ANTIPSYCHOTIC DRUGS (Neuroleptics)

These are drugs having a salutary therapeutic effect in psychoses.

CLASSIFICATION
A. Phenothiazines
1.Aliphatic side chain: Chlorpromazine, Triflupromazine
2.Piperidine side chain: Thioridazine
3.Piperazine side chain: Trifluoperazine, Fluphenazine
B. Butyrophenones: Haloperidol, Trifluperidol, Penfluridol
C. Thioxanthenes : Flupenthixol
D. Other heterocyclics: Pimozide, Loxapine
E. Atypical antipsychotics : Clozapine, Aripiprazole, Risperidone, Ziprasidone,
Olanzapine, Amisulpiride, Quetiapine, Zotepine.
 PATIENT COUNSELLING ON EACH CLASS OF DRUGS

A. PHENOTHIAZINES

1. Aliphatic Side Chain : Chlorpromazine, Triflupromazine

 Instruct patient to report these symptoms to physician immediately: sore throat,

fever, easy bruising, unusual bleeding, muscular rigidity, breathing difficulty, rapid
heart beat, yellow skin or sclera, skin rash.
 Remind patient to continue medication even if symptoms subside because
symptoms may recur if medication is discontinued. Caution patient not to stop
taking medication abruptly.
 Explain that drug may cause drowsiness and to avoid intake of alcoholic beverages
as well as any otc medications that also may cause drowsiness. Remind patient to
use caution when driving or performing other tasks that require mental alertness.
 Instruct patient to consult physician before taking other medications including
nonprescription drugs.
 Explain that dry mouth may be relieved by rinsing mouth with warm water, sucking
on sugarless hard candy or gum and taking frequent sips of water.

2. Piperidine side chain: Thioridazine

 Caution patient not to consume alcohol and to avoid otc medications while taking
drug.
 Tell patient/family to report seizures, headaches, faint feeling, dizziness, or changes
in mental function.
 Tell patient to use precautions against photosensitivity reactions. Advise use of
sunscreen.
 Caution patient not to drive while on medication, as may cause drowsiness or
dizziness.
 Inform patient that in hot weather patient may have increased risk of heat stroke
and increased sensitivity to sun.

3. Piperazine side chain: Trifluoperazine, Fluphenazine

 Instruct patient to report these symptoms to physician: abnormal movements,

involuntary muscle twitching or jaundice.
 Instruct patient to avoid intake of alcoholic beverages.
 Advise patient that drug may cause drowsiness and to use caution while driving or
performing other tasks requiring mental alertness.
  Caution patient to minimize exposure to sunlight and to use sunscreen or wear
protective clothing to avoid photosensitivity reaction.

B. BUTYROPHENONES: Haloperidol, Trifluperidol, Penfluridol

 Caution patient to avoid exposure to sunlight and to use sunscreen or wear

protective clothing to avoid photosensitivity reaction.
 Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
 Instruct patient to use mouth rinses, good oral hygiene, and sugarless gum or candy
to relieve dry mouth.
 Advise patient to avoid sudden position changes to prevent orthostatic hypotension.
 Inform patient of possible hair loss.
 Advise patient that drug may cause drowsiness and to use caution while driving or
performing other tasks requiring mental alertness.

C. THIOXANTHENES : Flupenthixol

 Instruct patient to avoid intake of alcoholic beverages.

 Advise patient that drug may cause drowsiness and to use caution while driving or
performing other tasks requiring mental alertness.
 Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
 Instruct patient to use mouth rinses, good oral hygiene, and sugarless gum or candy
to relieve dry mouth.
 Advise patient to avoid sudden position changes to prevent orthostatic hypotension.

D. OTHER HETEROCYCLICS: Pimozide, Loxapine

 Tell patient to immediately report fainting or loss of consciousness, palpitations,

high fever, muscle rigidity, involuntary body or facial movements, altered mental
status, irregular pulse, sweating, or seizures to health care provider.
 Advise patient to avoid strenuous activity during periods of high temperature or
humidity.
 Instruct patient to avoid alcoholic beverages, grapefruit juice, and grapefruit
products.
 Advise patient to take sips of water, suck on ice chips or sugarless hard candy, or
chew sugarless gum if dry mouth occurs.

E.ATYPICAL ANTIPSYCHOTICS : Clozapine, Aripiprazole,

Risperidone, Ziprasidone, Olanzapine, Amisulpiride, Quetiapine, Zotepine.

a. Clozapine
 Advise patient to change positions slowly and to sit up 1 to 2 min before standing
to minimize hypotension.
 Encourage patient to maintain high-fiber, high-fluid diet to prevent constipation.
 Teach patient that psychiatric symptoms will not improve until after several weeks
of therapy.
 Inform patient of risk of seizures and importance of taking medication as
prescribed.
 Stress the importance of regular follow-up care, including laboratory studies for
agranulocytosis (CBC).
 Instruct patient not to take OTC medications without consulting health care
provider

b. Aripiprazole
 Instruct patient to take prescribed dose once daily without regard to meals but to
take with food if GI upset occurs.
 Instruct patient not to stop taking aripiprazole feeling better.
 Tell patient to immediately report high fever, muscle rigidity, altered mental status,
irregular pulse, sweating, seizures, or rash to health care provider.
 Advise patient to avoid strenuous activity during periods of high temperature or
humidity.
 Instruct patient to avoid alcoholic beverages while taking aripiprazole.
 Instruct patients to get up slowly from lying or sitting position and to avoid sudden
position changes to prevent postural hypotension. Advise patient to report dizziness
with position changes to health care provider. Caution patient that hot tubs and hot
showers or baths may make dizziness worse.

c. Ziprasidone
 Advise patient not to crush or chew medication and to swallow capsules whole.
 Instruct patient to take each dose with food.
 Instruct patient to continue taking ziprasidone even if feeling better.
 Tell patient to immediately report fainting or loss of consciousness, palpitations,
high fever, muscle rigidity, altered mental status, irregular pulse, sweating,
seizures, or rash to health care provider.
 Advise patient to avoid strenuous activity during periods of high temperature or
humidity.
 Instruct patient to avoid alcoholic beverages.
 Advise patient to take sips of water, suck on ice chips or sugarless hard candy, or
chew sugarless gum if dry mouth occurs.
 Advise patient that drug may cause drowsiness and to use caution while driving or
performing other tasks requiring mental alertness.
 Advise patient about potential weight gain.

d. Olanzapine

 Instruct patient to take olanzapine exactly as directed and to not discontinue or

change the dose unless advised to do so by health care provider.
 Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
 Instruct patient not to take OTC medications without consulting health care
provider.
 Instruct patients to report the following symptoms to health care provider:
irritability, agitation, changes in vision, headache, dizziness, somnolence,
insomnia, nervousness, hostility, mental problems.
 Instruct women to notify health care provider if pregnant or planning to become
pregnant.
 Advise patient not to breastfeed while taking this medication.
 Instruct patient to avoid becoming overheated.
 Instruct patient to report involuntary face, tongue, mouth, or lip movements to
health care provider.

e. Quetiapine
 Advise patient to immediately report hyperpyrexia, muscle rigidity, altered mental
status, irregular pulse, tachycardia, and diaphoresis to health care provider.
 Advise patient to notify health care provider of drowsiness, seizures or involuntary
body or facial movements.
 Instruct patient to drink adequate liquids while taking this medication.
 Instruct patient to avoid alcoholic beverages.
 Instruct patient to get up slowly from lying or sitting position and to avoid sudden
position changes to prevent postural hypotension. Advise patient to report dizziness
with position changes to health care provider. Caution patient to avoid hot tubs and
hot showers and baths.

Prepared by: SANA UROOJ AHMED