New atypical antipsychotic drug

recently yet another atypical antipsychotic medication has been FDA approved and is commercially available. Lurasidone (Latuda) was approved for the treatment of schizophrenia.  It is claimed to be relatively devoid of weight gain, QT prolongation and metabolic alterations. It does have side effects of sedation, akathesias, parkinsonian symptoms, and agitation. 40 mg once daily is the recommended starting dose.  My own review of data leads to my conclusion that it had little to offer from older drugs. I recommend that the interested reader performa literature search at www.pubmed.gov (search lurasidone) and also read Daniel Carlat's review at "The Carlat Psychiatry Blog"

propoxyphene withdrawn from the U.S. market

Propoxyphene is discussed in the new 12th edition of "A Primer of Drug Action."  On Nov. 19th the FDA has withdrawn propoxyphene (Darvon and Darvocet) from US availability  Withdrawal was necessitated by the rare ocurrence of drug-induced heart rhythm abnormalities that are potentially serious or even fatal.
Bob Julien MD PhD

Buprenorphine implants

The new 12th edition of "A primer of Drug Action" discusses Suboxone therapy for opioid addiction. A recent article by Ling and coworkers at UCLA published in the Journal of the American Medical Association (Oct 13, 2010, vol. 304, pp. 1612-1614) compared 6-months of buprenorphine implants with placebo implants in 163 opioid dependent persons.  Drug free urines in the buprenorphine group occurred in 40% of subjects vs. 28% in placebo-treated persons.  treated persons had a lower incidence of cravings.  Data were encouraging and this offers yet another option for treating opioid dependence.  I would love to see a comparative trial of buprenorphine implants vs. naltrexone implants. That would provide a comparison of a partial agonist vs. an antagonist.  Lets wait and see.
Bob Julien MD PhD

Buprenorphine inplant

Dear Readers: With our 12th edition of "A Primer of Drug Action" released in October 2010, pharmacology continues to progress. In the text I discussed Suboxone (buprenorphine/naloxone) for opioid dependence. I also discussed naltrexone implanted pellets. Now under development is an implantable formulation of buprenorphine (Probuphine) in a polymer matrix sustained 6-month formulation (reference: Drug and Alcohol Dependence, July 2009, volume 103, pp. 37-43). Titan Pharmaceuticals (distributor of Fanapt) is developing this product in the U.S. and currently has it in clinical trial. I refer you to their website: www.titanpharm.com.  This may offer  yet another option for the pharmacological treatment of opioid dependence.  I appreciate the effort, but since buprenorphine is still an agonist opioid (a partial agonist), I hope that development of a naltrexone (antagonist) implant of similar design will be pursued commercially.
Robert Julien, MD PhD