[e-drug] Scarcity of essential (?) medicines (2)

["Valeria Frighi" <valeria.frighi@psych.ox.ac.uk>]

E-DRUG: Scarcity of essential (?) medicines (2)
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Dear Atieno,
what about flupenthixol injections?

I have the impression that extra-pyramidal side effects are the same as
with chlorpromazine but the metabolic side effects might not be as bad.
Same for haloperidol, ie less diabetes and weight increase. Even the
best possible  evidence is not very strong in this area  but these are
the antipsychotics I'd go for if chlorpromazine injections became
unavailable (actually, from a strictly medical rather than psychiatric
point of view,  maybe even if they remained available -although this
will have to be judged on each individual patient).

Remember that the term "phenothiazine diabetes" came out in the
American Journal of Psychiatry in 1968.
Moreover, the first evidence of the diabetogenic potential of
chlorpromazine is dated 1954, 2 years after this drug (which should
still be seen as a "godsend" for schizophrenia) was marketed!!

I'm on top of the literature in this field as I work as consultant in
endocrinology and diabetes for our local mental health trusts and I've
also got some large research projects on the go in this area. Still,
although I work extremely closely with the local psychiatrists, I am not
a psychiatrist but a physician.

So, whatever works best for the mental state should be chosen, and that
will have to be evaluated for each individual patient, of course taking
side effects into consideration.

Best wishes,

Valeria

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Dr Valeria Frighi
University Dept. of Psychiatry
Neurosciences Building
Warneford Hospital
Oxford
OX3 7JX
UK

Tel. -44 -1865 -223779
Fax -44 -1865 251076
Mobile phone 07974920013
"Valeria Frighi" <valeria.frighi@psych.ox.ac.uk>