Last week, the FDA approved the new antipsychotic drug Saphris for the treatment of schizophrenia and bipolar disorder in adults. Saphris is one of a class of brand-name drugs called “atypical antipsychotics” that includes Risperdal, Abilify, Seroquel and Zyprexa.

These “atypical antipsychotics” are distinguished from older, “typical antipsychotics” that include perphenazine, loxapine, haloperidol, thiothixene, and fluphenazine. All of these drugs have long been available as low-cost generics.

And last year, the first generic atypical antipsychotic — a generic version of Risperdal (risperidone) — hit the market, too. The price for risperidone has dropped dramatically in the past year … although your corner pharmacy isn’t necessarily passing along those savings.

For example, a pharmacist blogger did some research and found that while brand-name Risperdal goes for around $500 for 90 1mg tablets, pharmacies he called quoted him anywhere from $126.68 to $410 for the generic equivalent. He noted that many pharmacies cited the higher brand-name price first, so any generic price would sound good by comparison.

So is your best bet a brand-name antipsychotic, generic risperidone, or one of the older antipsychotic drugs?

Well, let’s compare the newest drug to hit the market — Saphris — with risperidone. According to reports:

In clinical trials with schizophrenia patients, Saphris was effective and well tolerated. Although Saphris demonstrated lower efficacy on positive symptoms than [risperidone] … Schering-Plough’s drug presented fewer adverse events than other atypical antipsychotics and some improvements on negative and cognitive symptoms compared to [risperidone]. However, Saphris’s twice-daily dosing regimen may be perceived to be inconvenient in the light of several other once daily options.

So it looks like a trade-off. The FDA, in announcing its approval of the drug, would only say that Saphris worked better than a placebo. We’ll have to see over time if Saphris proves to be worth paying brand-name prices.

My guess is that in most cases — or at least an increasing number of cases — doctors and psychiatrists are prescribing Risperdal first, and then the pharmacy is filling it as a generic, either as required by the insurance provider or at the customer’s request. While doctors like to have a variety of medications to choose from since all patients react differently, the brand-name antipsychotics face a declining market.

As for the older, “typical” antipsychotics, recent research indicates that they in many cases are similar in effectiveness to the newer drugs.

Bottom line: When you talk with your doctor or psychiatrist about antipsychotic medications, be sure to understand why he recommends a specific drug. Some doctors like to start their patients out on a typical antipsychotic first and move on to an atypical antipsychotic only if the initial treatments fail. But most today go straight to the atypicals. If you are concerned about cost, share this with your doctor so he can take this into account in making a recommendation.

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Tags: risperdal, saphris

This entry was posted on Sunday, August 16th, 2009 at 11:48 AM and is filed under drug costs, generic drugs. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.