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This is the Amilsupride & Tianeptine thread, 2 medications unavailable in the US but which I find intriguing. Please feel free to contribute.
Amilsupride and Tianeptine
- Thread starter firedoor
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its amisulpride (rather than amilsupride) which was available in my part of the world. i found it to not be very helpful. it is quite activating as far as antipsychotics go (somewhat like abilify) which is not great for your manic or psychotic patients, and some patients have a hard time tolerating it. also it seems to have a particular affinity to the tuberoinfundibular dopamine receptors hence +++prolactin with problems like low libido, galactorrhea etc worse than risperidone. sulpride is another drug that was used at lower doses (50mg) as an antidepressant in some cases - both these drugs are serotonergic i believe... but again rarely used these days. considering how weak the FDA's standards are (despite what pharma would have us believe) if it's not available here there's probably a good reason - it doesn't work all that well.
Some other drugs not available in US - reboxetine (now shown in a meta-analysis to be the most useless antidepressant), moclobemide (its okay actually i think it has some merit, reversible MAOI selective for MAOI-A), and lofepramine (tricyclic antidepressant but mainly blocks the NET almost no serotonergic effects, major plus is that it is fairly safe in overdose due to little effect on cardiac sodium channels)
Some other drugs not available in US - reboxetine (now shown in a meta-analysis to be the most useless antidepressant), moclobemide (its okay actually i think it has some merit, reversible MAOI selective for MAOI-A), and lofepramine (tricyclic antidepressant but mainly blocks the NET almost no serotonergic effects, major plus is that it is fairly safe in overdose due to little effect on cardiac sodium channels)
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Amisulparide has the best data suggesting that it can work as an augmentation agent of Clozaril in Clozaril-resistant psychosis. This was based on a published literature review of several articles and cases. I used to have a copy of it and I'll look for it but right now I'm in the middle of work.
Darned shame because I've had Clozaril-restistant psychotic patients, or patients where Clozaril was the only thing that worked but they could not be on it or as high a dosage of it due to side effects that occurred after being on it for years.
While there are case studies here and there of a med that seemed to improve someone on Clozaril, they are hit or miss, with as many cases saying it worked vs. not worked.
Darned shame because I've had Clozaril-restistant psychotic patients, or patients where Clozaril was the only thing that worked but they could not be on it or as high a dosage of it due to side effects that occurred after being on it for years.
While there are case studies here and there of a med that seemed to improve someone on Clozaril, they are hit or miss, with as many cases saying it worked vs. not worked.
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Indeed. There's some interesting bits of data on ibuprofen, of all things, on treatment resistant psychosis, for example.
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http://www.gjpsy.uni-goettingen.de/gjp-article-kaempf.pdf
http://www.ncbi.nlm.nih.gov/pubmed/15352931
Was looking for the article I mentioned above and I cannot find it right now but stumbled across these and they're similar to the article I was thinking of. In that original article, they did a lit-search on almost every case ever published where augmentation treatment was added to Clozaril with literally almost any psychotropic med you could think of. Several were hit or miss, but amisulparied almost always caused significant improvement when added with Clozaril.
A benefit I had with my former state job (that I'm now missing tremendously because the new job certainly is tough) is that if I needed to do so, I was able to spend literally hours on just one patient up to 5 days a week. In my current job, I about 3 hours to see 8 patients, and when you include the BS with dealing with insurance companies that want to cut-off payment for treatment, treatment team meetings, spending about 5 minutes per patient just writing the note, and looking for charts (spent 20 minutes today just for one chart that a social worker student took with her not knowing other people needed it), I really only got a few minutes per patient. I was able to spend hours on lit-reviews on real tough cases, then, not so much now.
http://www.ncbi.nlm.nih.gov/pubmed/15352931
Was looking for the article I mentioned above and I cannot find it right now but stumbled across these and they're similar to the article I was thinking of. In that original article, they did a lit-search on almost every case ever published where augmentation treatment was added to Clozaril with literally almost any psychotropic med you could think of. Several were hit or miss, but amisulparied almost always caused significant improvement when added with Clozaril.
A benefit I had with my former state job (that I'm now missing tremendously because the new job certainly is tough) is that if I needed to do so, I was able to spend literally hours on just one patient up to 5 days a week. In my current job, I about 3 hours to see 8 patients, and when you include the BS with dealing with insurance companies that want to cut-off payment for treatment, treatment team meetings, spending about 5 minutes per patient just writing the note, and looking for charts (spent 20 minutes today just for one chart that a social worker student took with her not knowing other people needed it), I really only got a few minutes per patient. I was able to spend hours on lit-reviews on real tough cases, then, not so much now.
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