GETTING THE BEST OUT OF ANTIPSYCHOTICS

• Bromperidol May Have the Edge on HaloperidolHaloperidol is well-knownand extensively usedthroughout the world. It was comparedwith its 'sister preparation', bromperidol,in 40 patients,most of whom had schizophrenia[l]. Patients received either bromperidol('Azurene', Cilag-Chemie Ltd,Switzerland) or haloperidol ('Haldol',Janssen Pharmaceutica,Belgium)in a uniform initialdoseof 5mg/day. In 9 casesthisdosagewas unchangedfor the 28 days of the double-blind study. In 31 it was increased. Meandailydoseat the end of the studywas 6.6mg.The most remarkabletherapeuticresults were obtained in the first 2-3 weeks,bromperidolhavingan earliereffectthan haloperidol, and at day 28 symptoms had improved in 65 % ofbromperidol and 50 % of haloperidol cases. On the totalevaluationindex,summing up the ratingsof all 29 psychoticsymptoms, bromperidolalwaysshowedmore improvementthan .haloperidol. Four bromperidoland 3 haloperidol patientsdeveloped Parkinson's diseasebut this was easilycontrolledwithbiperidenhydrochloride('Akineton'),No other extrapyramidal-motor reactionsoccurred.

• Haloperidol and lithium Can be Combined Safely for Treating ManiaFour casesof irreversiblebrain damagein patientstreated concomitantlywith haloperidol and lithium carbonatein a previousstudy gaverise to concernoverthe safetyof this combination.However, in 55 patientsin a more recentstudy there wereno signssuggesting evidence of brain damageor a dyskinesiathat persistedfollowing treatment [2]. 32 patientswere studiedprospectively,and 23 retrospectively. Patientsreceived haloperidol for a mean of 14.2 days in dosesup to 16.4mg!day, and lithium up to1881 mgt day(mean). The highestserum concentrationof lithium was 1.'14mEq!L (range0.27-I .85mEq/L) which was generallylowerthan in the 4 caseswhere brain damagehad previouslybeen reported.No greatadvantagewas obtainedin givinghigherdosesoflithium or more than 20mg haloperidol daily.

There were no irreversible neurologic effects in any of the patients and it wasconcluded that haloperidol and lithium was a safe and effective combination forthe treatment of mania.

• More Frequent Dosage with Chlorpromazine Masks Tardive DyskinesiaTardivedyskinesiahas becomean increasing problemassociatedwith the use of antipsychotics. Several hundred caseshavebeenreportedsince 1957. In 2 schizophrenic patients,administrationof their usual medication, chlorpromazine, qid insteadof once­daily reducedthe severityof dyskinesia, while reversible extrapyramidalsymptoms(pseudoparkinsonism) becameworse[3]. The2 patients, middle-income blackhousewives, had sufferedschizophrenia for 7 and 8 years, during which time they had receivedmainly antipsychotics(phenothiazines and haloperidol), but had alsohadBCf. The 14-weekcrossoverstudy showednosignificantdifferences in the severityof schizophrenic symptoms, nor in involuntary movementsof extremities betweenthe 2treatment frequencies. Onepatient received a dailydoseof chlorpromazine200mg and the other 100mg.

ll] Poldinger, W.: et al.: International Pharmacopsychiatry 12: 184 (No 3. 1977)[2] Juhl, R.P. eta!.: Diseases of the Nervous System 38: 675 (Sep 1977)[3] Jeste, D.V.eta!:: Ibid 38: 755(Sep 1977)

INPHARMA 12th November, 1977 p9