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Side Effects of Antipsychotics

Sedation (most common), seizures
  1. Extrapyramidal side effects
    1. Dystonia = Earliest to appear side-effect, develop within minute to hours of drug intake. Involuntary muscle spasm leading to involuntary movements of face, neck , jaw. Occur early in the course of T/t; most common in young man & associated high potency antipsychotics.
      Treatment - Anticholinergic drugs e.g. trihexyphenidyl, procyclidine or biperidine or Antihistaminic e.g. promethazine.
    2. Akathisia = Most common extrapyramidal side effect. Develops within hours to minutes of drug taken. Characterized by unpleasant feeling of subjective motor restlessness, a need to move & inability to keep still
      1. Decrease dose of neuroleptic medication
      2. Propranolol / beta adrenergic blocker (first line)
      3. Anticholinergics or benzodiazepines
    3. Parkinsonian symptoms:  Tremors / rigidity / hypokinesia / drooling of saliva/ stooped posture
      1. Decrease the dose of Neuroleptic Medication (Antipsychotic drug)
      2. Anticholinergic, Anti-histaminergic drugs.
    4. Tardive dyskinesia: Tardive meaning “Slow” In this patient Abnormal, irregular, involuntary choreoathetoid movements of Bucco -Lingual -masticatory muscles (Perioral Movements) limbs & the trunk.
      It appears late i.e at least 3 month (usually 5-10 years) after starting of the Antipsychotic drug.
      1. Decrease the dose of typical Antipsychotic
      2. Switch to an atypical drug Preferably Clozapine.
      3. Tetrabenazine
    5. Neuroleptic Malignant syndrome:  Life threatening characterized by high fever, Severe muscle rigidity, Autonomic symptoms viz tremors , sweating, BP, tachycardia, Changing level of consciousness from confusion to coma.
      Lab investigation: Increase level of CPK and leukocytosis.
      1. Supportive (Control fever and maintain hydration)
      2. Dantrolene
      3. Bromocriptine
  2. CVS: Postural hypotension
  3. Anticholinergic side effects: dry mouth, constipation, urinary retention, heart blocks ( maximum with thioridazine)
  4. Agranulocytosis:  With Clozapine occurs in 1 - 2% of patients on clozapine.
    Mostly in first 6 months
    Risk factors: old age, females
    Treatment: weekly monitoring of TLC, stop the drug if count less than 3000
  5. Endocrine: weight gain (olanzapine)
  6. Hyperprolactinemia: impotence, infertility, menstrual irregularities
  7. Skin: rashes with chlorpromazine
  8. Eye: retinitis pigmentosa (Thioridazine)
    1. Increased blood sugar: olanzapine, clozapine.
* Most common side effect of clozapine is excessive salivation (33%) and sedation (30%).
Unique side effect of clozapine is
  1. Dose independent— Agranulocytosis, (1-2%)
  2. Dose dependent side effect — seizures.

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