This rare but dangerous condition is more common with high doses of traditional antipsychotic drugs. A high fever develops over hours or days. Muscles become rigid, heart rate goes up and confusion ensues. The antipsychotic drug must be stopped immediately and treatment started, usually in the hospital, to prevent a potentially fatal outcome.
This rare but dangerous condition is more common with high doses of traditional antipsychotic drugs. A high fever develops over hours or days. Muscles become rigid, heart rate goes up and confusion ensues. The drug must be stopped immediately and treatment started, usually in the hospital, to prevent a potentially fatal outcome.
Newer antipsychotic drugs include:
Although it's not true in every case, risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole often have more tolerable side effects than older, traditional antipsychotic drugs, and, in some ways, they may be safer. Clozapine has some troubling side effects, but also positive effects, especially in the treatment of schizophrenia. Clozapine is used less frequently in the treatment of bipolar disorder, and rarely for depression.
Olanzapine (Zyprexa) is effective in the treatment of mania, but a mood stabilizer is also usually needed.
The starting dose is 5 to 10 milligrams, usually taken once per day, although depressed people may initially be prescribed 2.5 milligrams. The usual maximum dose is 20 milligrams per day. Most people take it before bed because of its sedating effect. Olanzapine may be taken with or without food.
The most common side effects are drowsiness, weight gain and lower blood pressure. Other possible side effects are agitation, restlessness, trembling, constipation, dizziness, dry mouth, blurry vision and headache. This drug may cause a rise in cholesterol and blood sugar, so health care professionals should monitor these levels. Tardive dyskinesia or neuroleptic malignant syndrome can occur with olanzapine use, but the risk appears much less than with traditional antipsychotics.
If you notice these or any other changes, talk to your doctor.
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A standard starting dose of risperidone (Risperdal) is 1 milligram per day, though it is not unusual to start with 0.25 or 0.5 milligrams when treating depression. The usual maximum dose is 6 milligrams per day. Risperidone can be taken with or without food.
Risperidone can cause brief drops in blood pressure at the beginning of treatment. Common side effects are a change in sleep (either trouble sleeping or sleeping more), sedation or a dulled feeling, anxiety or headache. You may be able to avoid these symptoms by starting with a low dose. Your doctor will monitor any weight gain, higher cholesterol and higher blood sugar. Tardive dyskinesia or neuroleptic malignant syndrome can occur with risperidone, but the risk appears much less than with traditional antipsychotics.
If you notice these or any other changes, talk to your doctor.
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The starting dose for quetiapine (Seroquel) is 25 to 50 milligrams per day, usually in two or three doses. The usual maximum dose is 800 milligrams per day. Quetiapine can be taken with or without food.
Quetiapine can cause brief drops in blood pressure that can lead to dizziness or fainting. Starting treatment with a low dose (for example, 25 milligrams twice per day) can reduce this risk. Quetiapine may also cause a small increase in the risk of developing a cataract or seizures.
Common side effects are sleepiness (especially in the first few days of treatment), dizziness, dry mouth, stomach upset, constipation and weight gain. Higher cholesterol and higher blood sugar levels may occur. Tardive dyskinesia or neuroleptic malignant syndrome can occur with quetiapine, but the risk appears to be much less than with traditional antipsychotics.
If you notice these or any other changes, talk to your doctor.
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The starting dose for ziprasidone (Geodon) is 20 milligrams twice per day, though a dose of 20 milligrams once per day may be useful for some people with depression. The usual maximum dose is 80 milligrams twice per day. Ziprasidone should be taken with food.
Common side effects are nausea, headache, constipation and dizziness. Some people become drowsy; others have trouble sleeping. When ziprasidone first came on the market, there were some concerns that it may cause problems to the heart's rhythm, but the risk does not appear any greater than the risk for placebo or other antipsychotic drugs. People with heart disease should discuss the risk with their doctor.
Ziprasidone can cause brief drops in blood pressure that can lead to dizziness or fainting. It may also cause a small increase in the risk of having a seizure. Unlike other antipsychotic drugs, ziprasidone does not appear to cause weight gain. This product does include the Food and Drug Administration's warning about high blood sugar and diabetes, so your doctor may monitor blood sugar levels from time to time.
Tardive dyskinesia or neuroleptic malignant syndrome can occur with ziprasidone use, but the risk appears to be less than with traditional antipsychotics.
If you notice these or any other changes, talk to your doctor.
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The starting dose for aripiprazole (Abilify) is 5-10 milligrams per day. The usual maximum daily dose is 30 milligrams. Aripiprazole may be taken with or without food.
Common side effects are headache, anxiety, insomnia, restlessness, nausea and constipation. It may cause some dizziness when a person stands up from a lying or sitting position. Aripiprazole does not appear to cause weight gain to the same degree as some other atypical antipsychotics. This product does, however, include the U.S. Food and Drug Administration's warning about high blood sugar and diabetes, so your doctor may monitor blood sugar levels from time to time.
Tardive dyskinesia or neuroleptic malignant syndrome can occur with aripiprazole, but the risk appears to be less than with traditional antipsychotics.
If you notice these or any other changes, talk to your doctor.
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The starting dose of clozapine (Clozaril) is 12.5 to 25 milligrams per day; the usual effective dose range is 100 to 900 milligrams per day.
The main danger of clozapine is a failure of the body to produce the white blood cells needed to fight infection (a condition called agranulocytosis). Clozapine treatment therefore requires monitoring of the white blood cell count. Other common side effects are drowsiness, dizziness, rapid heartbeat, constipation, stomach upset, weight gain, fever and headache.
Clozapine (Clozaril) is very useful for the treatment of schizophrenia, but because agranulocytosis is a very risky side effect, clozapine is usually not used unless other treatments have failed. Clozapine can be effective in some cases of bipolar disorder. It is rarely used for depression alone, except if symptoms of psychosis have been particularly resistant to other treatments.
Clozapine may cause tardive dyskinesia or neuroleptic malignant syndrome.
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Traditional antipsychotic drugs are very effective. These drugs may be useful when atypical antipsychotic drugs have not been. They may be tolerated well, particularly when used in low doses or when used only for brief periods.
The starting doses are usually taken two or more times per day. Once a regular dose is established, however, these drugs can be taken once per day.
| Generic Name | Brand Name | Dose | Maximum Dose | | Chlorpromazine | Thorazine | 10-25 milligrams per day | 1,000 milligrams per day | | Fluphenazine | Prolixin | 1-2.5 milligrams per day | 20 milligrams per day | | Trifluoperazine | Stelazine | 1-2 milligrams per day | 30 milligrams per day | | Perphenazine | Trilafon | 2-4 milligrams per day | 64 milligrams per day | | Thioridazine | Mellaril | 10-25 milligrams per day | 600 milligrams per day | | Haloperidol | Haldol | 0.5-1 milligrams per day | 15 milligrams per day | | Thiothixene | Navane | 1-2 milligrams per day | 30 milligrams per day | | Molindone | Moban | 5-10 milligrams per day | 100 milligrams per day | | Loxapine | Loxitane | 5-10 milligrams per day | 100 milligrams per day | |
Common side effects are muscle stiffness, muscle spasms that can be very persistent and distressing, restlessness, tremor, reduced facial expression, sedation, weight gain, low blood pressure, dry mouth, blurred vision or constipation. Tardive dyskinesia and neuroleptic malignant syndrome are more common with traditional antipsychotic drugs than with atypical antipsychotic drugs. If you notice these or any other changes, talk to your doctor.
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Last updated April 24, 2011
