• Fanapt: For treatment of schizophrenia in adults
• Latuda:
  • For treatment of schizophrenia
  • Depressive episodes associated with Bipolar I Disorder (bipolar depression) as monotherapy and as adjunctive therapy with lithium or valproate
• Rexulti:
  • For use as adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD)
  • Treatment of schizophrenia
    
• Saphris:
  • Schizophrenia
  • Acute treatment of manic or mixed episodes associated with Bipolar I Disorder as monotherapy or adjunctive treatment to lithium or valproate
• Seroquel XR:
  • Schizophrenia
  • Bipolar I disorder, manic or mixed episodes
  • Bipolar disorder, depressive episodes
  • Major depressive disorder, adjunctive therapy with antidepressants
• Vraylar:
  • Schizophrenia in adults
  • Acute treatment of manic or mixed episodes associated with bipolar 1 disorder
    

• Diagnosis of schizophrenia, schizoaffective disorder, bipolar depression, bipolar manic or mixed episodes, or major depressive disorder

AND

• Failure or clinically significant adverse effects to generic quetiapine AND one of the following atypical antipsychotics: aripiprazole, ziprasidone, olanzapine, risperidone

Schizophrenia, Schizoaffective Disorder, Bipolar Manic or Mixed Episodes:

• Patient has a diagnosis of schizophrenia, schizoaffective disorder, or bipolar manic or mixed episodes

AND

• Failure or clinically significant adverse effects to TWO of the following atypical antipsychotics: aripiprazole, ziprasidone, quetiapine, olanzapine, risperidone

Bipolar Depression:

• Patient has a diagnosis of bipolar depression

AND

• Failure or clinically significant adverse effects to TWO of the following: aripiprazole, ziprasidone, quetiapine, risperidone or olanzapine

OR

• For Latuda only: Diagnosis of metabolic syndrome

Major depressive disorder:

• Diagnosis of major depressive disorder

AND

• Concomitant therapy with an antidepressant medication

AND

• Failure or clinically significant adverse effects to TWO generic atypical antipsychotics (e.g., aripiprazole, ziprasidone, quetiapine, risperidone or olanzapine)

• Non-FDA approved indications, which are not listed in the Health Net Approved Indications and Usage Guidelines section, unless there is sufficient documentation of efficacy and safety in the published literature.

• Fanapt has a black box warning indicating increased mortality in elderly patients with dementia-related psychosis. Prescribers should consider other agents first because Fanapt can prolong the QT interval. It should also be titrated slowly to avoid orthostatic hypotension.
• According to the Texas Medication Algorithm Project (TMAP) and the American Psychiatric Association (APA), the choice of an antipsychotic should be guided by considering the clinical characteristics of the patient and the efficacy and side effect profiles of the medication. At the time of publication, Fanapt was not included. For a patient who experiences a first episode, the consensus is to use a single second generation antipsychotic agent (i.e. Abilify, Zyprexa, Seroquel, Risperdal, or Geodon). There is a lack of consensus to include first generation antipsychotics as an option for first episodes due to extrapyramidal symptoms (EPS) such as acute dystonic reaction, tardive dyskinesia, akathisia and Parkinsonism.
• A ``failure`` to prior therapy is defined as inadequate or lack of symptom control on reasonable doses of an alternative antipsychotic for an adequate trial period.
• For bipolar depression, TMAP recommends treatment with antimanics, lamotrigine, specific antipsychotics (i.e., quetiapine and olanzapine), and SSRIs as monotherapy or in combination prior to considering treatment with other atypical antipsychotics (e.g., aripiprazole, ziprasidone, risperidone).

1. Argo TR, Crimson ML, Miller AL, etal. Texas Medication Algorithm Project Procedural Manual: Schizophrenia Algorithm. The Texas Department of State Health Services. 2007.
2. Lehman AF, Lieberman JA, Dixon LB, etal. Practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry. 2004; 161 (Suppl 2):1-56.
3. Abilify [Prescribing Information]. Princeton, NJ: Bristol-Myers Squibb; February 2012.
4. Fanapt [Prescribing Information]. East Hanover, NJ: Novartis Pharmaceuticals; April 2014.
5. Geodon [Prescribing Information]. New York, NY: Pfizer; November 2009.
6. Risperdal [Prescribing Information]. Titusville, NJ: Janssen; March 2012.
7. Seroquel [Prescribing Information]. Wilmington, DE: Astra Zeneca; November 2011.
8. Zyprexa [Prescribing Information]. Indianapolis, IN: Eli Lilly; June 2011.
9. Seroquel XR [Prescribing Information]. Wilmington, DE: Astra Zeneca; October 2013.
10. Vraylar [Prescribing Information]. Actavis Pharma | Gedeon Richter Plc. September 2015.
11. American Hospital Formulary Service Drug Information Available at: http://www.medicinescomplete.com/mc/ahfs/current/. Accessed online June 17, 2014.
12. MicroMedex accessed at http://www.micromedexsolutions.com/micromedex2/librarian/ Accessed July 23, 2015.
13. American Psychiatric Association Practice Guideline for the Treatment of Patients with Major Depressive Disorder: Third Edition (2010). Available at: http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf. Accessed online July 23, 2015.
14. American Psychiatric Association Practice Guideline for the Treatment of Patients with Bipolar Disorder: Second Edition (2010). Available at: http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bipolar.pdf. Accessed online July 23, 2015.
15. Crismon ML, Argo TR, Bendele SD et al. Texas Medication Algorithm Project Procedural Manual: Bipolar Disorder Algorithms. July 2007. Available at: http://www.harding.edu/assets/druginfo/pdf/tmapalgorithmforbipolardisorder.pdf. Accessed online July 23, 2015.
16. Saphris [Prescribing Information]. St. Louis, MO: Forest Pharmaceuticals Inc.; March 2015.
17. Rexulti [Prescribing Information]. Rockville, MD: Otsuka Pharmaceutical Inc.; July 2015.