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NEUROLEPTIC DRUGS

Phenothiazines Daily dose (mg/day)


Chlorpromazine 200 – 1000
Thioridazine 200 – 1000
Trifluperazine 10 – 60
Fluphenazine 5-40
Fluphenazine
decanoate 12.5 – 50 mg in
every 1-3 weeks
Butyrophenone, Daily dose (mg/day)
Haloperidol 5 – 20
Haloperidol
decanoate 25 – 200 mg in
every 2-4 weeks
Dibenzoxayepines
Loxaprine 20 – 100

Diphenybutyl
Pimozide 2 -10
Mechanism of action:
Typical neuroleptics are so called because
of their ability to induce catalepsy and to inhibit the
effects of amphetamine, the drug known to
enhance the release of dopamine and cause
extrapyramidal side effect.

Atypical antipsychotic agents are so called


because they neither induce catalepsy nor block
the effects of amphetamine.
The degree of binding of neuroleptics to D2
receptors is directly related to the drugs
antipsychotic efficacy.

Side effects:
Neurological
Parkinsonism
Akathesia
Dystonia
Tardive Dyskinesia
Neuroleptic malignant syndrome (NMS)
Epileptogenic effects.
Cardiovascular side effects:
Orthostatic hypotension
Dizziness
Fainting

Endocrime side effects:


Neuroleptics elevate prolactin levels.
Prolactine elevation cause breast enlargement and
galactorrhoea, amenorrhoea, decreased
orgasm in women and reduce testosterone
Weight gain
Sexual side effects:
Libido
Impotence
Erectile dysfunction
Premature ejaculation
Delayed ejaculation

Haematological:
Agramulocytosis
Neutropenia
Aplastic anaemia
Dermatological Effects:
Allergic skin reactions
Photosensitivity reactions
Pigmentary changes

Ophthalmic side effect:


Retinal pigmentation
Pigmentaion of the eyes -
specially cornea and lens
Antichotinergic side effect:
Dry mouth
Blurred vision
Urinary retention
Constipation

Hepatic effects:
Jaundice
Liver function alteration
Atypical Antipsychotics
Effective antipsychotics without producing
undesirable extrapyroamidal side effects.
Antipsychotic without neuroleptic effect.
Selective lymbic dopamium blockade, D4 receptor
blockade
Drugs:
Clozapine 200 – 400mg / day
Resperidone 2 – 16mg / day
Ziprasidone 40 – 160mg / day
Olanzapine 5 – 20mg / day
Quetiapine 150 – 750mg / day
Aripiprazole 15 – 30mg / day
Side Effects:
Clozapine - Agranulocytosis
Seizures
Hypotension

Resperidone - Insomnia
Agitation
Dizziness
Rhinits
Low EPS

Olanzapine - Weight gain


Sedation
Liver enzyme abnormality
Side Effects:
Quetiapine - Sedation
Anticholinergic
Postural hypotension
weight gain
sexual side effects
Ziprasidone - Dizziness
Nausa
fatigue
Agitation
Postural hypotension