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

• Are used for the treatment of:
  • Schizophrenia
  • Schizophrenia-related disorders
  • Bipolar disorders
  • Delusional disorders
  • Agitation
  • OCD
  • Tourette’s syndrome
  • Amphetamine abuse

• Are used for the treatment of:
  • Schizophrenia
  • Schizophrenia-related disorders
  • Bipolar disorders
  • Delusional disorders
  • Agitation
  • OCD
  • Tourette’s syndrome
  • Amphetamine abuse

Typical (conventional, first generation):

• Haloperidol (Haldol)
  • Preparations:
    • Pills
    • Liquid
    • Injection
• Droperidole
  • Preparations:
    • Pills
    • Liquid
    • Injection
• 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).

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
• 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
• Akathisia
  • Symptoms:
    • Restlessness in the lower extremities
    • Inability to site still
  • Treatment:
    • Switch to atypical antipsychotics
    • Add B-blocker or
    • Decrease dose
• 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
• 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

• 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.