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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by ed_uk on January 19, 2006, at 15:51:23
What does anyone think of this article from Pubmed..........
Med Hypotheses. 2005;65(6):1005-9. Epub 2005 Sep 22.
If 'atypical' neuroleptics did not exist, it wouldn't be necessary to invent them: perverse incentives in drug development, research, marketing and clinical practice.
Charlton BG.
Perverse incentives in drug development, research, marketing and clinical usage can be illustrated by considering the example of the so-called 'atypical' neuroleptics which have grown to become a standard - indeed expanding - part of psychiatric practice despite their probable inferiority to older sedative agents. There is now ample evidence to suggest that neuroleptics (aka. anti-psychotics and major tranquillizers) are dangerous drugs, and patients' exposure to them should be minimized wherever possible. This clinical imperative applies whether neuroleptics are of the traditional type or atypical variety, albeit for different reasons since the traditional agents are neurotoxic, while atypicals are mainly metabolic poisons. Usage of traditional neuroleptics seems indeed to be declining progressively, but the opposite seems to be happening for 'atypicals', and new indications for these drugs are being promoted. Yet the atypical neuroleptics are a category of pharmaceuticals which are close to being un-necessary since there are safer, cheaper and pleasanter substitutes, such as benzodiazepines and the sedative antihistamines (e.g. promethazine, Phenergan). If 'atypical' neuroleptics did not exist, it would not be necessary to invent them. Analysis of how such expensive, dangerous and inferior drugs as the 'atypicals' have nevertheless come to dominate clinical practice casts light on the perverse incentives which now motivate the pharmaceutical industry in an era of massive state regulation. The lack of positive incentives to deploy off-patent drugs is longstanding, but there is a new disincentive in the widespread but erroneous belief that only randomized controlled trials (RCTs) can provide valid 'evidence' of effectiveness. Consequently, those who control RCTs now control clinical practice. It sometimes makes commercial sense to develop and market new drugs that are inferior to existing agents, since new drugs are patent-protected and can be promoted on the back of a mass of new RCTs funded and 'owned' by the pharmaceutical corporations. The current regulatory and patenting situation, therefore, requires major reform if drug efficacy and patient safety are to become higher priorities. Given that psychiatric practice is apparently 'locked-in' to prescribing atypicals, and if (as seems likely) most informed individuals would wish to avoid neuroleptics for themselves and their loved-ones except as a last resort; then in the short-term it may be wise for patients and their families to explore the possibilities of increased self-management of psychiatric problems using over-the-counter drugs, such as the sedative antihistamines. In the long-term, there need to be legal reforms to change the regulatory and commercial framework of incentives relating to drug development. These might include new forms of short-term re-patenting of old drugs.
Posted by ed_uk on January 19, 2006, at 15:53:34
In reply to Atypical APs vs sedative antihistamines, posted by ed_uk on January 19, 2006, at 15:51:23
Anyone feel like ditching Seroquel in favour of Phenergan? You'd certainly save a lot of money if you did LOL.
Ed
Posted by ed_uk on January 19, 2006, at 16:10:24
In reply to Atypical APs vs sedative antihistamines, posted by ed_uk on January 19, 2006, at 15:51:23
Uses of sedative antihistamines in psychiatry......
1. Diphenhydramine (Benadryl)
Insomnia, neuroleptic-induced acute akathisia, neuroleptic-induced dystonia.
2. Promethazine (Phenergan)
Insomnia, acute agitation eg. in schizophrenia or mania.
3. Hydroxyzine (Atarax, Vistaril)
Mild/moderate anxiety
3. Doxylamine
Insomnia
4. Cyproheptadine (Periactin)
Adjunct in schizophrenia, neuroleptic-induced akathisia
5. Chlorpheniramine (Chlor-Trimeton, Piriton)
Depression (perhaps?), anxiety disorders
Ed
Posted by zeugma on January 19, 2006, at 17:02:30
In reply to Atypical APs vs sedative antihistamines, posted by ed_uk on January 19, 2006, at 15:51:23
In the long-term, there need to be legal reforms to change the regulatory and commercial framework of incentives relating to drug development. These might include new forms of short-term re-patenting of old drugs.>>
Excellent idea, but it is a difficult thing to persuade anyone that drug development follows anything but an undeviating path to perfection. I exclude those who have taken the drugs that represent that undeviating path, but they tend not to be the type that get patent laws revised, through no fault of their own.
-z
Posted by Phillipa on January 19, 2006, at 21:16:09
In reply to Re: Atypical APs vs sedative antihistamines, posted by ed_uk on January 19, 2006, at 16:10:24
Well at least my new pdoc isn't giving me an atypical AP. He's sticking with the valium. Love PJ O
Posted by yxibow on January 20, 2006, at 1:18:08
In reply to Re: Atypical APs vs sedative antihistamines, posted by ed_uk on January 19, 2006, at 15:53:34
> Anyone feel like ditching Seroquel in favour of Phenergan? You'd certainly save a lot of money if you did LOL.
>
> EdGood god, Eddy, don't get me within a country mile. Make that 500 country miles of any phenothiazine.
Ever been in an emergency room in college for uncontrollable vomiting and they casually inject you with Compazine? Oh and then they leave you there to pace and want to break the plaster, until finally the nurse call button works and they inject you with Benadryl, which wears off by the time the taxi arrives and you can barely communicate to the driver. Bliss only arrives with an emergency call to your pdoc and klonopin.
No, a hundred times no.
I'll take Seroquel for all its side effects too. Not to mention the BJP averaging of about 1/2% per year of TD on Zyprexa. I don't want to even think about what it is for the phenothiazines.
Posted by ed_uk on January 20, 2006, at 13:25:09
In reply to Re: Atypical APs vs sedative antihistamines » ed_uk, posted by yxibow on January 20, 2006, at 1:18:08
Hi Yxi :)
Promethazine (Phenergan) is not the same as prochlorperazine (Compazine). Prochloperazine (Compazine) is a potent D2 antagonist, similar in many ways to haloperidol (Haldol). Promethazine (Phenergan) is a 'weak' D2 antagonist (as is Seroquel). Both Seroquel and Phenergan are antihistamines.
Regards
Ed
Posted by yxibow on January 21, 2006, at 1:36:03
In reply to Re: Atypical APs vs sedative antihistamines » yxibow, posted by ed_uk on January 20, 2006, at 13:25:09
> Hi Yxi :)
>
> Promethazine (Phenergan) is not the same as prochlorperazine (Compazine). Prochloperazine (Compazine) is a potent D2 antagonist, similar in many ways to haloperidol (Haldol). Promethazine (Phenergan) is a 'weak' D2 antagonist (as is Seroquel). Both Seroquel and Phenergan are antihistamines.
>
> Regards
>
> EdI realize about the Ki values :) But keep me out of that family nonetheless even if it is because of a horrible experience! They all lead far faster to TD, even Phenergan. Both Phenergan and Compazine are used both for anti-emesis, regardless of their strength. They have also been associated with dystonia and other variants of long term use. I wouldn't recommend them for antihistamine use unless no other A1 and A2 blocker worked for a patient, including doxepin, which is a TCA and yes, even that can cause TD although not as much as other tricyclics I believe. And more novel and compassionate things should be used in place of Compazine yet it is still widely used in medicine when other antihistamines and 5HT3 blockers can be used for anti-emesis. It was one of those cases of going to the hospital and getting sicker than staying home. Almost.
Seroquel in vivo is an antihistamine and explains why I am annoyingly loopy and sedated at night. Doesn't particularly solve any seasonal allargies though. It may dry out some patients, I haven't had that experience. It is fortunately far weaker of a D2 antagonist and occupies those receptors for a briefer portion of the day, than, as noted Haloperidol (or even high dose Risperdal which is just Haldol in molecular disguise.)
Posted by ed_uk on January 21, 2006, at 11:25:09
In reply to Re: Atypical APs vs sedative antihistamines » ed_uk, posted by yxibow on January 21, 2006, at 1:36:03
Hi Yxi :)
>They all lead far faster to TD, even Phenergan.
How can you be sure? There have been very few reports of TD with Phenergan.
>But keep me out of that family nonetheless even if it is because of a horrible experience!
I have also had a horrible experience, not with Compazine though, my experience was with Thorazine. I've taken Phenergan too. It caused more drowsiness than Thorazine but much less akathisia.
>Both Phenergan and Compazine are used both for anti-emesis, regardless of their strength.
Phenergan is believed to be antiemetic via its antihistamine and anticholinergic properties. Cyclizine, another antihistamine, has a similar antiemetic effect but doesn't block D2 receptors. Certain atypicals are also antiemetic, such as Zyprexa. Seroquel might be antiemetic too, I'm not sure.
Warm regards
Eddy
Posted by jono_in_adelaide on February 18, 2014, at 0:29:32
In reply to Re: Atypical APs vs sedative antihistamines » yxibow, posted by ed_uk on January 21, 2006, at 11:25:09
I took my first 1mg risperidone at bedtime, and awoke feeling considerably better - that had never happend with Phenergan or Benadryl taken for allergies
Posted by kavinsky99 on February 19, 2014, at 18:41:09
In reply to Re: Atypical APs vs sedative antihistamines, posted by jono_in_adelaide on February 18, 2014, at 0:29:32
I've tried old school antihistamines that are solely commercialized against allergies as sleep aids. They make me sleep (I mean they're able to induce sleep) and actually work quite well against anxiety during the day, but overall, my sleep isn't as refreshing as with some ADs (I use mirtazapine occasionaly as a sleep aid or for days of bad anxiety. it has a strong antihistamine effect) or AAPs. Also, they can be even more debilitating on attention/motivation/memory than an AD or AAP. Could it be because the other medications also act on other neurotransmitters?
But I do notice a lot of people who get a really bad effect on mood from the ADs or AAPs, even on the lowest possible dose, used only for sleep... which doesn't happen with a "pure" h1 blocker, so antihistamines might serve a good purpose for a lot of people.
I do agree that doctors really should explore their options when prescribing medication, based on their knowledge of the human biology and the chemistry of medications... not just going by what other people's guides or pharmaceutical reps tell them.
This is the end of the thread.
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