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AntipsychoticAka: Anti-Psychotic, Neuroleptic

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  1. Indications
    1. Psychosis (e.g. Schizophrenia)
  2. Efficacy: Newer low potency agents
    1. Atypicals only slightly better than high potency agents
      1. Similar efficacy in control of Psychosis
      2. Slightly less Extrapyramidal Side Effects (EPSE)
        1. Clozapine has much less EPSE, but has diabetes risk
      3. Higher weight, lipid and diabetes related conditions
      4. Compliance is similar for both types of agents
      5. Atypical antipsychotics are much more expensive
    2. References
      1. Barry (2003) Am Fam Physician 68(5):943
      2. Leucht (2003) Lancet 361:1581
  3. Preparations: D2 Antipsychotic Agents - High Potency
    1. General: Extrapyramidal Side Effects (EPSE) with all
    2. Haloperidol (Haldol) or Haloperidol decanoate
    3. Perphenazine (Trilafon)
      1. Well tolerated with similar efficacy to other agents
        1. Lieberman (2005) N Engl J Med 353:1209
    4. Thiothixene HCl (Navane)
      1. Typical Dose: 10 mg tid
      2. Maximum Dose: 60 mg per day
    5. Fluphenazine HCl (Prolixin)
      1. Typical Dose: 2.5 mg PO bid
      2. Maximum Dose: 40 mg PO or 100 mg IM per day
    6. Trifluoperazine (Stelazine)
  4. Preparations: D2 Antipsychotic Agents - Medium Potency
    1. Loxapine (Loxitane)
    2. Molindone (Moban)
  5. Preparations: D2 Antipsychotic Agents - Low Potency
    1. Chlorpromazine HCl (Thorazine) - not available in U.S.
      1. Anticholinergic Symptoms
      2. Alpha adrenergic blockade (Hypotension)
      3. Sedation
      4. Maximum dose: 1000 mg per day
    2. Thioridazine HCl (Mellaril) - not available in U.S.
      1. Anticholinergic Symptoms
      2. Alpha adrenergic blockade (Hypotension)
      3. Sedation
      4. Maximum Dose: 800 mg per day
  6. Preparations: Atypical Antipsychotics (Second Generation) - Serotonin-Dopamine Antagonists
    1. Dibenzodiazepine (Clozapine, Clozaril)
    2. Olanzapine (Zyprexa)
    3. Quetiapine (Seroquel)
    4. Risperidone (Risperdal)
    5. Ziprasidone (Geodon)
    6. Aripiprazole (Abilify)
  7. Adverse effects: General
    1. See Extrapyramidal Side Effects (EPSE)
    2. Ventricular arrhythmia (including Cardiac Arrest)
      1. Antipsychotic agent relative risk: 3.2
      2. Consider obtaining baseline EKG before starting therapy
      3. Consider electrolyte and Magnesium monitoring with high risk agents (e.g. Thioridazine)
      4. Avoid concurrent use of other medications prolonging QT Interval
        1. See Prolonged QT Interval due to Medication
      5. Drugs studied (from highest to lowest risk)
        1. Thioridazine
        2. Ziprasidone
        3. Haloperidol
        4. Quetiapine
        5. Risperidone
        6. Clozapine
        7. Olanzapine
      6. References
        1. Hennessy (2002) BMJ 325:1070
        2. Titier (2005) Drug Saf 28:35
  8. Adverse Effects: Second generation agents (atypicals)
    1. Weight gain
      1. Weight gain with all second generation agents except Aripiprazole and Ziprasidone
    2. Adverse Lipid effects
      1. Serum Triglyceride increase most with Clozapine, Olanzapine, Quetiapine
      2. HDL Cholesterol decrease is variable
    3. Diabetes
      1. Highest risk with Clozapine and Olanzapine
      2. Lowest risk with Ziprasidone and Aripiprazole
  9. Monitoring
    1. Extrapyramidal Side Effects (EPSE) - all agents
      1. Screen for Tardive Dyskinesia at each visit
      2. Screen for other EPSE symptoms
      3. Educate about Neuroleptic Malignant Syndrome
    2. Obesity Monitoring (all antipsychotics)
      1. Calculate BMI baseline, monthly for 3 months and then every 3 months thereafter
    3. Blood Pressure
      1. Obtain baseline, every 3 months and then annually
    4. Diabetes Mellitus Screening (Newer, atypical agents)
      1. Fasting Serum Glucose, 3 months and then annually
      2. Consider Hemoglobin A1C at four months after starting agent
      3. Screen for polyuria and polydipsia at each visit
    5. Hyperlipidemia (Newer, atypical agents)
      1. Lipid profile baseline and at 3 months
      2. Repeat lipids every 6 months if abnormal
        1. May decrease frequency to every 2 years if normal
    6. References
      1. Marder (2004) Am J Psychiatry 161:1334
  10. References
    1. Geddes (2000) BMJ 321:1371
    2. Glick (2001) Ann Intern Med 134:47
    3. Lieberman (2005) N Engl J Med 353:1209

Antipsychotic Agents (C0040615)

Definition (MSH)Agents that control agitated psychotic behavior, alleviate acute psychotic states, reduce psychotic symptoms, and exert a quieting effect. They are used in schizophrenia, senile dementia, transient psychosis following surgery or myocardial infarction, etc. These drugs are often referred to as neuroleptics alluding to the tendency to produce neurological side effects, but not all antipsychotics are likely to produce such effects. Many of these drugs may also be effective against nausea, emesis, and pruritus.
Definition (CSP)class of drugs used to treat symptoms of schizophrenia and other psychotic behavior; includes neuroleptics.
Definition (NCI)Also known as neuroleptics, major tranquilizers, or antischizophrenics, natural or synthetic. Antipsychotic Agents relieve and control the symptoms of schizophrenic illness (hallucinations, delusions, dementia). Most antipsychotic agents interfere with various neurotransmitter functions, often blocking dopamine receptors, and induce diverse behavioral, endocrine, motor-kinetic effects. (NCI04)
ConceptsPharmacologic Substance (T121)
MSHD014150
EnglishAnti-psychotic agent, antipsychotic agent, Antipsychotic Agents, Antipsychotic drug, Antipsychotic Drugs, antipsychotic tranquilizers, Antipsychotics, Antischizophrenic Agent, Major Tranquilizer, Major Tranquilizers, Major Tranquilizing Agents, Major Tranquillizing Agents, Neuroleptic, Neuroleptic Agent, Neuroleptic Agents, Neuroleptic drug, Neuroleptic Drugs, Neuroleptics
Spanishagente antipsicotico, agente antisicotico, antipsicotico, antisicotico, droga antisicotica, droga neuroleptica, neuroleptico
Parent ConceptsTranquilizing Agents (C0040614), psychopharmacologic agent (C0597318), Pharmaceutical Adjuvants (C0001552), Central Nervous System Agents (C0007680), Psychotropic Drugs (C0033978), Sedative/neuroleptic (C0360112), Duplicate concept (C1274013), USP Model Guidelines (C1579327)
SourcesAOD, CSP, LNC, MSH, NCI, NDFRT, PDQ, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)



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