I.                    Olanzapine (Zyprexa) – unlike other antipsychotics, it can be given at a starting does of once a day. Is good for mania.

a.       Side-effects: May cause: wt gain, diabetes, elevated lipids

                                                               i.      Sedation,

                                                             ii.      EPS at higher doses

II.                 Clozapine (Clozaril) -- good for refractory schizophrenia. Highest efficacy but used as last resort because of agranulocytosis, wt gain, sedation

a.       Side-effects: May cause: wt gain, diabetes, elevated lipids

                                                               i.      Sedation, drooling

                                                             ii.      Seizures if above 500 mg

                                                            iii.      Agranulocytosis in 1% of patients

III.               Risperidone (Risperidal) – the most typical of the atypical antipsychotics (has the highest affinity for D2 receptors). 

a.       Side-effects: May cause:

                                                               i.       EPS if more than 6 mg, Lewy body dz. 

                                                             ii.      increased prolacting (leading to gynecomastia, galactorrhea, disruption of menstrual cycle)

                                                            iii.      Orthostatis (so start at 1-2 mg)

                                                           iv.      High stroke risk

IV.              Quetiapine (Seroquil): can give a low dose (<100 mg) for nonspecific anxiety or dreams/anger. Also used for psychosis or mood d/o.

a.       Side-effects: may cause:

                                                               i.      Orthostatic hypotension, sedation, dizziness, weight gain

                                                             ii.      Low EPS

                                                            iii.      Less likely to cause hyperprolactinemia

V.                 Aripiprazole (Abilify) – is a partial D2 agonist (so can both increase/decrease D2 activity)

a.       Side-effects:

                                                               i.      Nausea

                                                             ii.      Insomnia (so give in morning)

                                                            iii.      Less likely to cause hyperprolactinemia

VI.              Ziprasidone (Geodon) – has to be given multiple times throughout the day even after reaching stead state.

a.       Side effects: severe cardiac side-effects

                                                               i.      Highest prolongation of QT and torsades

                                                             ii.      Sedation, dizziness, nausea

VII.            Paliperidone (Invega)

 

Typical Antipsychotics: block only dopamine receptors. Typical antipsychotics are more likely (than atypicals) to cause tardive dyskinesia.

 

Low Potency: have anticholinergic side-effects (dry mouth, blurry vision, urinary retention – give bethanechol, constipation, exacerbation of narrow-angle glaucoma), tardive-dyskinesia with prolonged use, neuroleptic malignant syndrome.

 

I.                    Chlorpromazine (thorazine)

II.                 Thioridazine (Mellaril)

 

High Potency: akathisia, acute dystonic reaction, EPS!, some anticholinergic but less than low-potency.

 

I.                    Haloperidol (Haldol)

II.                 Fluphenazine (Prolixin)

III.               Trifluperazine