The “Typicals”

Of the traditional medications, mesoridazine (Serentil), chlorpromazine (Thorazine) and thiorfdazine (Mellaril) are considered low potency agents.

They produce primarily sedative. hypotensive and anticholinergic symptoms (dry mouth, urinary retention, constipation, blurred vision end confusional states). They also can make the skin sensitive to light and lower the threshold for seizures. With toxic doses, anticholenergic side effects can lead to the development of delirium. There may be psychotic symptoms where none existed before. These toxic effects are more common in elderly persons, but it can happen in anyone.

The high potency agents include fluphenazine (Prolixin), trifluoperazine (Stelazine), thiothixene (Navane), and haloperidol (Haldol). This group produces the least amount of sedative and anticholenergic effects. However, they produce the most extrapyramidal effects. These effects include Parkinsonism (tremors, rigidity, shuffling gait, expressionless face, automatic movements, etc.); akathisia (extreme restlessness); and acute dystonic reactions (muscle spasms). In addition, the high potency agents are more likely to cause tardive dyskinesia (T.D.) T.D. is a darting or writhing involuntary motion that can occur in the tongue, mouth, hands, jaw or other parts of the body. Unlike the other movement disorders that occur from antipsychotic medications, this side effect does not necessarily occur early in the treatment. When it does occur it is important to bring it to the attention of a doctor immediately. Stopping the medication may make it worse temporarily and unfortunately, sometimes this side effect persists long after the medication is stopped.

Perphenazine (Trilafon). molindone (Moban) and loxapine (Loxitane) are intermediate in potency. They produce less sedation and anticholenergic side effects and less extrapyramidal effects than the high potency agents.

Treatments for Parkinsonism and extrapyramidal side effects include such drugs such as benztropine (Cogentin) and trihexyphenidyl (Artane). However, these drugs have side effects of their own, and the best options may be to either lower the dosage of the antipsychotic medication or switch to another medication. Propranolol or other beta-blockers are used to treat akathesia.

The “Atypicals"

The newer atypical medications include clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel) and Ziprasidone (Geodon). As a group, they have far fewer serious side effects, including relatively minor anticholenergic effects and almost no extrapyramidal effects. Because they are much safer than the traditional medications, the National Institute of Mental Health has urged all mental health providers to try these medications first.

While Risperdal, Zyprexa, Seroquel and Geodon are first-line medications, Clozaril is reserved for treatment-resistent cases.

Possible side effects of Clozaril include tiredness, increase in saliva, myocarditis (inflammation of the heart characterized by fever, fatigue and signs of heart failure), rapid heartbeat, blood pressure changes, nausea, dizziness, seizures and headache. Most of these effects will decrease or go away with time or as the dosage is adjusted.

In rare cases Clozaril can cause a blood disease called agranulocytosis, which can be fetal. Because of this risk, patients must have weekly blood tests for the first six months and biweekly blood tests after that. Symptoms of this blood disease include symptoms of flu or other infections (fever, sore throat, tiredness. etc.) If such symptoms occur, call your doctor immediately.

Because many of the side effects of Clozaril are dependent on how fast one increases the dose, it is common to take over a month to reach an effective dose of Clozaril. In addition to this long period required to reach a target dose, Clozaril takes awhile to show peak effects. A full trial to determine whether Clozaril is effective for an individual can take four to six months.

Possible side effects of Risperdal include fatigue, nervousness, headache, weight gain, low blood pressure and sleeping difficulties. This drug can also cause some of the same side effects as traditional medications, especially restlessness. Most of the side effects will decrease with time or as the dosage is adjusted.

Possible side effects of Zyprexa include dizziness, drowsiness, constipation, weight gain and restlessness. Zyprexa may cause diabetes or may make it harder to control diabetes, if one is already suffering from this disease. Symptoms of overdose may include drowsiness and slurred speech. If overdose is suspected, seek medical help immediately. Do not take Zyprexa if you are also taking the drug tramadol.

Possible side effects of Seroquel are drowsiness, dizziness, constipation and dry mouth. If they continue or are bothersome, check with your doctor. Contact your doctor immediately if you experience unexplained fever, extreme muscle stiffness, irregular or fast pulse, or change in alertness. Symptoms of overdose include drowsiness, rapid pulse, weakness, fatigue and dizziness. Although Seroquel was originally used at lower doses, many psychiatrists find that they need to use doses above 600 mg. in order to control symptoms.

Possible side effects of Geodon are feeling unusually tired, nausea, constipation, dizziness, restlessness, diarrhea, rash, cough and runny nose, and abnormal muscle movements, including tremor, shuffling, and uncontrollable movements. Approved by the FDA in 2001, Geodon is associated with little or no weight gain, a characteristic that distinguishes it from other antipsychotics. Although the risk of developing Tardive Dyskinesia with Geodon is less than with typical antipsychotics, it may take years before researchers can properly assess the actual risk of T.D. from this medication (The same goes for Risperdal). If you begin to show signs of T.D., inform your doctor immediately.

Geodon should not be taken with any drug that affects the QT interval in a heartbeat, such as thioridazine (Mellaril), quinidine (Quinidex), moxifloxacan (Avelox), pimozide (Orap), and sparfloxacin (Zagam). Because Geodon has a direct effect on the central nervous system, people taking this drug should be cautious when taking other drugs that affect the central nervous system. Studies have shown that Tegretol lessens the effects of Geodon.

It is important to tell your psychiatrist all the other drugs you are taking to check for interactions. Caffeine and nicotine have a tendency to reduce the blood levels of antipsychotics as well as many other drugs. Gel-type antacids, such as Gelusil and Maalox, interfere with the absorption of antipsychotic drugs and therefore should not be taken at the same time but may be taken at a different time of day. Drugs to reduce blood pressure should be used with caution when taking antipsychotics.

CAUTION: NAMI-NYS does not give medical advice. This page is for informational purposes only. Discuss all medication and medical decisions with your physician.