but chronic
schizophrenia usually takes many weeks to respond;
some patients may continue to improve for months.
Maintenance treatment with antipsychotic medications
reduces relapse rates in schizophrenia.36
Oral Second-generation antipsychotics are now used
more commonly than first-generation drugs, even
though controlled trials have failed to demonstrate a
clear advantage in efficacy with the newer drugs,
except for clozapine and possibly olanzapine.37,38
Clozapine can be effective for treatment of psychotic
symptoms in patients who have not responded to other
drugs. It also appears to be more effective than other
antipsychotics in decreasing the risk of suicide.39,40
Olanzapine appears to be more effective than aripiprazole, quetiapine, risperidone and ziprasidone in reducing psychotic symptoms.41
The more recently FDA-approved antipsychotic drugs
asenapine,42 iloperidone43 and lurasidone44 may be
effective for some patients, but their efficacy and safety relative to other drugs in the class remain to be
established.
Parenteral The long-acting parenteral antipsychotics listed in Table 5 are generally used in patients
with a history of relapse due to poor adherence to oral
maintenance therapy. Data on the newer long-acting
parenteral formulations such as paliperidone, olanzapine and aripiprazole are limited. Short-acting parenteral antipsychotics can be helpful for rapid treatment of
acute psychotic agitation or mania.45
Inhaled The first-generation antipsychotic loxapine
has been approved by the FDA as a powder for oral
inhalation (Adasuve) for acute treatment of agitation
associated with bipolar disorder or schizophrenia.
60
Cost2
12.5-25 mg IM
q2-3 wks
10-15 times previous
daily oral dose IM
q4 wks
$108.003
Long-Acting1
First-Generation
Fluphenazine decanoate
generic
Haloperidol decanoate
generic
Haldol (Janssen)
Second-Generation
Aripiprazole
Abilify Maintena
(Otsuka/Lundbeck)
Olanzapine pamoate
Zyprexa Relprevv (Lilly)
Paliperidone palmitate
Invega Sustenna (Janssen)
Risperidone
Risperdal Consta (Janssen)
Short-Acting5
First-Generation
Chlorpromazine generic
Droperidol generic
Fluphenazine hydrochloride
generic
Haloperidol lactate generic
Haldol (Janssen)
Second-Generation
Aripiprazole Abilify
(BMS/Otsuka)
Olanzapine generic
Zyprexa (Lilly)
Ziprasidone Geodon (Pfizer)
32.004
119.00
150-300 mg IM q2 wks
795.00
or 300-405 mg IM q4 wks
117-234 mg IM q4 wks
859.00
25-50 mg IM q2 wks
25 mg IM
2.5-5 mg IM
1.25 mg IM
573.00
16.00
2.00
6.00
2-5 mg IM
2.00
6.00
9.75 mg IM
21.00
5-10 mg IM
16.00
20.00
9.00
10-20 mg IM
Treatment Guidelines from The Medical Letter Vol. 11 ( Issue 130) June 2013
Initial
Adult Dosage
Usual
Adult Dosage1
10-50 mg bid
2.5-5 mg divided
q6-8h
200 mg bid
10 mg once/d
5 mg once/d or divided
5 mg bid
Loxapine4 generic
Loxitane (Watson)
Perphenazine generic
10 mg bid
129.00
371.00
139.00
Thioridazine5 generic
Thiothixene generic
Trifluoperazine generic
50-100 mg tid
2 mg tid
2-5 mg bid
60-100 mg in 2-4
divided doses
24 mg in divided
doses
100-200 mg bid
10 mg bid
10 mg bid
10-15 mg once/d
10-30 mg once/d
669.00
10, 15 mg ODT
5, 10 mg sublingual tabs
25, 50, 100, 200 mg tabs
25, 100 mg tabs
12.5, 25, 100 mg ODT
12.5, 25, 100, 150, 200 mg ODT
1, 2, 4, 6, 8, 10, 12 mg tabs
10-15 mg once/d
5 mg bid
12.5-25 mg bid
10-15 mg once/d
5-10 mg bid
100-300 mg tid
797.00
690.00
218.00
812.00
589.00
783.00
1 mg bid
6-12 mg bid
40 mg once/d
40-160 mg once/d
5-10 mg once/d
10-20 mg once/d
1.5, 3, 6, 9 mg ER tabs
6 mg once/d
6-12 mg once/d
25 mg bid
300-800 mg in 2 or 3
divided doses
300 mg once/d
2 mg once/d or
divided bid
400-800 mg once/d
4-8 mg once/d
20-40 mg bid
60-80 mg bid
Drug
Cost2
First-Generation
Chlorpromazine3 generic
Fluphenazine3 generic
Haloperidol3 generic
Second-Generation
Aripiprazole3 Abilify
(BMS/Otsuka)
orally disintegrating
Abilify Discmelt
Asenapine Saphris (Merck)
Clozapine7 generic
Clozaril (Novartis)
orally disintegrating generic
FazaClo (Jazz)
Iloperidone
Fanapt (Novartis)
Lurasidone Latuda
(Sunovion)
Olanzapine3 generic
Zyprexa (Lilly)
orally disintegrating generic
Zyprexa Zydis
Paliperidone3
Invega (Janssen)
Quetiapine generic
Seroquel (AstraZeneca)
extended release
Seroquel XR
Risperidone3 generic
Risperdal (Janssen)
orally disintegrating generic
Risperdal M-TAB
Ziprasidone generic
Geodon3 (Pfizer)
4 mg tid
$140.00
11.00
14.00
24.00
26.00
57.00
697.00
553.00
23.00
553.00
340.00
583.00
604.00
72.00
600.00
585.00
42.00
513.00
362.00
616.00
292.00
659.00
FDA requires the manufacturers of all second-generation antipsychotics to include product-label warnings
about hyperglycemia and diabetes, even though the
risks are not equivalent for all drugs in the class, and
about an increased risk of death among elderly patients
with dementia.48 Table 7 lists some relative adverse
effects of second-generation antipsychotics.
Treatment Guidelines from The Medical Letter Vol. 11 ( Issue 130) June 2013
61
Diabetes
Weight
Gain
Extrapyramidal
Symptoms
QTc
Prolongation
Elevated
Prolactin
Aripiprazole
Asenapine*
Clozapine
Iloperidone*
Lurasidone*
Olanzapine
Paliperidone
Quetiapine
Risperidone
Ziprasidone
+/
+
++++
++
+/
++++
++
++
++
+/
+
++
++++
++
+/
++++
+++
+++
+++
+/
++
++
+/
+/
++
+
++
+/
+++
+
+/
+
+
++
+/
+
+
+
+
++
+/
++
+/
+/
+/
+
+++
+/
+++
+
*Limited experience
Metabolism by CYP/P-gp
Comments
Aripiprazole
Asenapine
Clozapine
Iloperidone
Lurasidone
3A4, 2D6
1A2
1A2, 3A4, 2D6, 2C19
3A4, 2D6
3A4
Olanzapine
Paliperidone
Quetiapine
Risperidone
Ziprasidone
2D6, P-gp
3A4
3A4, 2D6 and P-gp
3A4
Dose adjustments required with strong 3A4 or 2D6 inhibitors and with 3A4 inducers
Low potential for interactions
Many interactions, primarily with 1A2 inhibitors and inducers
Dose adjustments required with strong 3A4 or 2D6 inhibitors
Contraindicated with strong 3A4 inducers and inhibitors; dose adjustments required
with moderate 3A4 inhibitors
Low potential for interactions; serum concentrations altered by strong 1A2 inhibitors
or inducers
Low potential for interactions
Dose adjustments required with strong 3A4 inducers and inhibitors
Dose adjustments required with 3A4 or 2D6 inhibitors and 3A4 inducers
Serum concentrations modestly effected by 3A4 inhibitors and inducers
62
Treatment Guidelines from The Medical Letter Vol. 11 ( Issue 130) June 2013
7.
8.
9.
10.
11.
12.
13.
14.
15. S Alwan et al. Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. N Engl J Med 2007; 356:2684.
16. C Louik et al. First-trimester use of selective serotonin-reuptake
inhibitors and the risk of birth defects. N Engl J Med 2007; 356:2675.
17. O Stephansson et al. Selective serotonin reuptake inhibitors during pregnancy and risk of stillbirth and infant mortality. JAMA 2013; 309:48.
18. LH Pedersen et al. Fetal exposure to antidepressants and normal milestone development at 6 and 19 months of age. Pediatrics 2010; 125:e600
(epub Feb 22).
19. KR Connolly and ME Thase. If at first you dont succeed: a review of
the evidence for antidepressant augmentation, combination and switching strategies. Drugs 2011; 71:43.
20. AJ Rush et al. Bupropion-SR, sertraline, or venlafaxine-XR after failure
of SSRIs for depression. N Engl J Med 2006; 354:1231.
21. Adjunctive antipsychotics for major depression. Med Lett Drugs Ther
2011; 53:74.
22. BM Wright et al. Augmentation with atypical antipsychotics for depression: a review of evidence-based support from the medical literature.
Pharmacotherapy 2013; 33:344.
23. PE Holtzheimer and HS Mayberg. Neuromodulation for treatmentresistant depression. F1000 Med Rep 2012; 4:22.
24. Repetitive transcranial magnetic stimulation (TMS) for medicationresistant depression. Med Lett Drugs Ther 2009; 51:12.
25. Vagus nerve stimulation for depression. Med Lett Drugs Ther 2005;
47:50.
26. JR Geddes and DJ Miklowitz. Treatment of bipolar disorder. Lancet
2013; 381:1672.
27. ME Thase and T Denko. Pharmacotherapy of mood disorders. Annu
Rev Clin Psychol 2008; 4:53.
28. L Tondo and RJ Baldessarini. Long-term lithium treatment in the prevention of suicidal behavior in bipolar disorder patients. Epidemiol
Psychiatr Soc 2009; 18:179.
29. LA Smith et al. Valproate for the treatment of acute bipolar depression:
systematic review and meta-analysis. J Affect Disord 2010; 122:1.
30. YW Shi et al. Association between HLA and Stevens-Johnson syndrome
induced by carbamazepine in Southern Han Chinese: genetic markers
besides B*1502? Basic Chem Pharmacol Toxicol 2012; 111:58.
31. P Cacoub et al. The DRESS syndrome: a literature review. Am J Med
2011; 124:588.
32. SH Joe et al. Feasibility of a slower lamotrigine titration schedule for
bipolar depression: a naturalistic study. Int Clin Psychopharmacol 2009;
24:105.
33. FDA Drug Safety Communication: valproate anti-seizure products contraindicated for migraine prevention in pregnant women due to decreased IQ
scores in exposed children. Available at www.fda.gov/Drugs/DrugSafety
/ucm350684.htm. Accessed May 12, 2013.
34. S Gentile. Antipsychotic therapy during early and late pregnancy. A systematic review. Schizophr Bull 2010; 36:518.
35. RJ Baldessarini. Chemotherapy in Psychiatry, third edition. New York:
Springer Press 2013.
36. S Leucht et al. Maintenance treatment with antipsychotic drugs for
schizophrenia. Cochrane Database Syst Rev 2012; 5:CD008016.
37. S Leucht et al. Second-generation versus first-generation antipsychotic
drugs for schizophrenia: a meta-analysis. Lancet 2009; 373:31.
38. L Hartling et al. Antipsychotics in adults with schizophrenia: comparative effectiveness of first-generation versus second-generation medications: a systematic review and meta-analysis. Ann Intern Med
2012;157:498.
39. HY Meltzer et al. Clozapine treatment for suicidality in schizophrenia:
International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry
2003; 60:82.
40. J Tiihonen et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009;
374:620.
41. S Leucht et al. A meta-analysis of head-to-head comparisons of secondgeneration antipsychotics in the treatment of schizophrenia. Am J
Psychiatry 2009; 166:152.
42. Asenapine (Saphris) sublingual tablets for schizophrenia and bipolar
Treatment Guidelines from The Medical Letter Vol. 11 ( Issue 130) June 2013
63
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Credit for the Physicians Recognition Award from organizations accredited by the ACCME.
AOA: This activity, being ACCME (AMA) approved, is acceptable for Category 2-B credit by the American Osteopathic Association (AOA).
Physician Assistants: The National Commission on Certification of Physician Assistants (NCCPA) accepts AMA PRA Category 1 Credit(s) from organizations accredited by ACCME. NCCPA also accepts AAFP Prescribed credits for recertification. Treatment Guidelines is accredited by both ACCME and AAFP.
Physicians in Canada: Members of The College of Family Physicians of Canada residing in the US are eligible to receive Mainpro-M1 credits (equivalent to AAFP
Prescribed credits), and members residing in Canada are eligible to receive Mainpro-M2 credits due to a reciprocal agreement with the American Academy of Family
Physicians. Treatment Guidelines CME activities are eligible for either Section 2 or Section 4 (when creating a personal learning project) in the Maintenance of
Certification Program of the Royal College of Physicians and Surgeons of Canada (RCPSC).
Physicians, nurse practitioners, pharmacists and physician assistants may earn 2 credits with this exam.
MISSION:
The mission of The Medical Letter's Continuing Medical Education Program is to support the professional development of healthcare professionals including physicians, nurse practitioners, pharmacists and physician assistants by providing independent, unbiased drug information and prescribing recommendations that are free
of industry influence. The program content includes current information and unbiased reviews of FDA-approved and off-label uses of drugs, their mechanisms of action,
clinical trials, dosage and administration, adverse effects and drug interactions. The Medical Letter delivers educational content in the form of self-study material.
The expected outcome of the CME Program is to increase the participants ability to know, or apply knowledge into practice after assimilating, information presented
in materials contained in Treatment Guidelines.
The Medical Letter will strive to continually improve the CME program through periodic assessment of the program and activities. The Medical Letter aims to be a
leader in supporting the professional development of healthcare professionals through Core Competencies by providing continuing medical education that is unbiased
and free of industry influence. The Medical Letter is supported solely by subscription fees and accepts no advertising, grants or donations.
GOAL:
Through this program, The Medical Letter expects to provide the healthcare community with unbiased, reliable and timely educational content that they will use to
make independent and informed therapeutic choices in their practice.
LEARNING OBJECTIVES:
The objective of this activity is to meet the need of healthcare professionals for unbiased, reliable and timely information on treatment of major diseases. The Medical
Letter expects to provide the healthcare community with educational content that they will use to make independent and informed therapeutic choices in their practice.
Participants will be able to select and prescribe, or confirm the appropriateness of the prescribed usage of the drugs and other therapeutic modalities discussed in
Treatment Guidelines with specific attention to clinical evidence of effectiveness, adverse effects and patient management.
Upon completion of this program, the participant will be able to:
1.
2.
3.
Explain the current approach to the management of patients with psychiatric disorders.
Discuss the pharmacologic agents available for treatment of depression, bipolar disorder and psychosis and compare them based on their efficacy, dosage
and administration, potential adverse effects and drug interactions.
Determine the most appropriate therapy given the clinical presentation of an individual patient.
Privacy and Confidentiality: The Medical Letter guarantees our firm commitment to your privacy. We do not sell any of your information. Secure server software (SSL)
is used for commerce transactions through VeriSign, Inc. No credit card information is stored.
IT Requirements: Windows 98/NT/2000/XP/Vista/7/8, Pentium+ processor, Mac OS X+ w/ compatible process; Microsoft IE 6.0+, Mozilla Firefox 2.0+ or any other
compatible Web browser. Dial-up/high-speed connection.
Have any questions? Call us at 800-211-2769 or 914-235-0500 or e-mail us at: custserv@medicalletter.org
Treatment Guidelines from The Medical Letter Vol. 11 ( Issue 130) June 2013
Treatment Guidelines from The Medical Letter Vol. 11 ( Issue 130) June 2013