Drugs used to Treat Antipsychotic-Induced Weight-Gain (Mnemonic) The following mnemonic is for the drugs used to treat antipsychotic-induced weight gain. The list is not based on priority; however, metformin is the preferred choice, especially when there is comorbid polycystic ovary disease. Orlistat, with calorie restriction, is also an effective choice. FORMAT-B F luoxetine  Orlistat Reboxetine Metformin, methylcellulose, melatonin Topiramate Bupropion 

Drugs and Conditions which Affect Serum Lithium Levels Question Which one of the following may affect blood levels of lithium? A. NSAIDS B. ACE inhibitors C. Thiazide diuretics D. Dehydration

Typical Versus Atypical Antipsychotics By definition, typical antipsychotics are those which produce extrapyramidal side effects, while atypical antipsychotics do not. However, at the doses used today, most atypical antipsychotics do not produce extrapyramidal side effects. Whether typical and atypical antipsychotics differ in efficacy in a long-held debate. Except for clozapine, there are no significant differences in the efficacy of typical and atypical antipsychotics.  Two large pragmatic studies, CATIE  in the United States, and CutLASS  in the United Kingdom, in 2005 and 2006, respectively, produced similar conclusions. Another meta-analysis, in 2009 showed that risperidone, olanzapine, and amisulpride were more effective compared to typical antipsychotics.  Overall, typical antipsychotics are more likely to produce extrapyramidal side effects, while atypical ones are more likely to produce metabolic side effects, including weight gain, hyperlipemia, and diabetes.  Clozapine is mo

Clinical Vignette: Preventing Complication in A Man with Agitation A 30-year-old man, who is a heavy alcohol drinker, presented to the emergency department with agitation, altered sensorium, marked tremors, visual hallucinations. On assessment, he is unaware of the time, place, and person. His blood pressure and pulse were 160/11 and 115/min on arrival but fluctuated on monitoring. A GP had given him haloperidol IM and diazepam IV to control his behavioral disturbance.  What treatment-complication could arise? a)        Seizures b)       Over-sedation c)        Respiratory depression d)       Arrhythmia e)        Worsening agitation Benzodiazepines for the Treatment of Catatonia Safest Treatment Option for Delirium Tremens WHO Alcohol Withdrawal Treatment Guidelines

Interactions of Clozapine The cytochrome P450 system of enzymes in the liver inactivates and removes the toxic substances, including drugs, from the body. These enzymes include CYP 2D6, 2C9, 2C19, and 1 A2. But certain drugs can inhibit or induce these enzymes themselves. Some SSRIs are potent inhibitors of an individual or multiple hepatic cytochrome P450 (CYP) pathways and the magnitude of these effects is dose-related. Several clinically significant drug interactions can, therefore, be predicted. For example, fluvoxamine is a potent inhibitor of CYP1A2 which can result in increased theophylline serum levels, fluoxetine is a potent inhibitor of CYP2D6 which can cause increased seizure risk with clozapine, and paroxetine is a potent inhibitor of CYP2D6 which can cause treatment failure with tamoxifen (a prodrug), leading to increased mortality. Escitalopram has the least impact on these enzymes. QID: 20200407130027659

The Safest NSAID for a patient on lithium What is the most suitable non-steroidal anti-inflammatory drug (NSAID) you can prescribe to a patient who is on Lithium therapy? >> Aspirin or Sulindac. 

  Lithium FAQ 01 What are the indications for lithium? We use lithium in the prophylaxis and treatment of mania, prophylaxis of bipolar disorder, as an augmentation strategy for patients with treatment -resistant depression. What are the common signs of lithium toxicity? Thirst, polyuria, memory problems, tremor, weight gain, tiredness, diarrhea. Cognitive dysfunction is the most common symptom that leads to non-compliance. Side effects are dose-related. What is the concentration at which toxic effects reliably occur? Toxic effects reliably occur at 1.5mmol/l but toxic effects can occur at MUCH LOWER LEVELS in many patients, especially in older patients, systemically ill patients, and in use of alcohol or other CNS active meds What are the two systems lithium causes the most damage to? Thyroid and kidneys What are the differences between the brands of lithium? There are differences in bioavailability, and recommendations are to keep to the patient on the same brand. If it is necess