Penggunaan FLUPHENAZINE DECANOATE di KLINIK PSIKIATRI

Rh Budhi Muljanto

Epidemiology of Schizophrenia

Afflicts 1 in 100 adults; approximately 2.4 million US adults1 Series of relapses and remissions2 Patients generally do not return to baseline functioning Further erosion in functioning after each relapse Educational, employment and social difficulties3 Increased mortality rate 2 - 4 times higher than general population4 Up to 10 times mortality rate in untreated vs. treated patients5 20 to 40% attempt suicide at least once; ~10% die by suicide2 Enormous costs to society and healthcare resources

1. NIMH Fact Sheet, rev 2006, www.nimh.nih.gov/publicat/numbers.cfm; 2. Kaplan and Sadock, 8th Ed; 3. APA 2004 DSM-IV; 4. APA 2004 (practice guideline); 5. Tiihonen et al 2006

Relapse Fuels the Progression of Illness

With each relapse Recovery can be slower and less complete More frequent admissions to hospital Illness can become more resistant to treatment Increased risk of self-harm and homelessness Regaining previous level of functioning is harder Loss of self-esteem Social and vocational disruption Greater use of healthcare resources Increased burden on families, caregivers

Nonadherence in Schizophrenia Patients

>40% of patients are poorly adherent1 Over a 4-year period, the majority will have some difficulties with adherence1 Many will cycle in and out of adherence Nonadherence tends to increase over time2 Nonadherence is not typically a conscious decision3 Clinicians and patients tend to overestimate adherence to the oral treatment regimen4

1. Valenstein M, et al. J Clin Psychiatry. 2006;67:1542; 2. Fleishhacker WW, et al. J Clin Psychiatry. 2003;64:1250; 3. Lacro JP et al. J Clin Psychiatry. 2002;63:892; 4. Byerly M et al. Psychiatry Res. 2005;133:129

Antipsychotics (Neuroleptics)

Typical Neuroleptics

High potency (Haldol) Medium potency (Stelazine) Low potency (Thorazine) Depot/Decanoate (Prolixin-D or Haldol-D/LA) Clozaril Risperidol Zyprexa Seroquel

Atypical Neuroleptics

Pigott-11/98

Benefits of Depot Antipsychotic Medications

Prevention or delay of relapse1,2 Early identification of nonadherence Clear attribution of cause of relapse or nonresponse Improved adherence Regular interactions between patient and healthcare provider Controlled administration Improved global functioning3 Improved interaction with family Patient convenience

1. Davis et al. Drugs. 1994;47:741-773.; 2. Mentschel et al. 156th mtg of APA; San Francisco, May 17-22, 2003. Abstract book, page 71.; 3. Adams et al. Br J Psychiatry. 2001;179:290-299

The Five Ps

Providers (hospitals, clinics, etc.) Patients Physicians Pharmacists/Pharmacy personnel Payers

+ Pharmaceutical manufacturers

Long-acting injectable antipsychotics

1st Generation Fluephenazine deconoate Haloperidol deconoate 2st generation Risperidone [Risperdal Consta] Paliperidone palmitate [monthly] Olanzapine pamoate [monthly]

Only 3 US-Approved Depot Antipsychotics

Fluphenazine Decanoate Type Injection interval Dosing Injection site EPS Tardive Dyskinesia Storage Typical 2 weeks Flexible Deltoid & gluteal Significant Yes Room temp. Haloperidol Decanoate Typical 4 weeks Flexible Deltoid & gluteal Significant Yes Room temp. Risperidone Long-acting Injection Atypical 2 weeks Fixed Unit Gluteal only Few EPS Less Refrigerate