Clinical Psychopharmacology: An Update

190 Pages·2019·1.74 MB·English

by  Prakash B. Behere, Anweshak Das, Aniruddh P. Behere

Clinical
Psychopharmacology
An Update
Prakash B. Behere
Anweshak Das
Aniruddh P. Behere
123
Clinical Psychopharmacology
Prakash B. Behere • Anweshak Das
Aniruddh P. Behere
Clinical
Psychopharmacology
An Update
Prakash B. Behere Anweshak Das
Department of Psychiatry Consultant Psychiatrist
D Y Patil Medical College & D. Y. Patil Psychiatric Clinic
Education Society (Deemed University) Guwahati
Kolhapur Assam
Maharashtra India
India
Aniruddh P. Behere
Pediatric Behavior Health
Helen Devos Childrens’s Hospital
Michigan State University College of
Human Medicine
Grand Rapids, Michigan
USA
ISBN 978-981-13-2091-0 ISBN 978-981-13-2092-7 (eBook)
https://doi.org/10.1007/978-981-13-2092-7
Library of Congress Control Number: 2018957629
© Springer Nature Singapore Pte Ltd. 2019
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721,
Singapore
Dedicated to
My Wife
Mrs. Manikyamba Prakash Behere
This book is the outcome of her inspiration.
—Prakash B. Behere
Foreword
It is a pleasure to write the foreword for Dr. Prakash Behere’s latest book entitled
Clinical Psychopharmacology: An Update. Dr. Behere was my postgraduate stu-
dent at the Postgraduate Institute of Medical Education and Research, Chandigarh,
during my early days as a postgraduate teacher. We have had interaction several
times since. I regard him as a very talented individual whose work in the area of
mental health, especially in the use of medications to treat different forms of mental
disorders has been exceptional and has vast clinical experience in treating the men-
tally ill. He has vast clinical experience in treating the mentally ill. The purpose of
this book is to highlight what the specific medicines offer in terms of benefits, side
effects, and risks. It provides practical information on how to use various psychotro-
pic drugs in clinical practice, emphasizing the mechanisms of action of these drugs
upon the receptors and enzymes in the brain.
Prof. Behere has worked to ensure that all the information in this book concern-
ing drug dosages, schedules, routes of administration, indications and contraindica-
tions, etc., is accurate at the time of publication. The book consists of 11 chapters in
all and the 10th chapter covers special populations which include the elderly, chil-
dren, adolescents, nursing and pregnant women.
Prof. Behere presents a balanced and an even approach in his writing which
allows the reader to consider the current range of views about modern psychotropic
medications. The publication of this book is a major event in the field of psycho-
pharmacology and represents a unique contribution to all mental health profession-
als. It has 11 chapters and interestingly at the end of every chapter there is a block
covering summary of that chapter.
I believe it is a book every medical practitioner would benefit from having access
to and will add to the treasure of existing books in psychopharmacology. Finally, I
am happy to write the Foreword for this book.
Naren N. Wig
Postgraduate Institute of Medical
Education and Research
Chandigarh, India
vii
Preface
This is an effort to provide an up-to-date, easy to use, and a portable source of drug
information for mental health professionals. This guide is intended to complement
Essential Psychopharmacology and Textbook of Psychopharmacology. It provides
practical information on how to use various psychotropic drugs in clinical practice,
emphasizing the mechanisms of action of these drugs upon the receptors and
enzymes in the brain.
Earlier we have written a book entitled Handbook of Clinical Psychopharmacology
in 2010, which was our initial attempt to write in psychopharmacology. As this
earlier book became very popular among postgraduates in psychiatry, we penned
this book.
It consists of 11 chapters—10 chapters cover various classes of drugs, and the
10th chapter covers special populations which include the elderly, children, adoles-
cents, pregnant and nursing women. All the selected drugs are presented in the same
design format in order to facilitate rapid access to information. Specifically, each
drug is individually divided into sections—class of the drug, history and introduc-
tion, classification, pharmacological action, doses, drug interactions, indications,
side effects, and special population. Only the essential facts about each drug have
been included in order to make the content concise and to avoid dilution of impor-
tant information. At the end of chapters, there is a block giving summary of the
chapter.
This book is intended to be genuinely helpful for practitioners of psychopharma-
cology by providing them with facts and relevant details of all the important psy-
chotropic drugs. Every effort has been made to provide accurate and up-to-date
information in accordance with the accepted standards and practice at the time of
publication.
Kolhapur, India Prakash B. Behere
Guwahati, India Anweshak Das
Grand Rapids, MI Aniruddh P. Behere
ix
Contents
1 Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Tricyclic and Tetracyclic Antidepressants . . . . . . . . . . . . . . . . . . . . . 1
1.2 Specific Serotonin Reuptake Inhibitors . . . . . . . . . . . . . . . . . . . . . . . 4
1.2.1 Fluoxetine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.2.2 Sertraline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.2.3 Fluvoxamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.2.4 Paroxetine and Paroxetine CR . . . . . . . . . . . . . . . . . . . . . . . . 11
1.2.5 Citalopram and Escitalopram . . . . . . . . . . . . . . . . . . . . . . . . . 13
1.3 Monoamine Oxidase Inhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
1.4 Selective Serotonin Norepinephrine Reuptake Inhibitors . . . . . . . . . 18
1.4.1 Venlafaxine and Desvenlafaxine . . . . . . . . . . . . . . . . . . . . . . 18
1.4.2 Duloxetine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
1.4.3 Milnacipran . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
1.5 Norepinephrine Dopamine Reuptake Inhibitors . . . . . . . . . . . . . . . . 23
1.5.1 Bupropion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
1.6 Serotonin Adrenaline Reuptake Inhibitors . . . . . . . . . . . . . . . . . . . . . 25
1.6.1 Trazodone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
1.6.2 Nefazodone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
1.7 Noradrenaline and Specific Serotonergic Agents. . . . . . . . . . . . . . . . 28
1.7.1 Mirtazapine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
1.8 Newer Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
1.8.1 Agomelatine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
1.8.2 Opipramol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
1.8.3 Dapoxetine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
1.8.4 Vilazodone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
1.9 Important Tables Related to Antidepressants . . . . . . . . . . . . . . . . . . . 36
1.10 Points to Remember . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
2 Antipsychotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
2.1 Typical Antipsychotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
2.1.1 Chlorpromazine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
2.1.2 Haloperidol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
2.1.3 Sulpiride and Levosulpiride . . . . . . . . . . . . . . . . . . . . . . . . . . 44
2.1.4 Loxapine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
xi
xii Contents
2.2 Atypical Antipsychotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
2.2.1 Olanzapine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
2.2.2 Risperidone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
2.2.3 Quetiapine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
2.2.4 Ziprasidone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
2.2.5 Clozapine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
2.2.6 Amisulpride . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
2.2.7 Aripiprazole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
2.2.8 Paliperidone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
2.2.9 Zotepine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
2.2.10 Asenapine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
2.2.11 Iloperidone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
2.3 Newer Atypical Antipsychotic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
2.3.1 Blonanserin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
2.3.2 Lurasidone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
2.4 Depot Antipsychotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
2.5 Description of Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
2.5.1 Flupenthixol Decanoate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
2.5.2 Fluphenazine Decanoate . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
2.5.3 Haloperidol Decanoate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
2.5.4 Pipothiazine Palmitate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
2.5.5 Zuclopenthixol Decanoate . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
2.5.6 Risperidone Long-Acting Injection (RLAI) . . . . . . . . . . . . . 83
2.5.7 Olanzapine Pamoate Long-Acting Injection (OPLAI) . . . . . 84
2.5.8 Aripiprazole Long Acting . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
2.6 Important Tables Related to Antipyschotics . . . . . . . . . . . . . . . . . . . 85
2.7 Points to Remember . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
3 Anxiolytics and Hypnotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
3.1 Benzodiazepines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
3.2 Newer Benzodiazepine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
3.3 Non-Benzodiazepines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
3.4 Beta Blockers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
3.5 Points to Remember . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
4 Mood Stabilizers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
4.1 Lithium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
4.2 Carbamazepine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
4.3 Valproate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
4.4 Gabapentin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
4.5 Topiramate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
4.6 Lamotrigine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
4.7 Points to Remember . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Contents xiii
5 Antiepileptics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
5.1 Phenytoin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
5.2 Oxcarbazepine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
5.3 Tiagabine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
5.4 Zonisamide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
5.5 Levetiracetam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
5.6 Phenobarbitone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
5.7 Carbamazepine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
5.8 Valproic Acid and Divalproex Sodium . . . . . . . . . . . . . . . . . . . . . . 127
5.9 Gabapentin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
5.10 Topiramate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
5.11 Newer Anticonvulsant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
5.12 Points to Remember . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
6 Sympathomimetics and Dopamine Receptor Agonists
(Psycho Stimulants) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
6.1 Amphetamines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
6.2 Modafinil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
6.3 Methylphenidate (d), Methylphenidate (d,l) . . . . . . . . . . . . . . . . . . 135
6.4 Atomoxetine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
6.5 Guanfacine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
6.6 Points to Remember . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
7 Drugs Used in Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
7.1 Cholinesterase Inhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
7.1.1 Tacrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
7.1.2 Donepezil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
7.1.3 Rivastigmine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
7.1.4 Galantamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
7.2 Noncholinesterase Inhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
7.2.1 Memantine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
7.3 Newer Agents: Huperzine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
7.4 Points to Remember . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
8 Antiparkinsonism: Drug Induced . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
9 Drugs Used in Substance Dependence . . . . . . . . . . . . . . . . . . . . . . . . . 153
9.1 Clonidine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
9.2 Disulfiram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
9.3 Naltrexone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
9.4 Varenicline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
9.5 Baclofen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
9.6 Acamprosate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
9.7 Bupropion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
9.8 Buprenorphine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
9.9 Naloxone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
9.10 Points to Remember . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166