Volume-9, Issue-6, June 2023

Abstract

Objective: Bipolar I disorder (BD-I) is a psychiatric illness characterized by erratic moods and impulsive behaviors. This survey assesses the prescription preferences among Indian psychiatrists for BD-I, current unmet needs, and benefits of endoxifen (a direct protein kinase C inhibitor) as a mood stabilizing agent in BD-I patients. 

Methods: A literature review was carried out based on data from the PubMed Database to identify relevant articles (published between January 1980 and May 2022) using specific keywords. Twenty clinically relevant questions belonging to six major domains were drafted: (i) key attributes in the selection of psychotropic medications as front-line therapy; (ii) preference for mania and mixed episodes in front-line therapy; (iii) key attributes for the selection of maintenance therapy; (iv) preference for maintenance therapy; (v) role and positioning of endoxifen in front-line and maintenance settings; and (vi) determination of patient subgroups who can experience benefits from endoxifen. A total of 77 psychiatrists with significant experience in managing patients with bipolar disorder were identified across different cities in India. An electronic survey link to the questionnaire was sent to all the participants to record their views. 

Results: For BD-I mania, a combination of mood stabilizers and an atypical antipsychotic was preferred. Typical side effects noted in Indian BD-I patients on lithium, valproate, or carbamazepine therapy include drug-induced tremors, hepatic failure, and metabolic disturbances. Experts suggested endoxifen in patients with acute and severe BD-I mania due to its good efficacy and tolerability profile. For the management of mixed episodes of BD-I, experts preferred endoxifen in combination with an antipsychotic therapy or selective serotonin reuptake inhibitor. Maintenance therapy was suggested in patients with more relapse tendencies and after a severe manic episode that warrants hospitalization. 

Conclusion: The good tolerability profile of endoxifen encourages its use in patients whose current treatment options for BDI bring challenging side effects.

Keywords: Bipolar I disorder, prescribing practices, management, endoxifen, India.

References

References not available