Extrapyramidal side effects of antipsychotics




Akathisia refers to an urge to keep moving. Typically the patients will pace about in the house and sit down and get up again. First line treatment of akathisia is propranolol although benzodiazepines have also been used. Akathisia can occur any time after starting the medication.

Tardive duskinesia (TD) refers to involuntary movements which can be perioral (such as lip smaking, chewing and darting tongue movements) or choreoathetoid movements of extremities or other body parts. TD usually does not occur within the first 3 months of starting the medications. TD can be difficult to treat and may require changing to medications that do no cause this side effect such as clozapine.

Dystonia occur within hours or days of starting the therapy. Characteristic features include muscle spasms (e.g. torticollis). Treatment of dystonia is acomplished by antihistaminic medications like diphenhydramine (Benadryl) or anticholinergics like benztropine or trihexphenidyl.

Neurolept maligant syndrome is a known side of antipsychotics that presents with hyperthermia, muscle rigidity and mental status changes. It usually occurs after 1-2 weeks of starting the therapy. Treatment includes stopping the medication and use of dantrolene, bromocriptine and amantidine.

Commonest antipsychotics leading to these side effects inlcude: chlorpromazine (Thorazine, Largactil), Fluphenazine (Prolixin) - Available in decanoate (long-acting) form, Perphenazine (Trilafon), Prochlorperazine (Compazine), Thioridazine (Mellaril, Melleril), Trifluoperazine (Stelazine), Mesoridazine, Periciazine, Promazine, Triflupromazine (Vesprin), Levomepromazine (Nozinan), Promethazine (Phenergan), Pimozide (Orap), Chlorprothixene (Cloxan, Taractan, Truxal), Clopenthixol (Sordinol), Flupenthixol (Depixol, Fluanxol), Thiothixene (Navane), Zuclopenthixol (Cisordinol, Clopixol, Acuphase)

No comments:

Post a Comment

Thank you for your time.