1. Copyright Notice
This presentation is copyrighted by the Psychopharmacology Institute.
Subscribers can download it and use it for professional use.
The contents of the presentation may be modified, but the Psychopharmacology Institute logo must remain visible in all slides.

2. Node 1 Newer SGAs: Could They Be First-Line?
David N. Osser, MD
Associate Professor of Psychiatry
Harvard Medical School
Brockton Division of the VA Boston Healthcare System
General Editor - Psychopharmacology Algorithm Project
Harvard South Shore Residency Training Program

3. I have free samples, shouldn’t I use them?
Unclear role

4. Equivalent to ziprasidone (one study)
Iloperidone (Fanapt)
Initially rejected in 2008
Approved in 2009
Equivalent to ziprasidone (one study)

5. Equivalent to ziprasidone (one study)
Iloperidone (Fanapt)
Initially rejected in 2008
Approved in 2009
Equivalent to ziprasidone (one study)
Marino, J., & Caballero, J. (2010). Iloperidone for the treatment of schizophrenia. Annals of Pharmacotherapy, 44(5),

6. Equivalent to ziprasidone (one study)
Iloperidone (Fanapt)
Initially rejected in 2008
Approved in 2009
Equivalent to ziprasidone (one study)
No role in algorithm

7. Iloperidone (Fanapt) Low incidence of EPS
More weight gain than risperidone
QTc prolongation
Twice-daily administration

8. Sublingual administration
Asenapine (Saphris)
Approved in 2009
Sublingual administration
Practicality?
Only 5% absorbed if swallowed
Evidence
One negative and two positive published studies
Unpublished negative studies

9. Sublingual administration
Asenapine (Saphris)
Approved in 2009
Sublingual administration
Practicality?
Only 5% absorbed if swallowed
Evidence
One negative and two positive published studies
Unpublished negative studies
Janicak, P. G., & Rado, J. T. (2009). Asenapine: a review of the data. Psychopharm Review, 44(12),

10. Sublingual administration
Asenapine (Saphris)
Approved in 2009
Sublingual administration
Practicality?
Only 5% absorbed if swallowed
Evidence
One negative and two positive published studies
Unpublished negative studies
Kane, J. et at (2010). Efficacy and safety of asenapine in a placebo-and haloperidol-controlled trial in patients with acute exacerbation of schizophrenia. Journal of clinical psychopharmacology, 30(2),
Ashih HW. Saphris and Fanapt: two new antipsychotics. Carlat Psychiatry Rep 2009;7:1Y3

11. Potential role in algorithm
Lurasidone (Latuda)
Effectiveness
It may be as effective as aripiprazole, quetiapine and ziprasidone
Seems less effective than olanzapine
Potential role in algorithm
Mild side effects profile
No studies in first-onset patients
Potkin, S. G., Ogasa, M., Cucchiaro, J., & Loebel, A. (2011). Double-blind comparison of the safety and efficacy of lurasidone and ziprasidone in clinically stable outpatients with schizophrenia or schizoaffective disorder. Schizophrenia research, 132(2),
Meltzer, H. Y., Cucchiaro, J., Silva, R., Ogasa, M., Phillips, D., Xu, J., ... & Loebel, A. (2011). Lurasidone in the treatment of schizophrenia: a randomized, double-blind, placebo-and olanzapine-controlled study. American Journal of Psychiatry, 168(9),

12. Potential role in algorithm
Lurasidone (Latuda)
Effectiveness
It may be as effective as aripiprazole, quetiapine and ziprasidone
Less effective than olanzapine
Potential role in algorithm
Mild side effects profile
No studies in first-onset patients
Potkin, S. G., Ogasa, M., Cucchiaro, J., & Loebel, A. (2011). Double-blind comparison of the safety and efficacy of lurasidone and ziprasidone in clinically stable outpatients with schizophrenia or schizoaffective disorder. Schizophrenia research, 132(2),
Meltzer, H. Y., Cucchiaro, J., Silva, R., Ogasa, M., Phillips, D., Xu, J., ... & Loebel, A. (2011). Lurasidone in the treatment of schizophrenia: a randomized, double-blind, placebo-and olanzapine-controlled study. American Journal of Psychiatry, 168(9),

13. Potential role in algorithm
Lurasidone (Latuda)
Effectiveness
It may be as effective as aripiprazole, quetiapine and ziprasidone
Less effective than olanzapine
Potential role in algorithm
Mild side effects profile
No studies in first-onset patients

14. Brexpiprazole (Rexulti)
Approved in 2015
Schizophrenia
Adjunct to antidepressants for MDD
Pharmacology
Less intrinsic activity than aripiprazole at D2 receptors
D2 partial agonist
Rexulti (Brexpiprazole) [Prescribing Information] Otsuka America Pharmaceutical, Inc., Rockville, MD .

15. Brexpiprazole (Rexulti)
Approved in 2015
Schizophrenia
Adjunct to antidepressants for MDD
Pharmacology
Less intrinsic activity than aripiprazole at D2 receptors
D2 partial agonist
Citrome, L. (2015). The ABC's of dopamine receptor partial agonists–aripiprazole, brexpiprazole and cariprazine: the 15 min challenge to sort these agents out. International journal of clinical practice, 69(11), .

16. Cariprazine (Vraylar)
Approved in 2015
Schizophrenia
Mania
Pharmacology
D2 partial agonist
Citrome, L. (2015). The ABC's of dopamine receptor partial agonists–aripiprazole, brexpiprazole and cariprazine: the 15 min challenge to sort these agents out. International journal of clinical practice, 69(11), .

17. Next Video: Drugs Not Recommended at Node 1