Treating schizophrenia with cariprazine: from clinical research to clinical practice. Real world experiences and recomme
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Annals of General Psychiatry Open Access
REVIEW
Treating schizophrenia with cariprazine: from clinical research to clinical practice. Real world experiences and recommendations from an International Panel Andrea Fagiolini1* , José Ángel Alcalá2, Thomas Aubel3, Wojciech Bienkiewicz4, Mats Magnus Knut Bogren5, Joaquim Gago6, Giancarlo Cerveri7, Michael Colla8, Francisco Collazos Sanchez9,10, Alessandro Cuomo1, Frieling Helge11, Eduardo Iacoponi12, Per‑Axel Karlsson13, Pradeep Peddu14, Mauro Pettorruso15, Henrique Jorge Ramos Pereira16, Johan Sahlsten Schölin17 and Ingo Bernd Vernaleken18,19
Abstract Background: Management of schizophrenia is sub-optimal in many patients. Targeting negative symptoms, among the most debilitating aspects of schizophrenia, together with positive symptoms, can result in significant functional benefits and dramatically improve quality of life for patients and their carers. Cariprazine, a partial agonist of the dopamine receptors D2/D3 has demonstrated effectiveness across symptom domains in clinical trials, particularly on negative symptoms. Objective: To obtain a broader insight from clinicians with specific experience with cariprazine, on how it affects patient populations outside the clinical trial setting. Methods: The panel addressed a series of psychopharmacologic topics not comprehensively addressed by the evidence-based literature, including characteristics of patients treated, dosing and switching strategies, duration of therapy, role of concomitant medications and tolerability as well as recommendations on how to individualize cariprazine treatment for patients with schizophrenia. Results: Patients recommended for cariprazine treatment are those with first episodes of psychosis, predominant negative symptoms (maintenance/acute phase) and significant side effects (metabolic side effects, hyperprolactine‑ mia, sedation) with other antipsychotics. When the long-term treatment of a lifetime illness is adequately weighted, cariprazine becomes one of the first-line medications, not only for patients with predominant negative symptoms but also for those with relatively severe positive symptoms, especially if they are at the first episodes and if a specific medi‑ cation is added for symptoms such as agitation or insomnia. For instance, patients with agitation may also benefit from the combination of cariprazine and a benzodiazepine or another sedating agent. Cariprazine may be prescribed as add-on to medications such as clozapine, when that medication alone is ineffective for negative symptoms, and sometimes the first may be discontinued or its dose lowered, after a period of stability, leaving the patient on a better tolerated antipsychotic regimen.
*Correspondence: [email protected] 1 School of Medicine, Department of Molecular Medicine, University of Siena, Siena, Italy Full list of author information is available at the end of the article © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, s
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