Medication Brand/Generic |
Form | Dose Schedule | Usual Dose Range | Most Common Side Effects for Group | Pros for Group | Cautions for Group |
"High Potency"
examples: Haldol Prolixin Stelazine Navane Loxitane |
tablets liquid injection depot injection |
1-3 times daily once every two to four weeks |
one-half mg to 100 mg a day or more depending on age, size, diagnosis, severity, and acuity | Side effects are less likely at
low to moderate doses and if occur are most commonly sedation or mild
treatable pyramidal effects. Less common are sun sensitivity, heat
intolerace, prolactin elevation, possible sexual side effects, or rarely
negative effects on liver, blood count, or cataracts.
High potency options cause more EPS and less sedation or orthostatic hypotension than low potency choices, and vice versa. Medium potency options are in between in these effects. Sedation, orthostatic hypotension (dizzy with change from lying or sitting to standing). Extrapyramidal symptoms (EPS) are possible side effects due to the dopamine blocking in the brain which also leads to the benefits of antipsychotics. EPS may include acute dystonic reactions (scary but not dangerous), false Parkinsonian symptoms, akathisia (restlessness) as reversible and treatable late or early side effects. Anticholinergics, antihistamines, amantadine or B blockers often reverse these effects. |
Antipsychotics are often the best
treatments for the conditions above. They are often very or dramatically
effective.
Haldol and Prolixin come in depot injection forms which help more for noncompliant patients. All "typicals" are available in cheaper generic forms. Many convenient to give options are available. Generally, no blood tests are needed. Thorazine and Mellaril were two of the first antipsychotics made available. Several "...zine" antipsychotics are great for nausea and vomiting. Moban is the least likely of all typical antipsychotics to cause weight gain. Generally, the most powerful tic suppressing medicine is
Pimozide. |
Extrapyramidal side effects (EPS)
are usually reversible or go away when the medicine is stopped. Tardive
diskinesia (TD) is irreversible about one third of the time (see Medical
Memo). The uncommon but potentially dangerous
neuroleptic malignant syndrome (NMS) is also an EPS effect.
"Atypicals" (page 2) are often preferred nowadays because they have far less EPS effects. These TD and NMS possibilities make antipsychotics "big guns" and therefore used in severe situations or when other milder options are inadequate. Mellaril and Pimozide, especially at higher doses, may affect heart rhythm. Therefore, an EKG may be helpful in some situations. Prolactin increase may show up as breast swelling or discharge and may affect sexual function. Although Arizona sun and heat effects may be worsened by this medicine
group, sun screen and heat exhaustion awareness steps are generally
sufficient. |
"Medium Potency"
examples: Trilafon Serentil |
tablets liquid injection |
once to three times daily |
2 to 64 mg/day for Trilafon or 50 to 400 mg/day or more for Serentil. | |||
"Low Potency"
examples:
Thorazine Mellaril Compazine |
capsules liquid injection suppository tablets as above |
once to three
times daily Same or as needed for vomiting. |
10 to 1000mg/day or more for
Thorazine
10 to 400-800mg/day for Mellaril 5 to 15 mg/day for child |
|||
Moban (molindane) |
tablets 5mg, 10mg, 25mg, 50mg, 100 mg liquid |
once to three times a day |
5 to 300mg/day | |||
Orap (pimozide) |
tablets 1 mg 2mg |
once to twice a day |
one-half to 10mg/day |
Simultaneous use of alcohol or cigarettes and especially street drugs
should be avoided. All medications should be avoided, if possible, in pregnancy.
This chart is intended to be a summary guide, not a full and complete list.