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CLINICAL SYNTHESIS   |    
New Options for the Treatment of Schizophrenia: A Clinical Review of the Three Most Recent Antipsychotic Drugs
Ana D. Stan, M.D., Ph.D.; Carol A. Tamminga, M.D.
FOCUS 2014;12:127-135. doi:10.1176/appi.focus.12.2.127
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Author Information and CME Disclosure

Ana D. Stan, M.D., Ph.D. and Carol A. Tamminga, M.D., Division of Translational Research in Schizophrenia, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX

Dr. Stan reports no financial relationships with commercial interests.

Dr. Tamminga has served on a drug development advisory board for Intracellular Therapies; served as an expert witness for Kaye Scholer LLP; and has served as a consultant for Astellas, Eli Lilly, Lundbeck, and Puretech Ventures/Karuna.

Send correspondence to: ana.stan@utsouthwestern.edu

Abstract

This clinical review summarizes the pharmacological characteristics, efficacy, and tolerability of asenapine, iloperidone, and lurasidone, the most recently approved antipsychotics in the treatment of schizophrenia. Newer agents have the task of distinguishing themselves for clinical use based on patient-relevant characteristics; some provide specialized features. The agents reviewed here are similar in overall clinical efficacy and tolerability, as well as being in a low risk for weight gain and metabolic syndrome, but are different in terms of formulation, schedule of administration, and particular side effects. Based on these distinguishing characteristics, we offer recommendations for the optimal clinical use of each drug.

Abstract Teaser
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Table 1.Comparative Receptor Binding Affinities of Asenapine, Iloperidone, Lurasidone, Haloperidol, Clozapine, and Olanzapine
Table Footer Note

Empty cells correspond to receptor binding affinities that have not been studied for a particular drug.

Table Footer Note

++++ = Very high affinity (<10 nM);

Table Footer Note

+++ = High affinity (equilibrium dissociation constant Ki = 10–100 nM);

Table Footer Note

++ = Moderate affinity (equilibrium dissociation constant Ki = 100–1,000 nM);

Table Footer Note

+ = Low affinity (equilibrium dissociation constant Ki = 1,000–10,000 nM); and

Table Footer Note

- = Negligible affinity (equilibrium dissociation constant Ki > 10,000 nM).

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Table 2.Short-Term Efficacy of Asenapine
Table Footer Note

PANSS = Positive and Negative Syndrome Scale. BPRSd = Brief Psychiatric Rating Scale derived from PANSS.

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Table 3.Short-Term Efficacy of Iloperidone
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Table 4.Short–Term Efficacy of Lurasidone
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Table 5.Comparative Pricing Information for 10 Tablets of Asenapine, Iloperidone, Lurasidone, Generic Risperidone, and Generic Olanzapine (40)
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References Container
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CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
Which of the following medications requires very slow titration because of the risk of orthostatic hypotension?

See Stan and Tamminga: Pharmacokinetics, Formulation and Metabolism, p 128
2.
Which of the following medications is formulated solely as a sublingual tablet?

See Stan and Tamminga: Pharmacokinetics, Formulation and Metabolism, p 128
3.
Which of the following medications requires administration with a meal of at least 350 calories for optimal absorption?

See Stan and Tamminga: Pharmacokinetics, Formulation and Metabolism, p 128
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