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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by tecknohed on October 16, 2005, at 8:41:59
I've read that these 2 drugs are in the pipeline for ADHD. Yet they 'are' both modafinil, which of course is already in use.
Attenace is basically just modafinil (Provigil) in specific/higher doses. Uh, why?
"The Attenace application is one way Cephalon is trying to protect its Provigil revenues, said Ilya Kravets, an analyst with investment research firm Mehta Partners of New York. Because Attenace is a different dose of modafinil than Provigil, the FDA treats it as a different drug and it can receive its own patent protections."
http://www.modafinil.com/article/attenace.html
Says it all really!As for Nuvigil, a single isomer of modafinil, it seems to me to be just another Lexapro 'wannabe'.
It is said to last longer in the body than Provigil and may have less of an interaction with birth control pills, which Provigil can render less effective. These would clearly be worthwhile changes but how exactly would removing the inactive isomer bring about such a change in action? Anybody?Teck.
Posted by med_empowered on October 16, 2005, at 9:42:47
In reply to Attenace and Nuvigil - any point?, posted by tecknohed on October 16, 2005, at 8:41:59
The Attenace thing is pure marketing...its like 5mgs Proscar (finasteride) morphing into 1mgs Propecia...suddenly, a "new drug" was invented. The funny thing is...it probably will work. Right now, ADHD applications for Provigil are strictly off-label, and don't seem to be that common. Once Attenace comes out, watch out for the usual "oohs" and "ahhhs" you see in psychiatric journals about any new drug--this one will be particularly welcomed b/c it will be a schedule IV stimulant for ADHD; re-fillable, just like cylert, only more effective than cylert or straterra, and also a viable augmentation option for bipolar, depression, and schizophrenia.
As for the isomer...I dont really know enough to answer that question. I do know that some data (unfortunately, COMPANY SPONSORED DATA) tends to show that lexapro works faster than celexa (and therefore faster than most SSRIs in general) and that's it more effective overall, probably in large part b/c of improved compliance on the part of patients. Its also supposedly a "cleaner" drug than celexa, although celexa is a pretty clean drug itself. I guess a different situation, but one somewhat similar, would be the Tegretol/Trileptal thing; they both work about the same (Tegretol might be more potent, but I haven't seen any hard data to that effect), but Trileptal, b/c of the added oxygen, plays *nicer* (not quite **nice**) with other drugs, and there isn't (usually) a need for blood tests. And then there's the Focalin thing...I'm not all that impressed by Focalin myself (its like the lexapro of ritalin), but I guess it works wonders for some people. At any rate, its about 2X as effective, mg per mg, as old-school ritalin and its side-effect profile is (supposedly) decidedly "cleaner". Speaking from a cynical point of view...it also helps to revive Ritalin as adhd treatment, since adderall has dominated the scene since it was re-introduced to the market in the mid 90s. It also cleans up the images of stimulants in general, allows for a whole new, very expensive series of Focalin drugs (focalin IR, focalin XR, etc.), and allows for expensive combo therapies (ex: ritalin LA+focalin). Brilliant. I read an article recently that said drug companies have pretty much stopped pumping out new, innovative drugs; if you look at the financial break down, big pharma spends more money on advertising than on R+D. Result? Lots of "me-too" drugs (Prozac leads to Zoloft leads to Celexa, etc. etc.) and then lots of Lexpro-type "new drugs"...basically pharmaceutical recycling. You'd expect more, what with the crazy high prices of meds and what not, but hey...maybe this is what happens when you let an industry pretty much self-regulate. Have a good one.
Posted by tecknohed on October 16, 2005, at 10:05:35
In reply to Re: Attenace and Nuvigil - any point?, posted by med_empowered on October 16, 2005, at 9:42:47
Posted by ed_uk on October 16, 2005, at 10:20:50
In reply to Attenace and Nuvigil - any point?, posted by tecknohed on October 16, 2005, at 8:41:59
>Attenace and Nuvigil - any point?
LOL, I doubt it ;-)
~ed
Posted by zeugma on October 16, 2005, at 13:43:22
In reply to Re: Attenace and Nuvigil - any point? » tecknohed, posted by ed_uk on October 16, 2005, at 10:20:50
If Nuvigil has fewer interactions with other meds then it's worth it for those who are dealing with polypharmacy (probably everyone who's reading this post). Provigil affects most of the P450 system to varying extents and generally makes life complicated, becuae it induces some enzymes and inhibits others. It induces its own metabolism by 3A4, and this potentially makes the drug less effective by lowering plasma levels in unpredictable fashion.
I know that Provigil made clotrimazole completely ineffective. I haven't been able to find out what enzyme clotrimazole is metabolized by, but that's part of the problem. A drug that differentially affects so many enzymes is bound to cause unexpected problems.
-z
Posted by ed_uk on October 16, 2005, at 14:33:18
In reply to Re: Attenace and Nuvigil - any point?, posted by zeugma on October 16, 2005, at 13:43:22
Hi Z,
>If Nuvigil has fewer interactions with other meds then it's worth it for those who are dealing with polypharmacy.......
You're right, I should stop being so cynical!
Kind regards
~Ed
This is the end of the thread.
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