Tuesday, January 18, 2005
Me and Big Pharm, Part Three, The Tale of Risperidone
Recently out of my residency and military obligation a new and exciting medicine was marketed named Risperidone. Now the excitement was understandable. It is an antipsychotic. Psychosis is the doctor name for nuts. Psychosis is generally understood as marked alterations in the normal patterns of perception (hearing voices), belief (they're all out to get me and I know this to be absolute fact) and thought process (hard to follow and gives you a headache trying to understand what they are talking about. Now many things can cause this from a nasty brain tumor to PCP. The "pure" psychiatric diagnosis is schizophrenia, severe bipolar, psychotic depression or similar.
The problem is that all the medications available were nasty and the patients hated them. Shrinks gave whopping doses for sedation only increasing side effects. So many patient skipped them and relapsed again. They were only partially effective at best. And who wants to put up with very stiff muscles, your eyes rolling back in your head, dopey sedation, dizziness on standing, dry mouth, shaking,...?
But the superhero was in Europe-Clozaril. This stuff was clearly more effective, much more. I can vouch for that in my own practice. But superdrug had plenty of Kryptonite: Sedation, seizures and a very nasty decrease in white blood cells resulting in several deaths. So the FDA was slow to approve and the monitoring was extensive.
So along comes risperidone/Risperidal. The studies showed it was more effective and had less side effects. But there was this funny 3mg twice a day dosing for everyone, not something you see for any psychotropic except Antabuse for alcoholics.
So I tried it whereever it could be useful. I was, and continue to be unimpressed. I have seen the same stiffness and rigidity in the old stuff. It doesn't appear any more effective than the old stuff. It does however make buck for the manufactureer. I'm not saying it doesn't help many people and maybe others have done better with it. There are other new meds now in this class that are superior, at least in side effects.
I have however eaten some very nice meals and only by relocating missed my free golf weekend at a seaside resort. Thanks for the food, but I cannot see prescribing an expensive drug when it doesn't have much benefit over a cheaper one. The problems are minimized by lower doses, but then so also with the old cheap meds. I gave this stuff every attempt to find a good use and prove itself to me. I never expected Michael Jordan here, but Luke Walton would have been cool. Instead our hero is Sam Bowie. Who you ask? He was taken before Jordan, Barkley and Stockton in the 1984 NBA Draft.
The problem is that all the medications available were nasty and the patients hated them. Shrinks gave whopping doses for sedation only increasing side effects. So many patient skipped them and relapsed again. They were only partially effective at best. And who wants to put up with very stiff muscles, your eyes rolling back in your head, dopey sedation, dizziness on standing, dry mouth, shaking,...?
But the superhero was in Europe-Clozaril. This stuff was clearly more effective, much more. I can vouch for that in my own practice. But superdrug had plenty of Kryptonite: Sedation, seizures and a very nasty decrease in white blood cells resulting in several deaths. So the FDA was slow to approve and the monitoring was extensive.
So along comes risperidone/Risperidal. The studies showed it was more effective and had less side effects. But there was this funny 3mg twice a day dosing for everyone, not something you see for any psychotropic except Antabuse for alcoholics.
So I tried it whereever it could be useful. I was, and continue to be unimpressed. I have seen the same stiffness and rigidity in the old stuff. It doesn't appear any more effective than the old stuff. It does however make buck for the manufactureer. I'm not saying it doesn't help many people and maybe others have done better with it. There are other new meds now in this class that are superior, at least in side effects.
I have however eaten some very nice meals and only by relocating missed my free golf weekend at a seaside resort. Thanks for the food, but I cannot see prescribing an expensive drug when it doesn't have much benefit over a cheaper one. The problems are minimized by lower doses, but then so also with the old cheap meds. I gave this stuff every attempt to find a good use and prove itself to me. I never expected Michael Jordan here, but Luke Walton would have been cool. Instead our hero is Sam Bowie. Who you ask? He was taken before Jordan, Barkley and Stockton in the 1984 NBA Draft.
