Antipsychotic Drugs: Precautions
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Neuroleptic malignant syndrome (NMS). NMS is a rare, idiosyncratic combination of extra-pyramidal symptoms (EPS), hyperthermia, and autonomic disturbance. Onset may be hours to months after drug initiation, but once started, proceeds rapidly over 24 to 72 hours. It is most commonly associated with haloperidol, long-acting fluphenazine, but has occurred with thiothixene, thioridazine, and clozapine, and may occur with other agents. NMS is potentially fatal, and requires intensive symptomatic treatment and immediate discontinuation of neuroleptic treatment. There is no established treatment. Most patients who develop NMS will have the same problem if the drug is restarted.
Tardive dyskinesia (TD). Tardive dyskinesia is a syndrome of involuntary movements that may appear in patients treated with neuroleptic drugs. Although prevalence of TD appears highest among the elderly, especially women, it is impossible to predict which patients are likely to develop the syndrome. Both the risk of developing TD and the likelihood that it will become irreversible are increased with higher doses and longer periods of treatment. The syndrome can develop after short treatment periods at low doses. Anticholinergic agents may worsen these effects. Clozapine has occasionally been useful in controlling the TD caused by other antipsychotic drugs.
Agranulocytosis has been associated with clozapine. This is a potentially fatal reaction, but can be prevented with careful monitoring of the white blood count. There are no well-established risk factors for developing agranulocytosis, and so all patients treated with this drug must follow the clozapine Patient Management System. For more information, call 1-800-448-5938.
Anticholinergic effects, particularly dry mouth, have been reported with all of the phenothiazines, and can be severe enough to cause patients to discontinue their medication.
Photosensitization is a common reaction to chlorpromazine. Patients must be instructed to use precautions when exposed to sunlight.
| Antipsychotic Drugs | |
| Brand Name (Generic Name) | Possible Common Side Effects Include: |
| Clozaril (clozapine) | Seizures, agranulocytosis, dizziness, increased blood pressure |
| Compazine (prochlorperazine) | Involuntary muscle spasms, dizziness, jitteriness, puckering of the mouth |
| Haldol (haloperidol) | Involuntary muscle spasms, blurred vision, dehydration, headache, puckering of the mouth |
| Mellaril (thioridazine) | Involuntary muscle spasms, constipation and diarrhea, sensitivity to light |
| Navane (thiothixene) | Involuntary muscle spasms, dry mouth, rash, hives |
| Risperdal (risperidone) | Involuntary muscle spasms, abdominal and chest pain, fever, headache |
| Stelazine (trifluoperazine hydrochloride) | Involuntary muscle spasms, drowsiness, fatigue |
| Thorazine (chlorpromazine) | Involuntary muscle spasms, labored breathing, fever, puckering of the mouth |
| Triavil | Involuntary muscle spasms, disorientation, excitability, lightheadedness |
Lithium carbonate commonly causes increased frequency of urination.
Antipsychotic drugs are pregnancy category C. (Clozapine is category B.) The drugs in this class appear to be generally safe for occasional use at low doses during pregnancy, but should be avoided near time of delivery. Although the drugs do not appear to be teratogenic, when used near term, they may cross the placenta and have adverse effects on the newborn infant, including causing involuntary movements. There is no information about safety in breast feeding.
As a class, the antipsychotic drugs have a large number of potential side effects, many of them serious. Specific references should be consulted.
— Samuel D. Uretsky, PharmD
