Typical Antipsychotics
Butyrphenones
- Haloperidol (Halodol®)
- Available doses: 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg
- Usual dose: 5 mg to 15 mg PO or IM
- Droperidol (Inapsine®)
- Available doses: 2.5 mg/ml
- Usual dose: 2.5 mg to 10 mg IM
Dibenzoxazepines
- Loxapine (Loxitane®)
- Available doses: 4 mg, 10 mg, 25 mg, 50 mg
- Usual dose: 45 mg, 90 mg
Dihydrindolones
- Molindone (Moban®)
- Available doses: 5 mg, 10 mg, 25 mg, 50 mg
- Usual dose: 30 mg to 60 mg po
Phenothiazines
- Chlorpromazine (Thorazine®)
- Available doses: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg, 100 mg/ml
- Usual dose: 300 mg to 600 mg
- Fluphenazine (Prolixin®)
- Available doses: 1 mg, 2.5 mg, 5 mg, 10 mg
- Usual dose: 5 mg to 15 mg
- Perphenazine (Trilafon®)
- Available doses: 2 mg, 4 mg, 8 mg, 16 mg, 16 mg/ml
- Usual dose: 32 mg to 64 mg
- Trifluoperazine (Stelazine®)
- Available doses: 1 mg, 2 mg, 5 mg, 10 mg
- Usual dose: 15 mg to 30 mg
- Mesoridazine (Serentil®)
- Available doses: 10 mg, 25 mg, 50 mg, 100 mg
- Usual dose: 150 mg to 300 mg
- Thioridazine (Mellaril®)
- Available doses: 10 mg, 15 mg, 25 mg, 50 mg, 100 mg
- Usual dose: 300 mg to 600 mg
Diphenylbutylpiperidine
- Pimozide (Orap®)
- Available doses: 1 mg, 2 mg
- Usual dose:2 mg to 6 mg
Thioxanthenes
- Thiothixene (Navane®)
- Available doses: 1 mg, 2 mg, 5 mg, 10 mg, 20 mg, 5 mg/ml
- Usual dose: 15 mg to 30 mg
Atypical Antipsychotics
- Are used for the treatment of:
- Schizophrenia
- Schizophrenia-related disorders
- Bipolar disorders
- Delusional disorders
- Agitation
- OCD
- Tourette’s syndrome
- Amphetamine abuse
Indication
- Are used for the treatment of:
- Schizophrenia
- Schizophrenia-related disorders
- Bipolar disorders
- Delusional disorders
- Agitation
- OCD
- Tourette’s syndrome
- Amphetamine abuse
Types of antipsychotics
Typical (conventional, first generation):
- Haloperidol (Haldol)
- Preparations:
- Pills
- Liquid
- Injection
- Preparations:
- Droperidole
- Preparations:
- Pills
- Liquid
- Injection
- Preparations:
- Loxapine
- Molindone
- Chlorpromazine (Thorazine)
- Perphenazine
- Fluphenazine
- Trifluoperazine:
- Mesoridazine
- Thioridazine
- Pimozide
- Thiothixene
Atypical (second generation):
- Benefits:
- Lower EPS
- Superior efficacy
- Prevent negative symptoms of schizophrenia
- Less likely to produce hyperprolactinemia
- Adverse effects:
- Atypical antipsychotic medications can cause major weight gain and changes in a person’s metabolism.
- This may increase a person’s risk of getting diabetes and high cholesterol.1
- A person’s weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication.
- Examples:
- Clozapine (Clozaril):
- Is the last choice
- It is a very effective medication that treats psychotic symptoms, hallucinations,
- But clozapine can sometimes cause a serious problem called agranulocytosis, which is a loss of the white blood cells that help a person fight infection.
- clozapine is potentially helpful for people who do not respond to other antipsychotic medications.
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
- Aripiprazole (Abilify)
- Paliperidone (Invega).
- Clozapine (Clozaril):
Side effects
General:
- Dizziness when changing positions
- Dry mouth
- Constipation
- Weight gain
Ocular:
- Blurred vision
- Pigmentary changes in the lens
Cardiac:
- Rapid heartbeat
- Hypotension
- QT prolongation
- Agranulocytosis
Skin:
- Sensitivity to the sun
- Skin rashes
CNS:
- Lowered seizure threshold
- Sedation
- Drowsiness
- Suppressed temperature regulation
Endocrine:
- Menstrual problems for women
- Hyperprolactinemia
- DM
Extrapyramidal:
- Acute Dystonic Reaction:
- Pathophysiology:
- Occurs within hours to days of initiation of treatment
- Uncontrollable spasm of muscles of neck, back, tongue, or lateral eye
- Laryngeal involvement causes stridor
- Treatment:
- Anticholinergics
- Benztropine 1-2 mg po bid
- Diphenhydramine 25-50 mg po tid
- Trihexyphenidyl 5-10 mg po bid
- Beta-blockers:
- Propranolol 20 mg po tid
- Anticholinergics
- Pathophysiology:
- Parkinsonism syndrome:
- Pathophysiology:
- Less dopamine than acetylcholine in Basal Ganglia
- Gradual onset
- Symptoms:
- Masked face
- Cogwheel rigidity
- Slowed movements
- Drooling
- Small handwriting
- Pill-rolling tremor
- Treatment:
- Anticholinergics
- Benztropine 1-2 mg po bid
- Diphenhydramine 25-50 mg po tid
- Trihexyphenidyl 5-10 mg po bid
- Dopaminergic agent:
- Amantadine (elderly) 100 mg po bid
- Anticholinergics
- Pathophysiology:
- Akathisia
- Symptoms:
- Restlessness in the lower extremities
- Inability to site still
- Treatment:
- Switch to atypical antipsychotics
- Add B-blocker or
- Decrease dose
- Symptoms:
- Tardive dyskinesia
- Symptoms:
- Involuntary choreoathetoid movements of face, trunk, or extremities
- Clozapine has low risk of minor risk of TD
- Treatment:
- Discontinue medication
- No Tx
- Symptoms:
- Neuroleptic malignant syndrome
- Pthophysiology:
- Symptoms:
- Marked muscle rigidity
- Fever
- Increased WBC
- Increased CK > 300 U/mL
- Delirium
- Treatment:
- Danterolene 4-8 mg/kg/day
- Bromocriptine 1.25-2.5 mg BID
Response to antipsychotics
- People respond in different ways to antipsychotic medications, and no one can tell beforehand how a person will respond. Sometimes a person needs to try several medications before finding the right one.
- Symptoms of schizophrenia, such as feeling agitated and having hallucinations, usually go away within days. Symptoms like delusions usually go away within a few weeks. After about six weeks, many people will see a lot of improvement.
- Some people may have a relapse—their symptoms come back or get worse. Usually, relapses happen when people stop taking their medication, or when they only take it sometimes.