Posted by med_empowered on February 6, 2007, at 9:57:32
In reply to Re: J+J and Janssen in trouble over Risperdal, posted by SLS on February 6, 2007, at 5:11:16
the problem is that the improvements don't justify the costs, and they certainly don't justify the ridiculous amount of off-label prescribing. Also, typicals vs. atypicals comparisons usually fail to take into account the prescribing practices of shrinks, especially in the 70s-80s, that led to such terrible side effects. For example: in lots of Europe, Thorazine was often given at moderate doses, 300mgs/day or often less. In the United States, docs commonly gave 600,800, 1,000, or more mgs/day even in cases that were not treatment-resistant. Plus, in the 70s and 80s there was a move towards high-dose, high-potency neuroleptics, so instead of giving 300mgs Thorazine like their european counterparts, a US shrink might routintely give 20mgs Haldol. Of course there were problems--neuroleptics in general are unpleasant, and ramping up dosages of high potency neuroleptics will make the patients' lives sheer hell. So when you compare, say, 4mgs Risperdal to 20mgs Haldol (which is a pretty common tactic in studies of atypicals), you will see a huge difference--but this difference is often largely due to excessive dose of the other drug.
One study I read compared zyprexa (dosed based on clinical judgement) to fixed-dose Haldol, 5mgs, with prophylactic benztropine. The results? Overall, there were none--one a few measures zyprexa came out a little ahead, but this didn't reach statistical significance. Think about it: 5mgs of Haldol (not a small dose when you realize some patients do OK on 1-3mgs) plus benztropine did just as well as zyprexa, while costing the government (and the government foots a lot of the
bill for atypicals) less money.
What I'm hoping is that we'll start analyzing neuroleptics in general...I think these drugs help some people, but they can also create some tremendous problems, and many people with psychotic disorders can do well without them.
poster:med_empowered
thread:730044
URL: http://www.dr-bob.org/babble/20070201/msgs/730316.html