A Mini Lecture with Dr. Dines
Typical (classic) antipsychotics, e.g. Thorazine, Haldol
Thorazine was used initially as a BP medication, when his antipsychotic effect was discovered. Therefore, all typical antipscychotics can drop the BP.
Spectrum: Potency vs. Anticholinergic SE
Potency (upper row)
weak drug -----------------------> strong drug
dry mouth <----------------------- negligible SE Anticholinergic effects (lower row) Thorazine dose is 600-1000 mg QD (weak, antocholinergic SE) as compared to Haldol 5-10 mg QD (strong, high potency, low incidence of anticholinergic SE)
Atypical antipsychotics - all of them are 5-HT blocker
Senile population - best choice in geriatric patients due to low incidence of anticholinergic SE and EPS
Abilify - very good choice, mixed
Agonist of 5-HT receptor
Risky for EPS especially at high doses
To avoid EPS, start Risperdal at a very low dose in elderly, e.g. 0.5 mg QD
Olanzapine is not a good choice in
Obese patients with
OGTT abnormal - induces DM2
Zyprexa comes in a very convenient dissolvable tablet - Zyprexa MT (mouth tablet) and IM injection form, Eli Lilly covers the entire spectrum with Zyprexa - PO, MT, and IM.
Greater QT interval - not used much
How often does a psychiatrist prescribe each drug?
Typical use of antipsychotics expressed in percentages:
30% Risperdal (potent drug even at a low dose)
25% Seroquel (almost no EPS)
10% Zyprexa and Haldol
Study Finds Little Advantage in New Schizophrenia Drugs - NYTimes
Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia - NEJM 9/05
Atypical Antipsychotics and the Risk for New-Onset Diabetes
Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Stefan Leucht et al. The Lancet, Volume 373, Issue 9657, Pages 31 - 41, 3 January 2009.