Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-17T23:26:06.576Z Has data issue: false hasContentIssue false
  • English
  • Français

Avoiding Side Effects in Ethnically Diverse Patients

Published online by Cambridge University Press:  07 November 2014

Henry A. Nasrallah
Henry A. Nasrallah*
Affiliation:
Dr. Nasrallah is Associate Dean and Professor of Psychiatry, Neurology, and Neuroscience at the, University of Cincinnati College of Medicine, in Ohio
*
Henry A. Nasrallah, MD, University of Cincinnati College of Medicine, 231 Albert Sabin Way, #7259, Cincinnati, OH 45267-0559; Tel: 513-558-4615; Fax: 513-271-1993; E-mail: henry.nasrallah@uc.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

Optimal treatment for patients with mental health illness depends upon accurate diagnosis, individualized treatment, patient adherence to effective agents, and an intact family support system. Healthcare system (eg, limited access to certain medications), provider (eg, bias and discrimination), and patient factors (eg, biologic and cultural) greatly influence the level of mental health care given, especially to minority populations. Furthermore, limited data in African Americans, Hispanics, and Asians suggest that there are racial, ethnic, and cultural variations in responsiveness to antipsychotic medications, as well as potential differences in the types, rates, and severity of adverse events. Non-Caucasian patients tend to receive older, less-expensive agents, sometimes at higher doses (African Americans, leading to potentially intolerable side effects and early withdrawal of therapy or a less than optimal therapeutic response, respectively. Differences in response may have a biologic, pharmacokinetic, or pharmacodynamic basis and may also be influenced by lifestyle factors (eg, diet, smoking). Variations in dopamine receptor occupancy and cytochrome P450 polymorphism may explain some racial/ethnic differences in antipsychotic effects and adverse-event profiles, suggesting that dosing may need to be individualized based on ethnicity. The newer atypical antipsychotics, while seemingly better tolerated compared with conventional antipsychotics, may not be totally devoid of bothersome side effects (eg, extrapyramidal side effects) in minorities. While further research is needed, recognition of potential interracial/ethnic pharmacogenetic differences may help minimize intolerable side effects and achieve optimal psychosis management.

Type
Research Article
Information
CNS Spectrums , Volume 10 , Issue S2 , 2005 , pp. 21 - 29
Copyright
Copyright © Cambridge University Press 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.U.S. Census Bureau. Statistical Abstract of the United States, 2001. Available at: http://www.census.gov/prod/2002pubs/01statab/pop.pdf Accessed October 8, 2004.Google Scholar
2.Kalow, W. Pharmacogenetics: past and future. Life Sci. 1990;47:1385–1397.Google Scholar
3.Wood, AJJ, Zhou, HH. Ethnic differences in drug disposition and responsiveness. Clin Pharmacokinet. 1991;20:350–373.CrossRefGoogle ScholarPubMed
4.US Department of Health and Human Services Office of the Surgeon General, SAMHSA, August 2001.Google Scholar
5.Smedley, BD, Stith, AY, Nelson, AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Board on Health Sciences Policy. Institute of Medicine of the National Academies. Available at: http://www.nap.edu/books/030908265X/html/ Accessed February 3, 2004.Google Scholar
6.Herbeck, DM, West, JC, Ruditis, I, et al.Variations in use of second-generation antipsychotic medication by race among adult psychiatric patients. Psychiatr Serv. 2004;55:677–684.Google Scholar
7.Opolka, JL, Rascati, KL, Brown, CM, Gibson, PJ. Ethnicity and prescription patterns for haloperidol, risperidone, and olanzapine. Psychiatr Serv. 2004;55:151–156.Google Scholar
8.Daumit, GL, Crum, RM, Guallar, E, et al.Outpatient prescriptions for atypical antipsychotics for African Americans, Hispanics, and whites in the United States. Arch Gen Psychiatry. 2003;60:121–128.CrossRefGoogle ScholarPubMed
9.Lawson, WB. Clinical issues in the pharmacotherapy of African-Americans. Psychopharmacol Bull. 1996;32:275–281.Google Scholar
10.Lawson, WB. Psychiatric diagnosis of African Americans. In: Herrera, JM, Lawson, WB, Sramek, JJ, eds. Cross Cultural Psychiatry. John Wiley & Sons; 1999:99–104.Google Scholar
11.Lawson, WB. Racial and ethnic factors in psychiatric research. Hosp Comm Psychiatry. 1986;37:48–54.Google Scholar
12.Arnold, LM, Strakowski, SM, Schwiers, ML, et al.Sex, ethnicity, and antipsychotic medication use in patients with psychosis. Schizophr Res. 2004;66:169–175.Google Scholar
13.Bond, WS. Ethnicity and psychotropic drugs. Clin Pharm. 1991;10:467–470.Google Scholar
14.Poland, RE, Lin, KM. Ethnicity and biological markers in depression. In: Lin, KM, Poland, RE, Nakasaki, G, eds. Psychopharmacology and Psychobiology of Ethnicity. Washington DC: American Psychiatric Press; 1993:11–35.Google Scholar
15.Sramek, JJ, Sayles, MA, Simpson, GM. Neuroleptic dosage for Asians: a failure to replicate. Am J Psychiatry. 1986;143:535–536.Google ScholarPubMed
16.Lawson, WB, Herrera, JM, Costa, J. The dexamethasone suppression test as an adjunct in diagnosing depression. J Assoc Acad Minor Phys. 1992;3:17–19.Google Scholar
17.Yamamoto, J, Fung, D, Lo, S, Reece, S. Psychopharmacology for Asian Americans and Pacific Islanders. Psychopharmacol Bull. 1979;15:29–41.Google Scholar
18.Hazlett, SB, McCarthy, ML, Londner, MS, Onyike, CU. Epidemiology of adult psychiatric visits to US emergency departments. Acad Emerg Med. 2004;11:193–195.Google Scholar
19.Tami, M, Palmer, L, Russo, P, Vassey, J. Schizophrenia care and the assessment program: treatment by race. Abstract presented at: the Annual Meeting of the American Psychiatric Association; May 18-23, 2002; Philadelphia, PA. Abstract NR 360.Google Scholar
20.Marin, H. The treatment of American Hispanics with antipsychotics: What do we know? Poster presented at: the Annual Meeting of the American Psychiatric Association; May 17-22, 2003; San Francisco, CA. Poster NR 728.Google Scholar
21.Lawson, WB, Carson, WH, Lam, S, Abou-Gharbia, N, Marcus, RN, Kaplita, S. Safety of aripiprazole in patients with schizophrenia grouped by race. Poster presented at: Annual Meeting of the American Psychiatric Association; May 17-22, 2003; San Francisco, CA. Poster NR 577.Google Scholar
22.Frackiewicz, EJ, Sramek, JJ, Herrerra, JM, Kurtz, NM, Cutler, NR. Ethnicity and antipsychotic response. Ann Pharmacother. 1997;31:1360–1369.Google Scholar
23.Morgenstern, H, Glazer, WM. Identifiying risk factors for tardive dyskinesia among long-term outpatients maintained with neuroleptic medications. Arch Gen Psychiatry. 1993;50:723–733.Google Scholar
24.Glazer, WM, Morgenstern, H, Doucette, J. Race and tardive dyskinesia among outpatients at a CMHC. Hosp Comm Psychiatry. 1994;45:38–42.Google Scholar
25.Jeste, DV, Lindamer, LA, Evans, J, Lacro, JP. Relationship of ethnicity and gender to schizophrenia and pharmacology of neuroleptics. Psychopharmacol Bull. 1996;32:243–251.Google Scholar
26.Sramek, J, Roy, S, Ahrens, T, Pinanong, P, Cutler, NR, Pi, E. Prevalence of tardive dyskinesia among three ethnic groups of chronic psychiatric patients. Hosp Comm Psychiatry. 1991;42:590–592.Google Scholar
27.Lin, KM, Poland, RE, Smith, MW, Strickland, TL, Mendoza, R. Pharmacokinetic and other related factors affecting psychotropic responses in Asians. Psychopharmacol Bull. 1991;27:427–439.Google Scholar
28.Potkin, SG, Shen, Y, Pardes, H, et al.Haloperidol concentrations elevated in Chinese patients. Psychiatry Res. 1984;12:167–172.Google Scholar
29.Binder, RL, Levy, R. Extrapyramidal reactions in Asians. Am J Psychiatry. 1981;138:1243–1244.Google Scholar
30.Lin, KM, Finder, E. Neuroleptic dosage for Asians. Am J Psychiatry. 1983;140:490–491.Google Scholar
31.Poolsup, N, Li Wan Po, A, Knight, TL. Pharmacogenetics and psychopharmacotherapy. J Clin Pharm Ther. 2000;25:197–220.Google Scholar
32.Seeman, P, Lee, T, Chau-Wong, M, Wong, K. Antipsychotic drug doses and neuroleptic/dopamine receptors. Nature. 1976;261:717–719.Google Scholar
33.Seeman, P, Titeler, M, Tedesco, J, Weinreich, P, Sinclair, D. Brain receptors for dopamine and neuroleptics. Adv Biochem Psychopharmacol. 1978;19:167–176.Google Scholar
34.Seeman, P. Atypical antipsychotics: mechanism of action. Can J Psychiatry. 2002;47:27–38.Google Scholar
35.Blum, K, Noble, EP, Sheridan, PJ, et al.Allelic association of human dopamine D2 receptor gene in alcoholism. JAMA. 1990;263:2055–2060.Google Scholar
36.Harris, RZ, Benet, LZ, Schwartz, JB. Gender effects in pharmacokinetics and pharmacodynamics. Drugs. 1995;50:222–239.Google Scholar
37.Mendoza, R, Smith, MW, Poland, RE, Lin, KM, Strickland, TL. Ethnic psychopharmacology: the Hispanic and Native American perspective. Psychopharmacol Bull. 1991;27:449–461.Google ScholarPubMed
38.Desai, NK, Sheth, UK, Mucklow, JC, et al.Antipyrine clearance in Indian villagers. Br J Clin Pharmacol. 1980;9:387–394.CrossRefGoogle ScholarPubMed
39.Fraser, HS, Mucklow, JC, Bulpitt, CJ, et al.Environmental factors affecting antipyrine metabolism in London factory and office workers. Br J Clin Pharmacol. 1979;7:237–243.Google Scholar
40.Bradford, LD. CYP2D6 allele frequency in European Caucasians, Asians, Africans and their descendents. Pharmacogenomics. 2002;3:229–243.Google Scholar
41.Eschelbaum, M, Gross, AS. The genetic polymorphism of debrisoquine/sparteine metabolism-clinical aspects. Pharmacol Ther. 1990;46:377–394.Google Scholar
42.[No authors listed]. Which atypical antipsychotic for schizophrenia? Drug Ther Bull. 2004;42:57–60.Google Scholar
43.Kinon, BJ, Ahl, J, Stauffer, VL, Hill, AL, Buckley, PF. Dose response and atypical antipsychotics in schizophrenia. CNS Drugs. 2004;18:597–616.Google Scholar
44.Casey, DE. The relationship of pharmacology to side effects. J Clin Psychiatry. 1997;58(suppl 10):55–62.Google Scholar
45.Aina, Y, Nandagopol, J, Nasrallah, HA. Endocrine disorders in schizophrenia: relationship to antipsychotic therapy. Curr Psychosis Ther Rep. 2004;2:78–83.Google Scholar
46.Rendell, JM, Gijsman, HJ, Keck, P, Goodwin, GM, Geddes, JR. Olanzapine alone or in combination for acute mania. Cochrane Database Syst Rev. 2003;3:CD004040.Google Scholar
47.Nemeroff, CB. Dosing of antipsychotic medicine olanzapine. J Clin Psychiatry. 1997;58(suppl 10):45–49.Google Scholar
48.Peuskens, J. Risperidone in the treatment of patients with chronic schizophrenia: a multi-national, multi-centre, double-blind, parallel-group study versus haloperidol. Br J Psychiatry. 1995;166:712–726.Google Scholar
49.Owens, DGC. Extrapyramidal side effects and tolerability of risperidone: a review. J Clin Psychiatry. 1994;55(suppl):29–35.Google Scholar
50. Zyprexa® [package insert]. Indianapolis, IN; Eli Lilly and Company; 2004.Google Scholar
51.Daniel, DG, Zimbroff, DL, Potkin, SG, et al.Ziprasidone 80 mg/day and 160 mg/day in the acute exacerbation of schizophrenia and schizoaffective disorder: a 6-week placebo-controlled trial. Neuropsychopharmacology. 1999;20:491–505.Google Scholar
52.Marder, SR, McQuade, RD, Stock, E, et al.Aripiprazole in the treatment of schizophrenia: safety and tolerability in short-term, placebo-controlled trials. Schizophr Res. 2003;61:123–136.Google Scholar
53.Arvanitis, LA, Miller, B, and the Seroquel Trial 13 Study Group. Multiple fixed doses of Seroquel (quetiapine) in patients with acute exacerbation of schizophrenia: a comparison with haloperidol and placebo. Biol Psychiatry. 1997;42:233–246.Google Scholar
54.Jones, M, Huizar, K. Quietiapine monotherapy for mania associated with bipolar disorder. Poster presented at: the 5th International Conference on Bipolar Disorder; June 12-13, 2003; Pittsburgh, PA.Google Scholar
55.Marder, SR, Conley, R, Ereshefsky, L, Kane, JM, Turner, MS. Clinical guidelines: dosing and switching strategies for long-acting risperidone. J Clin Psychiatry. 2003;64:1386–1387.Google Scholar
56.Nemeroff, CB. Dosing the antipsychotic medication olanzapine. J Clin Psychiatry. 1997;58(suppl 10):45–49.Google Scholar
57.Sussman, N. Review of atypical antipsychotics and weight gain. J Clin Psychiatry. 2001;62:5–12.Google Scholar
58.Haddad, PM, Wieck, A. Antipsychotic-induced hyperprolactinaemia: mechanisms, clinical features and management. Drugs. 2004;64:2291–2314.Google Scholar
59.Zhang, XY, Zhou, DF, Cao, LY, Zhang, PY, Wu, GY, Shen, YC. Prolactin levels in male schizophrenic patients treated with risperidone and haloperidol: a double-blind and randomized study. Psychopharmacology (Berl). Published on-line July 31, 2004.Google Scholar
60.Rosenheck, R, Perlick, D, Bingham, S, et al.Effectiveness and cost of olanzapine and haloperidol in the treatment of schizophrenia: a randomized controlled trial. JAMA. 2003;290:2693–2702.Google Scholar