side effects of antipsychotic agents
TRANSCRIPT
Side effects of Anti-Psychotic agents
Edited by: Prithwiraj Maiti, MBBS
House physicianDepartment of Internal Medicine, R.G.Kar Medical College
Author: “An Ultimate Guide to Community Medicine”Author: “A Practical Handbook of Pathology Specimens and Slides”
[Both published by Jaypee Brothers Medical Publishers, India]
Side effects of Anti-psychotic agentsPart 1: Autonomic side effects
Side effects Mechanism Maximum with ManagementDry mouth
Muscarinic cholinergic blockade
Chlorpromazine
NoneConstipation LaxativesCycloplegia None, occasionally Pilocarpine
(2%)Urinary retention Occasionally catheterization
Delirium Physostigmine, occasionally Diazepam
Mydriasis Thioridazine None, occasionally Pilocarpine (2%)
Orthostatic hypotension α1 Adrenergicblockade Chlorpromazine
Change in posture, raise legs; plasma expanders (in severe
cases only)Impotence Decrease dose/ change
medicationImpaired ejaculation Thioridazine
Side effects of Anti-psychotic agentsPart 2: Extrapyramidal side effects (EPSE)
Side effects Mechanism Maximum with ManagementParkinsonian side effects
(Ex: Tremor)
D2 receptor blockade in brain
Haloperidol
Anti-Parkinsonian medicationAcute dystonia
Rabbit syndrome (Peri-oral tremor)
Akathisia (motor restlessness) Beta blockers (Propranolol)/ BZDs
Neuroleptic Malignant Syndrome
(Fever, EPS, High CPK, catatonic symptoms and autonomic dysfunction)
Sudden reduction in dopamine activity due
to blockade of Dopamine receptors
HaloperidolChlorpromazine
Bromocriptine, Dantrolene,
Baclofen, Adequate rehydration, Add-on
LorazepamTardive Dyskinesia (Late
onset oro-facial dyskinesia)D2 receptor
super-sensitivityChlorpromazine
AripiprazoleClonazepam
Side effects of Anti-psychotic agentsPart 3: CNS side effects
Side effects Mechanism Maximum with ManagementSeizures Decreased seizure
threshold ClozapineChlorpromazine
Decrease dose/ Change to a safer drug
Sedation Histaminergic blockade
May be beneficial, if chief complaint: Decrease dose
Side effects of Anti-psychotic agentsPart 4: Metabolic and Endocrine side effects
Side effects Mechanism Maximum with ManagementWeight gain H1 blockade
ClozapineOlanzapine
Change drugDietary restrictionDiabetes
Weight gain + Inhibition of glucose transport into muscle
GalactorrheaIncreased Prolactin
released due toDopaminergic
blockade in hypothalamus
HaloperidolRisperidone
Change drug
Side effects of Anti-psychotic agentsPart 5: Allergic side effects
Side effects Mechanism Maximum with ManagementCholestatic jaundice
Hypersensitivity reaction
Chlorpromazine Change drugSupportive care
Agranulocytosis ClozapineStop drug urgently
Treat infectionG-CSF (Filgastrim) may be
used
Side effects of Anti-psychotic agentsPart 5: Cardiac side effects
Side effects Mechanism Maximum with ManagementECG changes
(especially QT prolongation)Anticholinergic effectCalcium channel block
ThioridazinePimozide
Change the drug in severe cases
Side effects of Anti-psychotic agentsPart 6: Ocular side effects
Side effects Mechanism Maximum with ManagementGranular deposits in cornea
and lens PhotosensitivityChlorpromazine (Dose-related)
Change drug
Pigmentary retinopathy Thioridazine(Dose-related)
Preventive: Never give more than 800 mg/day
Side effects of Anti-psychotic agentsPart 7: Dermatological side effects
Side effects Mechanism Maximum with ManagementPhotosensitive reaction
Photosensitivity Chlorpromazine (High dose)
Avoid sunlightUse sunscreen
Blue-grey metallic discoloration
Change drug