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Evaluation of Drug Sorption to PVC- and Non-PVC-based Tubes in Administration Sets Using a Pump
Published on: March 11, 2017
Antipsychotic dosing and drug delivery
Cara R Rabin1, Steven J Siegel
1Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892, USA. cara.rabin@gmail.com
Current Topics in Behavioral Neurosciences
|February 12, 2011
Summary
Antipsychotic medication efficacy is linked to dopamine D2 receptor antagonism. Continuous delivery systems, like depots, offer superior treatment outcomes and adherence compared to oral forms.
Area of Science:
- Pharmacology
- Neuroscience
- Psychiatry
Background:
- The dopamine hypothesis of schizophrenia has historically guided antipsychotic medication development.
- Dopamine D2 receptor antagonism is the primary mechanism for current antipsychotic efficacy and dosing.
- The concept of 'atypicality' arose from early observations of clozapine's unique properties.
Purpose of the Study:
- To review the mechanism of action of antipsychotic medications and its relation to dosing and delivery.
- To explore the role of temporal receptor occupancy and adherence in treatment effectiveness.
- To discuss the advantages and limitations of various drug delivery systems for antipsychotics.
Main Methods:
- Review of historical discoveries and evidence supporting the dopamine hypothesis.
- Analysis of chlorpromazine equivalents for dosing and non-D2 mechanisms.
- Examination of receptor occupancy patterns and adherence issues.
- Evaluation of clinical studies and meta-analyses on depot vs. oral antipsychotics.
- Discussion of barriers and innovations in long-term antipsychotic delivery systems.
Main Results:
- Dopamine D2 receptor antagonism remains central to antipsychotic dosing and efficacy.
- Continuous receptor occupancy is theorized as optimal for treatment effectiveness.
- Long-term depot preparations demonstrate superiority over oral administration in adherence and outcomes.
- Significant barriers exist in developing traditional depot formulations for many antipsychotics.
- Novel delivery systems, including microspheres and implants, are being developed to overcome these limitations.
Conclusions:
- Antipsychotic dosing should be related to dopamine D2 receptor affinity.
- Enhanced efficacy and adherence may be achieved through continuous drug delivery.
- Further development of long-acting injectable and implantable antipsychotic formulations is warranted.
- Addressing clinical, ethical, regulatory, and logistical barriers is crucial for advancing antipsychotic delivery.
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