Download Neuroleptic (Antipsychotic) Fact Sheet

Alexander Lerman, M.D.
Adult, Child & Adolescent Psychiatry
250 North Bedford Road | Chappaqua NY 10514
Tel. (914) 238-0566 | fax (914) 914/238-0567 | E-Mail: [email protected]
Neuroleptic Fact Sheet
General
“Psychotropic drugs” are substances that as at least one of their effects influence the
functioning of brain cells. By selective use of psychotropic drugs a psychiatrist can — with greater
or lesser degrees of safety and effectiveness — disrupt or relieve symptoms of psychiatric illness.
At higher doses, most such substances are dangerous. In general, the more extreme the
symptom, the more likely a drug can help. For some individuals the benefit can be extraordinary.
Often, medication is only partially effective, and should be used as one among several elements
of a treatment plan.
Use of Neuroleptics
“Neuroleptic” or “antipsychotic” drugs tend to reduce levels of activity and excitation in specific
regions of the brain, in most cases by reducing the impact of an excitatory brain chemical called
Dopamine. In large doses, in people suffering from psychotic symptoms, these drugs are used to
stop hallucinations and delusional thinking. In smaller doses, in a broader range of people, these
drugs can promote clarity of thinking and alleviate rage attacks, severe anxiety, motor tics,
anxiety, mood swings, distress associated with autistic-spectrum disorders, and extreme
hyperactivity.
Safety
In general, these drugs are safe and effective. Many of these problems can be relieved by
lowering the dose, or using palliative medication.

sleepiness and emotional dullness

intellectual impairment (although people often improve intellectual function on treatment of
psychiatric problems, particularly in the case of “thought disorder” for which neuroleptics are
the treatment of choice)

weight gain

blurred near vision

muscle stiffness, sometimes severe (Benztropine or Benadryl can relieve this symptom)

sensitivity to sunlight (sunscreen and/or care with sun exposure should be used)

unusual hormonal symptoms, such as low-grade breast development in men, disruption of
menstruation in women
In rare to extremely rare circumstances, more serious problems can occur. These include

potentially irreversible twitching, also known as Tardive Dyskinesia — by definition, an
individual must be on medication for months to years to develop this problem. This problem
is more likely to occur, and at greater risk to be irreversible, in the elderly.

“Neuroleptic Malignant Syndrome” - a syndrome of extreme muscle stiffness and fever.

Reversible cardiac problems - in rare cases fatal disturbances of heart rhythm.

Severe allergic reactions (as with any other drug)
These dangers can be reduced by good medical monitoring, and must be weighed against the
risk of not using the medication.
“Atypical Antipsychotics”
The new-generation drugs [olanzapine (Zyprexa), quetiapine (Seroquel); risperidone
(Risperdal); aripiprazole (Abilify), and others] are generally considered safer (and are also much
more expensive). Recently they have come under scrutiny for increased risk for inducing obesity,
Type II diabetes and elevated cholesterol in some people. Under some circumstances, we may
consider an “old-generation” neuroleptics.
Safety Precautions
Required safety measures include
 A comprehensive medical check-up including EKG, height and weight, liver function blood
tests (blood testing is sometimes delayed or deferred), and vital signs prior to treatment.
An internist or pediatrician should follow the patient and be in contact with me.
 Regular follow-up visits to screen for neurologic problems
 Monitoring at school for children to watch for cognitive dulling.
 Use of sunscreen until enhanced sun sensitivity has been ruled out.
 Watch for constipation, muscle stiffness, restlessness.
Regular follow-up visits, even if everything is going well, are essential to safely using
these medications.
Medication Interactions
In general, most medications obtainable without a prescription, i.e. Tylenol, cold remedies, can
be safely used with these medications. Watch for “synergistic” drowsiness with medications that
can cause sedation. Avoid “herbal” preparations of unknown consistency and quality.
Use in Pregnancy
While neuroleptics drugs are not absolutely contraindicated in pregnancy (compared with some
drugs which almost invariably cause birth defects) they should NOT be used in pregnancy. If
you might be pregnant, or think you may have become pregnant while taking this medication,
consult a doctor immediately.
Risk of Addiction
There is no risk of addiction or abuse with these medications. Withdrawal reactions after
stopping these medications are extremely uncommon.
Pharmaceutical Promotions
Dr. Lerman does not accept gifts, free samples, or other forms of payment from drug
companies. He does participate in medical-education seminars and solicits technical and other
information from pharmaceutical companies.