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[PMID]:28376877
[Au] Autor:San L; Estrada G; Oudovenko N; Vieta E
[Ad] Endereço:Mental Health Department, Parc Sanitari Sant Joan de Deu, CIBERSAM, Carrer Camí Vell de la Colonia, 25 Sant Boi de Llobregat, Barcelona, Spain. lsan@pssjd.org.
[Ti] Título:Rationale and design of the PLACID study: a randomised trial comparing the efficacy and safety of inhaled loxapine versus IM aripiprazole in acutely agitated patients with schizophrenia or bipolar disorder.
[So] Source:BMC Psychiatry;17(1):126, 2017 Apr 04.
[Is] ISSN:1471-244X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The management of acute agitation manifesting in patients with schizophrenia or bipolar disorder requires swift pharmacological intervention to provide rapid symptomatic relief and prevent escalation to aggression and violence. Antipsychotic medications are widely used in this setting and the availability of an inhaled formulation with deep lung absorption of the antipsychotic loxapine has the potential to deliver a faster onset of therapeutic effect than the available intramuscular formulations of antipsychotics. METHODS: The efficacy of inhaled loxapine and the alternative antipsychotic aripiprazole delivered via intramuscular (IM) injection will be compared in the Phase IIIb PLACID study. Adults (18-65 years) with a confirmed diagnosis of schizophrenia or bipolar I disorder presenting with acute agitation will be randomly assigned to open-label treatment in a 1:1 ratio. Clinical evaluation will be conducted by raters blinded to treatment assignment. The primary efficacy endpoint is time to response (defined as a Clinical Global Impression of Improvement [CGI-I] score of 1 [very much improved] or 2 [much improved]). Secondary endpoints will include the percentage of responders at different time points after dosing; the proportion of patients who receive 1 or 2 doses of study drug; time to second dose; time to rescue medication; satisfaction with study drug (evaluated using Item 14 of the Treatment Satisfaction Questionnaire for Medication); and safety and tolerability. Approximately 360 patients will be recruited with an interim analysis conducted once 180 patients have completed the study to decide whether to stop for futility or continue with or without an increase in the sample size up to additional 288 patients. DISCUSSION: The PLACID trial will assess the efficacy and safety of inhaled loxapine with deep lung absorption compared with the IM antipsychotic, aripiprazole, in acutely agitated patients with schizophrenia or bipolar disorder. In the event that the median time to response of inhaled loxapine is significantly shorter than that of the intramuscular aripiprazole, the PLACID study has the potential to support the inhaled antipsychotic therapy as the standard of care in this setting. TRIAL REGISTRATION: The study protocol was registered with the European Clinical Trials Database on the 31 October 2014 (EudraCT number 2014-000456-29 ).
[Mh] Termos MeSH primário: Agressão/efeitos dos fármacos
Aripiprazol/uso terapêutico
Transtorno Bipolar/tratamento farmacológico
Protocolos Clínicos
Loxapina/uso terapêutico
Agitação Psicomotora/tratamento farmacológico
Psicologia do Esquizofrênico
[Mh] Termos MeSH secundário: Administração por Inalação
Adolescente
Adulto
Idoso
Antipsicóticos/administração & dosagem
Antipsicóticos/efeitos adversos
Antipsicóticos/uso terapêutico
Aripiprazol/administração & dosagem
Aripiprazol/efeitos adversos
Transtorno Bipolar/complicações
Seres Humanos
Injeções Intramusculares
Loxapina/administração & dosagem
Loxapina/efeitos adversos
Masculino
Meia-Idade
Agitação Psicomotora/complicações
Esquizofrenia/complicações
Esquizofrenia/tratamento farmacológico
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antipsychotic Agents); 82VFR53I78 (Aripiprazole); LER583670J (Loxapine)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170731
[Lr] Data última revisão:
170731
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170406
[St] Status:MEDLINE
[do] DOI:10.1186/s12888-017-1291-5


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[PMID]:28335658
[Au] Autor:Hellings JA; Arnold LE; Han JC
[Ad] Endereço:a Kansas City Regional Center of Missouri Department of Mental Health , University of Missouri-Kansas City , Kansas City , MO , USA.
[Ti] Título:Dopamine antagonists for treatment resistance in autism spectrum disorders: review and focus on BDNF stimulators loxapine and amitriptyline.
[So] Source:Expert Opin Pharmacother;18(6):581-588, 2017 Apr.
[Is] ISSN:1744-7666
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Drug development and repurposing are urgently needed for individuals with autism spectrum disorders (ASD) and psychiatric comorbidity, which often presents as aggression and self-injury. Areas covered: We review dopamine antagonists, including classical and atypical, as well as unconventional antipsychotics in ASD. The older antipsychotic loxapine is discussed in terms of preliminary albeit limited evidence in ASD. Emerging promise of amitriptyline in ASD is discussed, together with promising BDNF effects of loxapine and amitriptyline. Expert opinion: In ASD, pharmacotherapy and specifically dopamine antagonist drugs are often prescribed for challenging behaviors including aggression. The novel antipsychotics risperidone and aripiprazole have received most study in ASD and are FDA-approved for irritability in children with ASD over age 5 years; individuals with ASD are prone to weight gain, Type II diabetes and associated side effects. Low dose loxapine has properties of classical and novel antipsychotics but importantly appears more weight neutral, and with promising use in adolescents and adults with ASD. Amitriptyline appears effective in ASD for irritability, aggression, gastrointestinal problems, and insomnia, in children, adolescents and adults however our adult data on amitriptyline in ASD is still in preparation for publication. Both loxapine and amitriptyline may stimulate BDNF; further studies are warranted.
[Mh] Termos MeSH primário: Amitriptilina/uso terapêutico
Transtorno do Espectro Autista/tratamento farmacológico
Loxapina/uso terapêutico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Amitriptilina/farmacologia
Antipsicóticos/uso terapêutico
Aripiprazol/uso terapêutico
Fator Neurotrófico Derivado do Encéfalo/metabolismo
Criança
Antagonistas de Dopamina/uso terapêutico
Seres Humanos
Humor Irritável/efeitos dos fármacos
Risperidona/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antipsychotic Agents); 0 (Brain-Derived Neurotrophic Factor); 0 (Dopamine Antagonists); 1806D8D52K (Amitriptyline); 82VFR53I78 (Aripiprazole); L6UH7ZF8HC (Risperidone); LER583670J (Loxapine)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170417
[Lr] Data última revisão:
170417
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170325
[St] Status:MEDLINE
[do] DOI:10.1080/14656566.2017.1308483


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[PMID]:28208695
[Au] Autor:de Berardis D; Fornaro M; Orsolini L; Iasevoli F; Tomasetti C; de Bartolomeis A; Serroni N; Valchera A; Carano A; Vellante F; Marini S; Piersanti M; Perna G; Martinotti G; Di Giannantonio M
[Ad] Endereço:The National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, 64100 Teramo, Italy. domenico.deberardis@aslteramo.it.
[Ti] Título:The Role of Inhaled Loxapine in the Treatment of Acute Agitation in Patients with Psychiatric Disorders: A Clinical Review.
[So] Source:Int J Mol Sci;18(2), 2017 Feb 08.
[Is] ISSN:1422-0067
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:Loxapine is a first generation antipsychotic, belonging to the dibenzoxazepine class. Recently, loxapine has been reformulated at a lower dose, producing an inhaled powder that can be directly administered to the lungs to treat the agitation associated with psychiatric disorders, such as schizophrenia and bipolar disorder. Thus, the aim of this narrative and clinical mini-review was to evaluate the efficacy and tolerability of inhaled loxapine in the treatment of acute agitation in patients with psychiatric disorders. The efficacy of inhaled loxapine has been evaluated in one Phase II trial on patients with schizophrenia, and in two Phase III trials in patients with schizophrenia and bipolar disorder. Moreover, there are two published case series on patients with borderline personality disorder and dual diagnosis patients. Inhaled loxapine has proven to be effective and generally well tolerated when administered to agitated patients with schizophrenia and bipolar disorder. Two case series have suggested that inhaled loxapine may also be useful to treat agitation in patients with borderline personality disorder and with dual diagnosis, but further studies are needed to clarify this point. However, the administration of inhaled loxapine requires at least some kind of patient collaboration, and is not recommended in the treatment of severe agitation in totally uncooperative patients. Moreover, the drug-related risk of bronchospasm must always be kept in mind when planning to use inhaled loxapine, leading to a careful patient assessment prior to, and after, administration. Also, the higher costs of inhaled loxapine, when compared to oral and intramuscular medications, should be taken into account when selecting it for the treatment of agitation.
[Mh] Termos MeSH primário: Antipsicóticos/administração & dosagem
Loxapina/administração & dosagem
Transtornos Mentais/complicações
Agitação Psicomotora/tratamento farmacológico
Agitação Psicomotora/etiologia
[Mh] Termos MeSH secundário: Antipsicóticos/efeitos adversos
Antipsicóticos/farmacocinética
Ensaios Clínicos como Assunto
Seres Humanos
Inalação
Loxapina/efeitos adversos
Loxapina/farmacocinética
Transtornos Mentais/diagnóstico
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antipsychotic Agents); LER583670J (Loxapine)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170428
[Lr] Data última revisão:
170428
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170218
[St] Status:MEDLINE


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[PMID]:28152454
[Au] Autor:Meng M; Zhao N; Pederson CC; Harrison E; Green C; Gorman SH; Reuschel S
[Ad] Endereço:Covance Laboratories, Inc., United States. Electronic address: minmeng923@gmail.com.
[Ti] Título:Simultaneous quantification of loxapine, loxapine N-oxide, amoxapine, 8-hydroxyloxapine and 7-hydroxyloxapine in human plasma using LC-MS/MS.
[So] Source:J Chromatogr B Analyt Technol Biomed Life Sci;1046:87-97, 2017 Mar 01.
[Is] ISSN:1873-376X
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Loxapine is an antipsychotic medication used for the treatment of schizophrenia. In vivo, loxapine is metabolized to multiple metabolites. A high performance liquid chromatographic-tandem mass spectrometry (LC-MS/MS) method has been developed and validated for the determination of loxapine and 4 of its metabolites, loxapine N-oxide, amoxapine (N-desmethyl loxapine), 8-hydroxyloxapine and 7-hydroxyloxapine, in human plasma to support regulated clinical development. During method development, several technical challenges such as poor chromatography, separation of structural isomers, and inadequate sensitivity were met and overcome. The final method utilized micro-elution solid phase extraction (SPE) to extract plasma samples (100µL), and the resulting extracts were analyzed using reversed phase LC-MS/MS using a turbo-ionspray interface in positive ionization mode with selected reaction monitoring (SRM). The method was fully validated according to the current regulatory guidance for bioanalysis over the calibration curve range 0.0500-50.0ng/mL for all analytes using 1/x -weighted linear regression analysis. Based on three separate runs, the between-run precision and inter-day precision for all five analytes at all concentrations, including the LLOQ (lower limit of quantitation) quality control at 0.0500ng/mL, varied from 0.0% to 13.8%, while the accuracy ranged from 86.4% to 109.3% of nominal. The extraction recoveries of loxapine and the four metabolites were above 80%. Various forms of short-term and long-term stability were established in both solutions and matrix, including the stability of loxapine and the four metabolites in human plasma for up to 260days of storage at -20°C. This method has been used to support a regulated clinical study, which included the successful execution of incurred sample reanalysis (ISR) testing. To the best of our knowledge, this is the first published methodology in which these five analytes were quantified with a single extraction and injection.
[Mh] Termos MeSH primário: Cromatografia Líquida de Alta Pressão/métodos
Loxapina/análogos & derivados
Loxapina/sangue
Espectrometria de Massas em Tandem/métodos
[Mh] Termos MeSH secundário: Adolescente
Antipsicóticos/sangue
Antipsicóticos/farmacocinética
Antipsicóticos/uso terapêutico
Criança
Seres Humanos
Limite de Detecção
Modelos Lineares
Loxapina/farmacocinética
Loxapina/uso terapêutico
Reprodutibilidade dos Testes
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE I; JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Antipsychotic Agents); LER583670J (Loxapine)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170522
[Lr] Data última revisão:
170522
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170203
[St] Status:MEDLINE


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[PMID]:27421880
[Au] Autor:Jørgensen TR; Emborg C; Dahlen K; Bøgelund M; Carlborg A
[Ad] Endereço:Medivir AB, Blasieholmsgatan 2, 111 48, Stockholm, Sweden. Tine.Rikke.Jorgensen@medivir.com.
[Ti] Título:The effect of the medicine administration route on health-related quality of life: Results from a time trade-off survey in patients with bipolar disorder or schizophrenia in 2 Nordic countries.
[So] Source:BMC Psychiatry;16:244, 2016 Jul 16.
[Is] ISSN:1471-244X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Agitation episodes are common among patients with schizophrenia or bipolar disorder. Oral and intramuscular administration methods are commonly used in pharmacological treatment of acute agitation. Recently, an innovative inhalation product with loxapine(Adasuve®)has become available for treatment of acute agitation episodes associated with bipolar disorder or schizophrenia. The objective for the present study was to investigate the impact of the pharmacological treatment's administration methods on the health-related quality of life (HRQoL) in patients with bipolar disorder or schizophrenia in Denmark and Sweden using a time trade-off (TTO) approach. METHODS: The TTO methodology was used to examine the HRQoL impact of administration method of pharmacological treatment of acute agitation. Data were collected via an internet-based survey, using an existing panel of respondents with schizophrenia or bipolar disorder. RESULTS: Respondents considered living with schizophrenia/ bipolar disorder, having one yearly agitation episode treated with inhaler better than living with the same conditions and receiving treatment with tablet or injection. The utility value was 0.762 for inhalable treatment, 0.707 for injection and 0.734 for tablet treatment. CONCLUSIONS: Patients' preference for treatment delivery options showed that inhalation was associated with a significant utility gain when compared to injection or tablets. Inhalable loxapine may be a new tool for control of agitation episodes for strengthening the patient provider alliance when taking patient's preference for delivery method into consideration.
[Mh] Termos MeSH primário: Administração por Inalação
Administração Oral
Injeções Intramusculares
Loxapina/administração & dosagem
Agitação Psicomotora/tratamento farmacológico
Qualidade de Vida
[Mh] Termos MeSH secundário: Adulto
Antipsicóticos/administração & dosagem
Antipsicóticos/uso terapêutico
Transtorno Bipolar/complicações
Transtorno Bipolar/tratamento farmacológico
Feminino
Seres Humanos
Loxapina/uso terapêutico
Masculino
Preferência do Paciente
Agitação Psicomotora/complicações
Esquizofrenia/complicações
Esquizofrenia/tratamento farmacológico
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antipsychotic Agents); LER583670J (Loxapine)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170731
[Lr] Data última revisão:
170731
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160717
[St] Status:MEDLINE
[do] DOI:10.1186/s12888-016-0930-6


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[PMID]:27416108
[Au] Autor:Chua AL; Silberstein S
[Ad] Endereço:a Jefferson Headache Center , Thomas Jefferson University , Philadelphia , PA , USA.
[Ti] Título:Inhaled drug therapy development for the treatment of migraine.
[So] Source:Expert Opin Pharmacother;17(13):1733-43, 2016 Sep.
[Is] ISSN:1744-7666
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The inhalation of substances, both medicinally and recreationally, is a commonly used method of drug administration but has been underutilized in the treatment of neurologic disorders such as migraine. Three drugs have been studied as potential inhalable treatments for acute migraine: dihydroergotamine (MAP0004), prochlorperazine (Staccato prochlorperazine), and loxapine (Staccato loxapine). AREAS COVERED: This review discusses the available literature describing the pharmacokinetics, tolerability and efficacy of MAP0004, Staccato prochlorperazine and Staccato loxapine, including data from Phase II and Phase III clinical trials. EXPERT OPINION: Inhaled DHE offers rapid absorption with a pharmacokinetic profile similar to IV administration. Improved side effect profile results from more selective binding at antimigraine serotonergic receptors 5-HT1B and 5-HT1D. Inhaled prochlorperazine is rapidly absorbed and resulted in statistically significant migraine pain relief at 2 hours compared to placebo but is not currently being pursued by the manufacturer as a potential migraine abortive. Inhaled loxapine is also rapidly absorbed into systemic circulation but Phase IIb trials did not show statistically improved pain relief or pain freedom compared to placebo. MAP0004 will likely provide a good alternative to patients seeking rapid relief without the need for injection or other invasive routes.
[Mh] Termos MeSH primário: Di-Hidroergotamina/administração & dosagem
Loxapina/administração & dosagem
Transtornos de Enxaqueca/tratamento farmacológico
Proclorperazina/administração & dosagem
[Mh] Termos MeSH secundário: Administração por Inalação
Animais
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
436O5HM03C (Dihydroergotamine); LER583670J (Loxapine); YHP6YLT61T (Prochlorperazine)
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160715
[St] Status:MEDLINE
[do] DOI:10.1080/14656566.2016.1203901


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[PMID]:27173632
[Au] Autor:Cumin M; Fercot É; Boric A; Cudennec T
[Ad] Endereço:Service de médecine gériatrique, HU-PIFO, site Ambroise Paré (AP-HP), 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
[Ti] Título:[Not Available].
[Ti] Título:21/21 Complications en cascade au cours d'une hospitalisation..
[So] Source:Soins Gerontol;(119):45-6, 2016 May-Jun.
[Is] ISSN:1268-6034
[Cp] País de publicação:France
[La] Idioma:fre
[Mh] Termos MeSH primário: Hospitalização
Síndrome Maligna Neuroléptica/diagnóstico
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Agressão
Antipsicóticos/efeitos adversos
Transtornos Cognitivos/etiologia
Seres Humanos
Loxapina/efeitos adversos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antipsychotic Agents); LER583670J (Loxapine)
[Em] Mês de entrada:1608
[Cu] Atualização por classe:160513
[Lr] Data última revisão:
160513
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:160514
[St] Status:MEDLINE


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[PMID]:27121764
[Au] Autor:Pollack CV
[Ad] Endereço:a Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA.
[Ti] Título:Inhaled loxapine for the urgent treatment of acute agitation associated with schizophrenia or bipolar disorder.
[So] Source:Curr Med Res Opin;32(7):1253-60, 2016 Jul.
[Is] ISSN:1473-4877
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Acute agitation is a serious complication of schizophrenia and bipolar disorder, which may escalate quickly to aggressive behavior. Rapid treatment is therefore important to calm and stabilize the patient, reducing the potential for harm to the patient and others, and allowing further assessment. Current guidelines suggest that where pharmacologic intervention is indicated, medication should preferably be non-invasive, should have a rapid onset and should control aggressive behavior in the short term without compromising the physician-patient relationship in the long term. OBJECTIVES: This article presents an overview of a new inhaled formulation of the established antipsychotic loxapine, which aims to provide a more rapidly acting agent for the treatment of acute agitation without the disadvantages of intramuscular or intravenous injection. DISCUSSION: Inhaled loxapine is rapidly absorbed with intravenous-like pharmacokinetics, with a time to maximum plasma concentration of 2 minutes and a plasma half-life of approximately 6 hours. In phase III studies, loxapine reduced agitation within 10 minutes of inhalation; agitation was decreased at all subsequent assessments during a 24-hour evaluation period. Inhaled loxapine was generally well tolerated with no undue sedation. The most common adverse events were dysgeusia, mild sedation, and dizziness. Inhaled loxapine is contraindicated in patients with asthma, COPD or other pulmonary disease associated with bronchospasm. CONCLUSIONS: Inhaled loxapine rapidly reduces acute agitation in patients with schizophrenia or bipolar disorder and is generally well tolerated. The non-invasive route of delivery respects the patient's autonomy, reducing the perception of coercion or forced medication. Inhaled loxapine is therefore an effective and appropriate option for use in the emergency setting in patients with acute agitation.
[Mh] Termos MeSH primário: Antipsicóticos
Transtorno Bipolar/tratamento farmacológico
Loxapina
Agitação Psicomotora/tratamento farmacológico
Esquizofrenia/tratamento farmacológico
[Mh] Termos MeSH secundário: Administração por Inalação
Antipsicóticos/administração & dosagem
Antipsicóticos/efeitos adversos
Antipsicóticos/farmacocinética
Antipsicóticos/uso terapêutico
Seres Humanos
Loxapina/administração & dosagem
Loxapina/efeitos adversos
Loxapina/farmacocinética
Loxapina/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antipsychotic Agents); LER583670J (Loxapine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160429
[St] Status:MEDLINE
[do] DOI:10.1185/03007995.2016.1170004


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[PMID]:27015036
[Au] Autor:Roncero C; Ros-Cucurull E; Grau-López L; Fadeuilhe C; Casas M
[Ad] Endereço:*Addiction and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital-Public Health Agency, Barcelona (ASPB), CIBERSAM; and †Department of Psychiatry and Legal Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain.
[Ti] Título:Effectiveness of Inhaled Loxapine in Dual-Diagnosis Patients: A Case Series.
[So] Source:Clin Neuropharmacol;39(4):206-9, 2016 Jul-Aug.
[Is] ISSN:1537-162X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Episodes of psychotic agitation are frequent in patients with dual diagnosis, that is, in patients with concomitant psychiatric and substance use disorders. Rapid intervention is needed to treat the agitation at a mild stage to prevent the escalation to aggressive behavior. Inhaled loxapine has been demonstrated to rapidly improve symptoms of mild-to-moderate agitation in adults with psychiatric disorders (schizophrenia and bipolar disorder), but data on patients with dual diagnosis are scarce. METHODS: This study is a retrospective review of data from a case series of patients with dual diagnosis, which were attended for symptoms of agitation while at the emergency room (n = 9), in the outpatient clinic (n = 4), or during hospitalization (n = 1) at 1 center in Spain. All patients received inhaled loxapine for treating the agitation episodes. RESULTS: Data from 14 patients with dual diagnosis were reviewed. All patients had 1 or more psychiatric disorders (schizophrenia, bipolar I disorder, drug-induced psychotic disorder, posttraumatic stress, borderline or antisocial personality disorder, depression, or anxiety) along with a variety of substance use disorders (alcohol, cocaine, cannabis, amphetamines, hypnotics and antianxiety drugs, caffeine, or street drugs). Overall, only 1 dose of inhaled loxapine (9.1 mg) was needed to calm each patient during an acute episode of agitation. CONCLUSIONS: Inhaled loxapine was rapid, effective, and well accepted in all dual-pathology patients presenting with acute agitation in the emergency setting. Inhaled loxapine facilitated both patient cooperation and an adequate management of his or her disease.
[Mh] Termos MeSH primário: Antipsicóticos/uso terapêutico
Loxapina/uso terapêutico
Agitação Psicomotora/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Transtornos de Ansiedade/complicações
Transtorno Bipolar/complicações
Diagnóstico Duplo (Psiquiatria)
Feminino
Seres Humanos
Masculino
Meia-Idade
Escalas de Graduação Psiquiátrica
Agitação Psicomotora/diagnóstico
Agitação Psicomotora/etiologia
Estudos Retrospectivos
Esquizofrenia/complicações
Transtornos Relacionados ao Uso de Substâncias/complicações
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antipsychotic Agents); LER583670J (Loxapine)
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170120
[Lr] Data última revisão:
170120
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160326
[St] Status:MEDLINE
[do] DOI:10.1097/WNF.0000000000000153


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[PMID]:26973742
[Au] Autor:Zeller SL; Citrome L
[Ad] Endereço:Alameda Health System, Department of Psychiatric Emergency Services, Oakland, California; University of California-Riverside, Department of Psychiatry, Riverside, California.
[Ti] Título:Managing Agitation Associated with Schizophrenia and Bipolar Disorder in the Emergency Setting.
[So] Source:West J Emerg Med;17(2):165-72, 2016 Mar.
[Is] ISSN:1936-9018
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Patient agitation represents a significant challenge in the emergency department (ED), a setting in which medical staff are working under pressure dealing with a diverse range of medical emergencies. The potential for escalation into aggressive behavior, putting patients, staff, and others at risk, makes it imperative to address agitated behavior rapidly and efficiently. Time constraints and limited access to specialist psychiatric support have in the past led to the strategy of "restrain and sedate," which was believed to represent the optimal approach; however, it is increasingly recognized that more patient-centered approaches result in improved outcomes. The objective of this review is to raise awareness of best practices for the management of agitation in the ED and to consider the role of new pharmacologic interventions in this setting. DISCUSSION: The Best practices in Evaluation and Treatment of Agitation (BETA) guidelines address the complete management of agitation, including triage, diagnosis, interpersonal calming skills, and medicine choices. Since their publication in 2012, there have been further developments in pharmacologic approaches for dealing with agitation, including both new agents and new modes of delivery, which increase the options available for both patients and physicians. Newer modes of delivery that could be useful in rapidly managing agitation include inhaled, buccal/sublingual and intranasal formulations. To date, the only formulation administered via a non-intramuscular route with a specific indication for agitation associated with bipolar or schizophrenia is inhaled loxapine. Non-invasive formulations, although requiring cooperation from patients, have the potential to improve overall patient experience, thereby improving future cooperation between patients and healthcare providers. CONCLUSION: Management of agitation in the ED should encompass a patient-centered approach, incorporating non-pharmacologic approaches if feasible. Where pharmacologic intervention is necessary, a cooperative approach using non-invasive medications should be employed where possible.
[Mh] Termos MeSH primário: Antipsicóticos/administração & dosagem
Transtorno Bipolar/complicações
Serviço Hospitalar de Emergência/organização & administração
Loxapina/administração & dosagem
Agitação Psicomotora/tratamento farmacológico
Esquizofrenia/complicações
[Mh] Termos MeSH secundário: Administração por Inalação
Gerenciamento Clínico
Seres Humanos
Guias de Prática Clínica como Assunto
Sociedades Médicas
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Antipsychotic Agents); LER583670J (Loxapine)
[Em] Mês de entrada:1612
[Cu] Atualização por classe:170220
[Lr] Data última revisão:
170220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160315
[St] Status:MEDLINE
[do] DOI:10.5811/westjem.2015.12.28763



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