Antipsychotics In the adult population, antipsychotic medications are generally prescribed for the management of psychotic conditions and disruptive behavior. In this population, the commonly reported side effects of antipsychotics include tardive akinesia, acute extrapyramidal side effects, and neuroleptic malignant syndrome. The extrapyramidal side effects are notoriously prevalent and include symptoms such as akinesia, dystonia, and akathisia. Parkinsonism and akinesia consist of lack of or Table 3: Typical Antipsychotics and Atypical Antipsychotics Generic and Brand Names Initial Dosage Maximum Dosage
slowed movement, depressed affect, salivation, expressionless face, tremor, and shuffling gait. Atypical antipsychotics produce fewer side effects. As a class of psychotropic medications, antipsychotics are generally implicated in acute cardiac and cerebrovascular events that increase the risk of mortality in adults. Clinicians are advised to effectively monitor drug use and side effects in patients on antipsychotics (Table 3).
Major Adverse Effects
Typical Antipsychotics Haloperidol (Haldol) Atypical Antipsychotics Aripiprazole (Abilify)
0.25 to 0.5 mg per day
0.25 to 4 mg per day
Extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome
5 mg per day
2.5 to 15 mg per day
Headache, agitation, anxiety, insomnia, somnolence, akathisia, lightheadedness, weight gain, nausea, dyspepsia, constipation, vomiting Agranulocytosis, neuroleptic malignant syndrome, deep venous thrombosis, pulmonary embolism, glucose dysregulation, weight gain, increased serum creatine kinase, increased serum lipids (including triglycerides), seizures, tachycardia, confusion, sedation, dizziness, salivary pooling Orthostatic hypotension, sedation, weight gain, glycemic dyscontrol, elevation of serum lipids (triglycerides), anticholinergic effects (e.g., constipation), nausea, dizziness (not orthostatic), tremor, insomnia, overactivation, akathisia, neuroleptic malignant syndrome, tardive dyskinesia
Clozapine (Clozaril) 6.25 to 12.5 mg per day
6.25 to 400 mg per day (slow titration)
Olanzapine (Zyprexa)
2.5 mg per day
2.5 to 15 mg per day
Quetiapine (Seroquel) Risperidone (Risperdal)
25 mg at bedtime 50 to 400 mg at bedtime Sedation, orthostatic hypotension, dizziness, agitation, insomnia, headache, neuroleptic malignant syndrome
0.25 to 0.5 mg at bedtime
0.25 to 3 mg at bedtime Hypotension (especially orthostatic), tachycardia, dysrhythmias, electrocardiogram changes, syncope, sedation, headache, dizziness, restlessness, akathisia, anxiety, extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome
Ziprasidone (Geodon)
20 mg twice per day with food
20 to 80 mg twice per day with food
Extrapyramidal symptoms, somnolence, headache, dizziness, nausea, akathisia
Psychotropic Medications in Children Generally, the use of psychotropic medications is not recommended for children except in cases where the response to conventional medications for symptomatic control is poor. In these conditions, the use of psychotropic medication in children
is based on FDA approval. Table 4 summarizes the current schedule of selected FDA-approved psychotropic medications for children.
Table 4: Schedule of Selected FDA-approved Psychotropic Medications for Children Generic and Brand Names FDA-Approved Indications and Dosing Antidepressants Prozac/Sarafem (Fluoxetine)
MDD: >8 years: 10–20 mg PO qDay, initially; start at 10 mg/day in lower weight children, then may gradually increase the dose after 1 week; not to exceed 20 mg qDay OCD: >7 years: 10 mg PO qDay, initially; may gradually increase the dose after 2 weeks to 20 mg qDay; further increases may be considered after several weeks; adolescents and higher weight children: Typical dosage range 20–60 mg qDay; lower weight children: Typical dosage range 20–30 mg qDay OCD: <8 years: Safety and efficacy not established; ages 8–17 years: 25 mg PO qHS initially; may titrate by 25 mg/day increments every 4–7 days to 50–200 mg/day
Luvox (Fluvoxamine)
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Book Code: PYFL4024
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