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  • N&PD Moderators: Skorpio

Abilify (aripiprazole)

^ And by "dirty", I don't mean impure, but not having a clean pharmacological profile, i.e. hitting several receptors or other targets. In case someone got me wrong.
 
I think we are are really being treated by the drug reps and not the doctors quite often. Doctors seem to get their continuing education about pharmaceuticals from their drug reps who have a definite interest in getting the docs to prescribe their drugs. Kickback programs, trips, etc. have not been uncommon in the past as a reward to the doctors for prescribing the latest greatest drugs.

Apsig, you did absolutely the right thing in questioning your medication. Unfortunately, we have to be proactive and take charge of our own medical care and cannot blindly put our trust in the doctors anymore.
 
Alcyone, it is to a certain extent a guessing game. They don't really care what the drugs hit as long as they see the right biological effect in enough people to get approval and subsequent sales.

This is not the case for all drugs and treatments, obviously. You don't just guess to develop a new treatment for cancers or a disease with more understood pathology.

But as you mention a condition like "depression," which is most of the time simply an excuse for unhappiness that comes from life to be treated as a medical condition, science as a whole doesn't really know what the molecular mechanism behind happiness and sadness is so anything that seems to work is good enough for them to throw towards the unhappy population in hopes of them getting effect off it and providing the drug company with their business.

It is a pitiful way to go about things and not to be fair not all companies share these sorts of logic (it is mostly the big companies trying to rake in profits), but this is the time we are currently living in. Things will get better eventually as science continues to develop but this era of pharmaceutical guesswork is akin to unregulated manufacturing businesses of the 19th/20th Centuries pouring pollution into the air with no regard for the consequences.
 
I agree that the pharmaceutical industry and FDA are more in the wrong, but I the 'standard of care' in psychiatry is rather poor. A physician should not dispense or simply because they are buried with sample packs of this shit. And to be honest........they do not read the prescribing information beyond dosing and indications.....I have met a few who did otherwise, and they charge concierge rates (ie, no insurance accepted, cash up front). Most people cannot afford $300-1,000/month to see the" elite" of the field. But such is the nature of things........

What's more upsetting; television campaigns pushing drugs directly to consumers, aggressively and pervasively. If you're told enough times that "you might be depressed and not know it", you may believe it. But the reach of these companies is immense, extending far into medical literature and research. But, I am not some anti-corporate idealist, they are trying to" sling crack rock" because they don't have a" wicked jump shot" (some rapper, not sure). Is it unethical, sure, but I can think of worse........to maintain solvency they almost need to be morally bankrupt, because legitimate cash-cow wonder-drugs (ex, Viagra), only come along so often.
 
In my field drug reps are not nearly as influential......in fact, due to the inherent risks associated with cardiothoracic anesthesiology (and the larger field, as a whole), an anesthesiologist must be intimately familiar with the anesthetic agents. I even had a wacky elderly instructor who advocated personal trials of anesthetic agents by fellows, administered by other physicians in fellowship. It was not required but many of us took him up on this 'challenge', but he was a rather notorious and 'open' opioid addict (apparently making him limited to academic and intraop advisory). However, I was approached by a rep trying to push lusedra (fospropofol, a disodium phosphate salt....ie, water-soluble). I have no use for Lusedra for the most part, and I prefer the "anesthesiologists best friend", propofol. Funny note on fosprop, it is a C-IV whereas prop is stil Rx only.....the basis of this is due to fosprop's oral activity......................
 
I thought they scheduled propofol in response to the death of Michael Jackson?

I dunno, though, it seems like one would be able to smoke propofol pretty easily [this is absolutely not a good idea!]. One need not achieve anesthesia to get some euphoria, so the therapeutic window is larger for recreational use [but still extremely dangerous!].
 
Propofol is not quite as tricky as people believe, but I agree that self-administration of propofol in the abscense of support is dangerous. Generally, the physicans, PA's, nurses etc, found dead with the syringe in the arm, have abused this compound extensively prior to overdose, and as with IV barbs, the abusers gain a perceptual tolerance.......and as is often the case, the respiratory system eventually "disagrees". And yes, years ago I tried IV veterinary grade propofol, and yes, the subanesthetic high is subjectively cleaner and more pleasurable than IV pentobarb, and does not cause the barb" hangover". This is by NO means an endorsement for abuse, as self-admin can and will eventually result in death. While there is no specific drug designed to reverse the drugs effect, it can be done; I do it regularly in the OR. But please note, I have never seen any patient presenting with a propofol OD, and I don't think I have explain why............. Since we use so much of the compound in anesthesiology, hospitals require huge volumes of the drug in stock, and it is handled rather differently than drugs such as morphine, meperidine etc, which technically must be regularly accounted for by the hospital pharmacists (however in practice, they do a half-assed job). Interestingly, it is much easier to swipe these injectables than it is to take hydrocodone tablets. One could literally walk off with a case of propofol unnoticed, where as a bottle of oxycodone would raise some eyebrows...

Fospropofol, which is a compound I do not use (partially because it not indicated for my use, and moreover, I dislike the unreliable pharmacokinetics and unknown potential toxicities). It has been pushed by reps nonetheless, because it is a name-brand and far more expensive. But its one thing to pimp out 'Abilify' to psychiatrists, but to push general anesthetics seems abit much. Sure propofol can cause injection site irritation, but this generally is a result of hasty or poorly skilled administration. And yes, I've seen one case of severe rhabdo caused by lengthy infusions, and know of some deaths resulting from improper admin (some 'elective' aka cosmetic surgeons are so cheap that they try to handle the anesthesiology, or have the PA do it; which is largely why fatal complications from anesthesiology are more frequent in these settings).
 
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