• 한국임상약학회지
• /
• 제22권2호
• /
• pp.137-142
• /
• 2012

Background & Purpose: It is well known that Extrapyramidal symptoms (EPS) is induced by atypical antipsychotic agents less frequently than by typical antipsychotic agents. The purpose of this study was to evaluate differences in rates of the use of antiparkinson agent, most commonly prescribed for the management of EPS, between patients with atypical agents and those with typical agents. Methods: This cross-sectional study was conducted in a retrospective way with the Electronic Medical Record (EMR) of the 312 patients for whom the Antipsychotics were prescribed by the Psychiatry Department of the Inje University Ilsan Paik Hospital, from January of 2005 to February of 2011. They received either typical agents (N=15) or atypical agents (N=297) and those 2 groups were compared in terms of antiparkinson agent use. Also, we assessed the difference between individual atypical antipsychotic agents regarding antiparkinson agent use. Results: There was no significant difference in the rates of antiparkinson agent use between the two groups (the typical agent 13.33% vs. the atypical agent 9.76%, p = 0.6512). Meanwhile, the rates of antiparkinson agent use with aripiprazole versus quetiapine (aripirazole 25% vs. quetiapine 3.57%, p = 0.003) were significantly different, Also the rates of antiparkinson agent use with aripiprazole versus risperidone (aripiprazole 25% vs. risperidone 9.52%, p = 0.0216) had a statistical meaning. Conclusions: There was no significant difference in the rates of antiparkinson agent use between patients with atypical agents and those with typical agents. However the rate of antiparkinson agent use was significantly lower with aripiprazole compared with quetiapine or risperidone.

• 대한조현병학회지
• /
• 제24권1호
• /
• pp.1-7
• /
• 2021

Clozapine is the first and most effective atypical antipsychotic drug for treatment-resistant schizophrenia (TRS). After withdrawal of clozapine due to concerns of agranulocytosis, clozapine was reintroduced with a comprehensive safety monitoring system, the clozapine patient monitoring system (CPMS). The reintroduction was a response to the pressure from psychiatrists and patients with TRS and their families. Clozapine is still the best single agent for the treatment of TRS. However, approximately 30% of patients with TRS still show psychotic symptoms. In patients with clozapine-resistant schizophrenia (CRS), augmentation of other antipsychotic agents could be considered after a thorough evaluation of proper clozapine treatment. In this review, the status of clozapine in patients with TRS and CRS will be discussed.

• 한국임상약학회지
• /
• 제30권2호
• /
• pp.81-86
• /
• 2020

Background: The number of patients with dementia continues to increase as the age of aging continues to grow. Psychiatric symptoms caused by senile dementia are controlled using antipsychotics. However, these antipsychotics can lead to Parkinson's disease, and abuse of dopamine derivatives such as levodopa among Parkinsonian drugs can lead to psychosis. Therefore, we evaluated the patterns of prescribed antipsychotics and antiparkinsonian drugs in patients with senile dementia. Methods: We used data from the sample of elderly patients from the Health Insurance Review and Assessment Service (HIRA-APS-2016). We analyzed the patterns of prescribing antipsychotics and antiparkinsonian drugs including prescribed daily dosage, period of prescription, and number of patients with both antipsychotics and antiparkinsonian drugs for senile dementia. Results: Among the 159,391 patients with dementia included in this analysis, 4,963 patients (3.1%) and 16,499 patients (10.4%) were prescribed typical and atypical antipsychotic drugs, respectively. The most frequently prescribed typical antipsychotic was haloperidol (4,351 patients with dementia), whereas the atypical agent was quetiapine (12,719 patients). The most frequently prescribed antiparkinsonian drugs were in the order of levodopa/carbidopa, benztropine, and ropinirole. In addition, 1,103 and 3,508 patients prescribed typical and atypical antipsychotics, respectively, were co-prescribed antiparkinsonian drugs. Conclusions: Atypical antipsychotics were the preferred prescription in patients with senile dementia. The prescription dose was relatively low; however, the average treatment duration was mostly long-term. Selection of antipsychotics and/or antiparkinsonian drugs should be made carefully in senile dementia and the causal relationship of adverse drug reactions needs further study.

• The Korean Journal of Physiology and Pharmacology
• /
• 제13권2호
• /
• pp.71-78
• /
• 2009

(S)-Carbamic acid 2-[4-(4-fluoro-benzoyl)-piperidin-1-yl]-1-phenyl-ethyl ester hydrochloride (YKP1447) is a novel "atypical" antipsychotic drug which selectively binds to serotonin (5-$HT_{2A}$, Ki=0.61 nM, 5-$HT_{2C}$, Ki=20.7 nM) and dopamine ($D_2$, Ki=45.9 nM, $D_3$, Ki=42.1 nM) receptors with over $10\sim100$-fold selectivity over the various receptors which exist in the brain. In the behavioral studies using mice, YKP1447 antagonized the apomorphine-induced cage climbing ($ED_{50}$=0.93 mg/kg) and DOI-induced head twitch ($ED_{50}$=0.18 mg/kg) behavior. In the dextroamphetamine-induced hyperactivity and conditioned avoidance response (CAR) paradigm in rats, YKP1447 inhibited the hyperactivity induced by amphetamine ($ED_{50}$=0.54 mg/kg) and the avoidance response ($ED_{50}$=0.48 mg/kg); however, unlike other antipsychotic drugs, catalepsy was observed only at much higher dose ($ED_{50}$=68.6 mg/kg). Based on the CAR and catalepsy results, the therapeutic index (TI) value for YKP1447 is over 100 (i.p.). These results indicate that YKP1447 has an atypical profile and less undesirable side effects than currently available drugs.

• 대한정형외과학회지
• /
• 제55권3호
• /
• pp.276-280
• /
• 2020

49세 남자 환자가 숙박업소에서 의식을 잃은 채 발견되어 응급실로 내원하였다. 환자는 조현증 및 주요우울증으로 항정신병 약물 및 항우울증 약물(vortioxetine hydrobromide, mirtazapine, sertraline hydrochloride, quetiapine, alprazolam)을 복용 중이었으며 환자 주변에 상기 약물들을 과량 복용한 흔적이 남아있었다. 신체검사에서 좌측 둔부 및 가측 대퇴부로 동통, 창백 및 부종 관찰되었으며 좌측 족관절 이하의 능동 관절운동이 불가하였다. 그리고 경골 및 비골신경 영역의 감각이 소실되어 있었다. 가장 종창이 심했던 가측 대퇴부에서 측정한 둔부 구획 내 압력은 42 mmHg 이었으며 자기공명영상에서 좌측 둔부 근육 및 주변 연부 조직의 부종 및 고강도 신호를 보이고 있었다. 응급 근막절개술을 시행하였고 24시간 이후 하지 감각 및 근력이 일부 회복되었다.

• 생물정신의학
• /
• 제19권3호
• /
• pp.146-151
• /
• 2012

Clozapine is an atypical antipsychotic agent that is more effective than the typical neuroleptics in the treatment of refractory schizophrenia. Recently, there has been an increased recognition of the association of clozapine with myocarditis and cardiomyopathy. Commonly used diagnostic tests have limited sensitivity in diagnosing this potentially life-threatening complication. Here we report a case of 36-year-old male patient who developed fever, tachycardia, and dyspnea after introduction of clozapine. By clinical evaluation and laboratory test we diagnosed the patient with myocarditis and treated him successfully. To our knowledge this is the first case report of clozapine-induced myocarditis in Korea.

• 한국임상약학회지
• /
• 제11권2호
• /
• pp.89-96
• /
• 2001

Ziprasidone is equally effective as haloperidol in treating schizophrenia with fewer side effects and drug interactions. Ziprasidone is an atypical antipsychotic agent and works by blocking serotonin and dopamine receptors in the central nervous system, specifically 5-HT2A and D2 receptors. Low anticholinergic side-effects and low EPS would recommend the drug for use in the elderly. Ziprasidone inhibits reuptake of norepinephrine and serotonin at neurojunction sites in vitro, indicating a potential efficacy for depression and negative symptoms which often follow after exacerbation of schizophrenia. Patients with recent acute myocardial infarction and uncompensated heart failure are contraindicated to the drug due to a possibility of QT prolongation. Although ziprasidone is metabolized by cytochrome P450 3A4, there is no significant drug interaction with the drugs that induce or inhibit the isoenzyme. Ziprasidone is safe with coadministration of lithium and there has been no significant drug interaction reported with oral birth control pills.

• 대한임상독성학회지
• /
• 제3권2호
• /
• pp.135-138
• /
• 2005

Amisulpride is a newly developed atypical antipsychotic agent effective in treating the positive and negative symptom of schizophrenia. Over-dose of amisulpride can cause hypocalcemia and thus may lead to QT prolongation. We report a case of hypocalcemia and QT prolongation. The QT prolongation was normalized after calcium supplement.

• 생물정신의학
• /
• 제28권2호
• /
• pp.50-57
• /
• 2021

Objectives Clozapine is the most effective atypical antipsychotic agent for the treatment-resistant schizophrenia (TRS), however, only 40%-70% of TRS patients respond to clozapine. Moreover, TRS encompasses various symptom dimensions. Therefore, augmentation with other medications for clozapine is frequently applied. However, the prescription pattern of clozapine and combined medications in Korea is yet to be examined. This study aims to investigate the maintenance treatment pattern of clozapine and augmentation agents in one Korean tertiary hospital. Methods The patients with schizophrenia spectrum disorders under clozapine maintenance, defined as one-year clozapine continuation, were subjected for analysis. Medication data at one-year time-point after clozapine initiation was extracted and analyzed. Results Among total 2897 patients having clozapine prescription experience from January 2000 to December 2018, 1011 patients were on clozapine maintenance. The mean age of clozapine initiation was 30.2 ± 11.3 years, and the maintenance dose of clozapine was 217.8 ± 124.3 mg/day. Combination rate of antipsychotics, mood stabilizers, and antidepressants were 43.5%, 25.3%, 38.6%, respectively. Most frequently prescribed drugs in each category were aripiprazole, valproate, and sertraline. Olanzapine equivalent dose of combined antipsychotics was 10.4 ± 7.7 mg/day. Male patients were prescribed higher dose of combined antipsychotics and higher rate of antidepressants. Female patients had later onset of clozapine prescription. Patients with two or more combined antipsychotics were prescribed higher dose of clozapine and higher rate of antidepressants compared to patients with one combined antipsychotic. Conclusions Taken together, among the patients taking clozapine, a substantial rate of patients were under polypharmacy. The present findings based on the real-world prescription pattern could provide the valuable clinical information on the treatment of TRS-related conditions.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권22호
• /
• pp.9587-9592
• /
• 2014

Nausea and vomiting are common adverse events in chemotherapy. In spite of the serious effects on the quality of life and further treatment, they remain overlooked by physicians, and no standard treatment has been developed. Neurokinin-1 (NK-1) receptor antagonists and palonosetron are the major agents in the standard regimen for treating moderately and highly emetogenic chemotherapy-induced nausea and vomiting (CINV). However, NK-1 receptor antagonists first became commercially available at the end of 2013 and palonosetron has not been extensively applied in China. Olanzapine was recommended as a therapy for moderate and severe CINV in antiemesis-clinical practice guidelines in oncology in 2014 for the first time. It is an atypical antipsychotic agent, which can block multiple receptors on neurotransmitters. During more than 10 years, olanzapine has demonstrated significant effects in preventing CINV and treating breakthrough and refractor CINV, which was observed in case reports, precise retrospective studies, and phase I, II and III clinical trials, with no grade 3 to 4 adverse events. In particular, it is superior to aprepitant and dexamethasone in delayed nausea and vomiting. Therefore, this compound is worthy of further investigation.