New Antipsychotic FDA Approval – Cobenfy
Cobenfy (xanomeline/trospium chloride) has just been approved for schizophrenia treatment in the US. This is huge. It's the first antipsychotic in decades to not target dopamine directly. It's got a much, much better side-effect profile, and it might work for negative and cognitive symptoms.
FOR MORE READING – news report/patient-centred plain language overview: See here.
FOR MORE READING – scientific evidence report: See here (note: the drug is referred to as 'KarXT' in this report).
I couldn't be happier right now. People with psychosis go through so, so much trying to find medications that are both useful and tolerable, and psychiatry has historically neglected psychotic people's needs so, so awfully. (Not to mention how little there is that actually helps with anything other than positive symptoms.) So I'm really, really hoping that with the proof that we can, in fact, make antipsychotics that aren't based on the same old pharmacological things we've tried before. Cobenfy is a muscarinic agonist/antagonist in fixed combination – and it also indirectly regulates dopamine and glutamate. And given that we know both dopamine and NMDA are probably involved in schizophrenia somehow – AND that treating things to do with either is hard – this is so, so, so exciting.
This isn't to say Cobenfy doesn't have side-effects (the most common ones being nausea, constipation, dyspepsia, vomiting, hypertension, dry mouth, and tachycardia. We also know that there is a small risk of extrapyramidal symptoms, and that prolactin-related side-effects do happen, unfortunately). We don't know much about how it affects folks in the long-term, or much about the long-term tardive dyskinesia risk. But even so, it's progress compared to some of the worse antipsychotic side-effects.
Moreover, there is a possibility it might be useful for negative and cognitive symptoms. Holy crap.
I'm really really really excited. I hope this is the start of a shift in psychiatry towards better standards of patient-centred care for psychosis. Y'all have deserved better for far too long – here's hoping this is the start of more ethical, effective treatment.
