Updated 1/09
Haldol Prolixin Stelazine Navane Loxitane 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. 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 and atypical antipsychotics to
cause weight gain.
Generally, the most pwerful tic suppressing medicine is Pimozide. "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. Trilafon Serentil Thorazine Mellaril Compazine 10 to 400-800mg/day for Mellaril
5 to 15 mg/day for child Simultaneous use of alcohol or cigarettes and especially street drugs
should be avoided. All medications should be avoided, if possible, in pregnancy.
Medication
Brand/GenericForm
Dose
Schedule
Usual Dose
Range
Most
Common Side Effects for Group
Pros for
Group
Cautions
for Group
"High Potency"
examples:
(Haloperidol)
(Fluphenazine)
(Trifluoperazine)
(Thiothixene)
(Loxapine)tablets
liquid
injection
depot injection
1-3 times daily
once every two to four weeksone-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.
Antipsychotics are often the best
treatments for the conditions above. They are often very or dramatically
effective.
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, Spring, 1999 issue). The uncommon but potentially dangerous
neuroleptic malignant syndrome (NMS) is also an EPS effect.
"Medium Potency"
examples:
(Perphenazine)
(Mesoridazine)tablets
liquid
injectiononce to three times daily
2 to 64 mg/day for Trilafon or
50 to 400 mg/day or more for Serentil.
"Low Potency"
examples:
(Chlorpromazine)
(Thioridazine)
(Prochlorperazine)capsules
liquid
injection
suppository
tablets
as aboveonce to three
times daily
Same or as needed for vomiting.10 to 1000mg/day or more for
Thorazine
up to 40 mg/day for adults
Moban
(Molindane)tablets
5mg
10mg
25mg
50mg
100 mg
liquidonce to three times a day
5 to 300mg/day
Orap
(Pimozide)tablets
1 mg
2mgonce to twice a day
one-half to 10mg/day
This chart is intended to be a summary guide, not a full and complete list.