Danger zones – areas of risk with psychotropics
Christopher Doran in Prescribing Mental Health Medication, 2013
Statistically, and in day-to-day clinical practice, most psychotropic medication side effects are uncomfortable and bothersome but do not present areas of serious risk to health and safety. As with all medications, however, there are some psychotropic medication interactions and certain clinical situations that present serious risk of morbidity or, rarely, mortality. This chapter will focus on these areas of more significant risk, their symptoms, prevention and treatment. The areas covered in this chapter include: P-450 interactions Serotonin syndrome Anticholinergic intoxication Lithium toxicity QTc interval issues Extrapyramidal symptoms and other movement disorders Neuroleptic malignant syndrome Tardive dyskinesia (TD) Monoamine oxidase inhibitor (MAOI) interactions Other interactions, including blood dyscrasias, hepatoxicity and seizures Other than issues of P-450 interactions which are better understood in a different format, each condition will be further divided to address: N the syndrome and its cause N signs and symptoms N clinical situations of increased risk N prognosis N prevention N treatment.
Clinical Profiles of Selected New Generation Antipsychotics
S. Joseph in Personality Disorders, 2019
Risperidone is a serotonin-dopamine receptor antagonist, approved for the treatment of psychotic disorders. The possibility of decreased risk of tardive dyskinesia should make risperidone attractive to psychiatrists and other physicians treating patients on an antipsychotic. The only other antipsychotics currently available in the United States with decreased risk of tardive dyskinesia, low extrapyramidal symptoms, and effectiveness for negative and positive symptoms are olanzapine and clozapine. Clozapine may be considered for treatment of various chronic and severe treatment-refractory and dysfunctional conditions which would benefit from long-term maintenance on an antipsychotic. Clozapine can be successfully employed in the treatment of patients with parkinsonism accompanied by psychotic symptoms. Clozapine is a superior medication for the treatment of a variety of chronic psychotic conditions and selected chronic severe mental disorders. Sertindole is comparable to olanzapine, though olanzapine has an extrapyramidal symptoms risk that is slightly greater than that of sertindole.
Pharmacological profile and pharmacogenetic approaches of antipsychotics
Bernard Fried, Bernard Sherma in Schizophrenia, 2010
INTRODUCTION Since the antipsychotic effects of chlorpromazine have been found in 1950s, many antipsychotics have been introduced. They enabled psychiatrists to use various strategies of pharmacotherapies against schizophrenia (1). The first generation antipsychotics induced many side-effects such as sedation and involuntary movements. The development of atypical antipsychotics was regarded as the major advance primarily because these drugs reduced such side-effects. “Atypical antipsychotics” can be defined as the antipsychotics that have ‘low extrapyramidal symptoms’ and ‘good for negative symptoms’. Since various atypical antipsychotics, however, have different pharmacological profile, understanding those diverse profiles helps to make more accurate choices of drugs in clinical practice.
The preclinical profile of brexpiprazole: what is its clinical relevance for the treatment of psychiatric disorders?
Published in Expert Review of Neurotherapeutics, 2015
Leslie Citrome, Tine Bryan Stensbøl, Kenji Maeda
Brexpiprazole is a serotonin–dopamine activity modulator in clinical development for schizophrenia, adjunctive treatment of major depressive disorder, agitation in Alzheimer’s disease and post-traumatic stress disorder. It is a partial agonist at 5-HT1A and D2 receptors with similar potency, and an antagonist at 5-HT2A and adrenergic α1B/2C receptors. Compared with aripiprazole, brexpiprazole is more potent at 5-HT1A receptors and displays less intrinsic activity at D2 receptors. This unique serotonin and dopamine modulatory activity has shown robust antipsychotic, antidepressant-like and anxiolytic activities, and limited extrapyramidal symptom liability with pro-cognitive efficacy in animal models. Phase III clinical trials have been successfully completed in schizophrenia and adjunctive use in major depressive disorder, with the US FDA approval obtained for these uses; Phase III studies in Alzheimer’s disease and post-traumatic stress disorder are ongoing.
Risperidone induced angioedema with concurrent EPS symptoms: a case report and review of literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Gursharan Singh Samra, Saumitra Kant, Robert Chow
Angioedema has recently been reported as a side effect associated with the antipsychotic risperidone. We report a case of dystonia with concurrent angioedema due to risperidone. A 40-year-old male with a history of schizophrenia was started on 3 mg of risperidone BID and developed perioral and periorbital edema along with increased muscle rigidity and hand tremor within 24 h of initial administration. His symptoms abated after cessation of risperidone and intravenous administration of corticosteroids and antihistamine. This case study adds to the current literature, which has already established angioedema as a dose-dependent side effect of risperidone. Moreover, this case study aims to increase awareness about the potential for the simultaneous occurrence of angioedema and extrapyramidal symptoms, and promotes vigilance among prescribers so that the life-threatening consequences of such effects can be avoided.
Antipsychotic therapy: risks and benefits at end of life
Published in Progress in Palliative Care, 2010
Antipsychotics are frequently used in the palliative care setting for a variety of symptoms and disorders, including delirium or agitation, nausea and vomiting, and insomnia. Evidence is most supportive of their use in the management of delirium and nausea and vomiting. However, antipsychotics, particularly the atypical agents, have complex mechanisms and receptor binding and, as a result, provide benefit for various symptoms or clusters of symptoms. Therapeutic outcomes may differ by type of agent (typical versus atypical antipsychotic) and the underlying mechanisms. The overall benefits of antipsychotics in palliative care should be carefully balanced with the potential adverse effects. In addition to extrapyramidal symptoms, antipsychotics are associated with numerous adverse effects, including the metabolic syndrome, increased prolactin levels, QTc prolongation, and increased mortality. Recently, published evidence has found little difference between the atypical and typical antipsychotics in regards to mortality or sudden cardiac death.
Related Knowledge Centers
- Adverse Effect
- Akathisia
- Bradykinesia
- Dystonia
- Parkinsonism
- Extrapyramidal
- Movement Disorder