CC RUBIE ANN G.

TILLOR

Drug Name Dosages Indications Mechanism of Action Contraindications Special Precautions Adverse Reactions Drug Interactions
(Generic)
TYPICAL ANTI-PSYCHOTICS
Haloperidol For management of the Haloperidol is a first- Haloperidol is Patient with dementia-related Leucopenia, Adrenaline, alcohol,
manifestations of acute generation (typical contraindicated if there is psychosis, bipolar disorders, extrapyramidal symptoms, barbiturates, CNS
and chronic psychotic antipsychotic) which documented seizures or EEG abnormalities, risk hyperkinesia, depressants, other
disorders including exerts its antipsychotic hypersensitivity to this of falls, risk of QT prolongation, parkinsonism, drowsiness, antipsychotics,
schizophrenia, manic action by blocking drug, in Parkinson disease, risk factors for stroke, severe CV insomnia, agitation, anticholinergics,
states, and drug-induced dopamine D2 receptors dementia with Lewy body, disease, decreased gastrointestinal headache, depression, dopaminergic, TCADs,
psychoses, such as in the brain. comatose patient, in any motility, paralytic ileus, urinary psychotic disorder, tardive lithium,
steroid psychosis. condition with the retention, BPH, xerostomia, visual dyskinesia, oculogyric antihypertensives,
depressed central nervous problems, and narrow angle crisis, somnolence, CYP3A4 inducers
It may also be useful in system (CNS). Since many glaucoma. dizziness, visual (e.g. , anticonvulsants,
the management of drugs (barbiturates, disturbances, tachycardia, rifampicin, St John's
aggressive and agitated benzodiazepines, and Concomitant use with arrhythmias, ECG wort),
patients, including opioids) can cause antidepressants and anticholinergic changes, altered LFTs, drugs that prolong QT
patients with organic depression to CNS, agents. Avoid abrupt withdrawal. hypotension, weight interval
mental syndrome or concurrent use of Renal and hepatic impairment, changes, GI upset, salivary (e.g. , antiarrhythmics)
mental retardation. haloperidol should be Elderly, Children and in Pregnancy. hypersecretion, or cause electrolyte
avoided or used with great anticholinergic effects imbalance, diuretics,
caution. (e.g. dry mouth, blurred sympathomimetics,
vision), rash, metoclopramide,
photosensitivity, impaired phenindione.
temperature regulation,
convulsions, sexual
dysfunction. Altered concentration of
haloperidol with
CYP3A4 and CYP2D6
inhibitors and inducers.
May increase plasma
concentration of tricyclic
antidepressant

Chlorpromazin Chlorpromazine is a Chlorpromazine is a Hypersensitivity; Parkinson's disease; CV disease; Tardive dyskinesia (on Potentiation of
e typical antipsychotic neuroleptic that acts by preexisting CNS renal or hepatic impairment; long-term therapy). anticholinergic effects of
blocking the depression, coma, bone- cerebrovascular and respiratory anti-Parkinson agents
 used for the treatment postsynaptic dopamine marrow suppression; disease; jaundice; DM; Involuntary movements of and TCAs may lead to
of: receptor in the phaeochromocytoma; hypothyroidism; paralytic ileus; extremities may also an anticholinergic crisis.
Schizophrenia (primarily mesolimbic lactation. prostatic hyperplasia or urinary occur.
the positive symptoms) dopaminergic system retention; epilepsy or history of Dry mouth, constipation, Additive orthostatic
Bipolar I acute manic and inhibits the release seizures; myasthenia gravis; urinary retention, hypotensive effect in
type of manic-depressive of hypothalamic and pregnancy; elderly (especially with mydriasis, agitation, combination with
illness hypophyseal hormones. dementia), and debilitated patients. insomnia, depression and MAOIs.
Acute agitation marked Avoid direct sunlight. convulsions; postural
by explosive It has antiemetic, hypotension, ECG Reverses
hyperexcitable behavior serotonin-blocking, and changes. antihypertensive effect
out of proportion to the weak antihistaminic of guanethidine,
initial provocation properties and slight Allergic skin reaction, methyldopa and
To control nausea and ganglion-blocking amenorrhea, clonidine.
vomiting activity. gynecomastia, weight
Persistent singultus gain. Hyperglycemia and Potentially
(chronic hiccups) raised serum cholesterol. Fatal: Additive
Relief of apprehension depressant effect with
before surgery Potentially sedatives, hypnotics,
Fatal: Agranulocytosis. antihistamines, general
Instantaneous deaths anesthetics, opiates and
associated with ventricular alcohol.
tachyarrhythmias. Marked
elevation of body
temperature with heat
stroke. Neuroleptic
malignant syndrome,
extrapyramidal
dysfunction.

Flupentixol
Levopromazine
Clozapine 2nd Generation Anti- Clozapine is an FDA- Clozapine acts an FDA states the following Patient with CV or cerebrovascular Significant: Orthostatic Enhances the CNS effects o
psychotic (atypical) approved atypical antagonist to both Black Box warnings: disease or conditions predisposing hypotension, bradycardia, narcotics, antihistamines an
antipsychotic drug for dopamine and serotonin Neutropenia (due to the to hypotension, history of or risk syncope, seizures, benzodiazepines. May redu
Chemical Class: treatment-resistant receptors. risk of agranulocytosis) factors for seizure, risk or history of decreased gastrointestinal therapeutic effect of
Dibenzodiazepine schizophrenia. Orthostatic hypotension QT prolongation, DM, BPH, motility, urinary retention,
norepinephrine.
 It binds to the dopamine Seizures urinary retention, xerostomia, BPH xerostomia, visual
D4 with higher affinity Myocarditis decreased gastrointestinal motility, problems, CNS Increased plasma level with
than dopamine D2 Dementia (risk of a and visual problems. Smokers. depression, dyslipidemia, CYP1A2 inhibitors (e.g.
receptor contributing to cardiovascular event) eosinophilia, esophageal ciprofloxacin, fluvoxamine
the decrease in negative CYP2D6 poor metabolizers. dysmotility/aspiration,
contraceptives, caffeine).
symptoms and Patients taking strong CYP2D6 extrapyramidal symptoms,
extrapyramidal inhibitors. risk of fall, fever, Decreased plasma level wit
symptoms. hyperglycemia, QT CYP1A2 inducers.
Avoid abrupt withdrawal. Renal prolongation, suicidal
and hepatic impairment. ideation, temperature Increased risk of neurolepti
regulation disturbance, malignant syndrome with
Elderly (not indicated for use in deep vein thrombosis, lithium. Risk of seizures w
dementia-related psychosis). pulmonary embolism, valproic acid.
Pregnancy and lactation. weight gain, tachycardia,
visual disturbance, Potentially Fatal: Increased
constipation, nausea, of myelosuppression with l
vomiting, dyspepsia,
acting depot antipsychotics
dizziness, insomnia,
vertigo, and headache.

Risperidone 2nd Generation Anti- Schizophrenia (in adults Risperidone is a Risperidone should not be Patient w/ known CV Weight changes, metabolic May enhance effects of
psychotic (atypical) and children aged 13 and Benzisoxazole atypical given if a known disease (e.g. history of changes, and sedation are antihypertensives and
up) antipsychotic w/ mixed allergy/hypersensitivity to MI or ischemia, heart a significant concern with CNS depressants.
Bipolar I acute manic or serotonin dopamine risperidone or paliperidone failure, conduction risperidone. Increased risk of QT
mixed episodes as antagonist activity that (a metabolite or prolongation when given
abnormalities),
Chemical Class: monotherapy (in adults binds to 5-HT2- risperidone) is present. Risperidone may produce w/ drugs known to cause
Benzisoxazole and children aged 10 and receptors in the CNS and cerebrovascular extrapyramidal symptoms this effect (e.g.
up) in the periphery w/ a Hallucinogen persisting disease, conditions that (EPS) which can include antiarrhythmics, TCAs).
Bipolar I acute manic or very high affinity; binds perception disorder or would predispose to acute dystonia, akathisia,
mixed episodes to dopamine- HPPD may be a relative hypotension (e.g. tardive dyskinesia (TD), May antagonize the
adjunctive with lithium D2 receptors w/ less contraindication for dehydration, and parkinsonian features. actions of levodopa and
or valproate (in adults) affinity. risperidone because some hypovolemia), other dopamine agonists.
Autism-associated patients treated with parkinsonian Serious side effects of
irritability (in children risperidone for their HPPD syndrome, history of antipsychotic medications Carbamazepine and
aged 5 and up. reported that panic and seizures or other (like risperidone) can other enzyme inducers
visual symptoms conditions that may include neuroleptic (e.g. rifampicin,
intensified. malignant syndrome phenobarbital) may
 potentially lower (NMS). Although the
seizure threshold, pre- pathogenesis of NMS is
existing not clear, it is a life-
threatening condition that
hyperprolactinemia,
can manifest with altered
and possible prolactin-
mental status, fever, "lead
dependent tumors. pipe" rigidity, and
autonomic instability
Avoid abrupt including hypertension,
withdrawal. Hepatic or tachypnea, and
renal impairment. tachycardia.
decrease the serum
levels of the active
antipsychotic fraction of
risperidone.
Increased plasma
concentration w/
fluoxetine, paroxetine or
verapamil.

Elderly w/ dementia-
related psychosis.
Pregnancy and
lactation.

Olanzapine Oral: Olanzapine is a second- An atypical (second- Black box warning Patient w/ cerebrovascular disease Causes an increase in Increased olanzapine
Initially, 10 mg daily as a single dose. Adjust dose according to response for
generation (atypical) generation) olanzapineofregarding
at intervals not less or conditions predisposing to appetite leading to clearance w/ CYP1A2
antipsychotic
than 24 hr w/in the range of 5-20 mg daily. antipsychotic that exerts dementia-related hypotension, history of blood hyperphagia with a inducers (e.g.
medication. The FDA its action primarily on psychosis. Elderly patients dyscrasias, bone marrow consequence of weight carbamazepine,
has approved this dopamine and serotonin with dementia who present depression, , myeloproliferative gain. omeprazole). Inhibits
IM: Initially, 5-10 mg medication for the receptors. It works on with symptoms of disease, history of seizures or metabolism w/ CYP1A2
followed by 5-10 mg following conditions: dopamine D2 receptors psychosis should not be conditions that lower the seizure hypertriglyceridaemia, inhibitors (e.g.
as required 2 hrs in the mesolimbic prescribed olanzapine due threshold. IM: Acute MI, unstable hypercholesterolaemia fluvoxamine). May
Schizophrenia if the pathway as an to an increased risk of angina bradycardia, recent heart antagonize effects of
later. Max: 20
mg/day (combined patient is over the age of antagonist, blocking mortality. surgery. Elderly w/ dementia- levodopa and dopamine
oral and parenteral 13; dopamine from having a related psychosis. Hepatic and renal high potential to cause agonists.
dose). Patients could Bipolar disorder potential action at the Olanzapine is impairment. Pregnancy and reduced insulin sensitivity,
only receive up to 3 including mixed or post-synaptic contraindicated in patients lactation. leading to impaired
manic episodes receptor. Olanzapine bin with a known glucose tolerance.
injections in any 24-
hr period. ds loosely to the receptor hypersensitivity to this
and dissociates easily, medication. Dyslipidemia, weight gain,
allowing for normal impaired glucose tolerance
dopamine
 neurotransmission. The leading to metabolic
effect on the D2 syndrome.
receptors leads to a
decrease in positive
symptoms in patients,
including hallucinations,
delusions, and
disorganized speech,
thought, and
behavior. Olanzapine wo
rks similarly on
serotonin 5HT2A
receptors in the frontal
cortex as an antagonist.
Its effects on serotonin
lead to a decrease in
negative symptoms,
including anhedonia, flat
affect, alogia, avolition,
and poor attention.

Quetiapine ORAL : As FDA approved for blocks 5HT1A, 5-HT2, There are currently no quetiapine correlates with
immediate- schizophrenia, acute D1,D2,H1, A1, and A2 know FDA As mentioned before, quetiapine, an increased risk of death
release/film-coated manic episodes, and receptors. contraindications along with other atypical in dementia-related
tab: Initially, 25 mg adjunctive treatment for Quetiapine itself does of quetiapine. However, antipsychotics, is associated with an psychosis in elderly
bid on day 1, major depressive not act on cholinergic or there are several increased risk of death in elderly patients. Alongside this
followed by 50 mg disorder; Non-FDA benzodiazepine precautions to be patients with dementia-related risk, neuroleptic malignant
bid on day 2, 100 mg approved indications receptors. However, a considered when psychosis. syndrome should be a
bid on day 3 and 150 such as generalized metabolite of quetiapine, administering this drug. Precautions are also necessary for consideration due to its D2
mg bid on day 4. anxiety disorder. norquetiapine, blocks (PLS REFER TO patients with a history of cardiac receptor blockage.
Titrate dose M1 receptors. Blocking PRECAUTIONS) arrhythmia, hypokalemia, and
according to response of the D2 receptor in hypomagnesemia. The clinician least likely of atypical
between 300-450 mg mesocortical and should consider metabolic panels antipsychotics to cause
daily given in 2 mesolimbic pathways is before starting the drug. In patients extrapyramidal symptoms.
divided doses from indicated in the with diabetes mellitus, patients There is an increased risk
treatment of should have their glucose monitored for suicidal thoughts and
 day 4 onwards. Max: schizophrenia for in an attempt to avoid hyperosmolar behavior associated with
750 mg daily. negative and positive coma. drug treatment in
symptoms, respectively. major depressive disorder
Increased dopamine in patients.
these pathways has
shown to be associated Somnolence, orthostatic
with schizophrenia. hypotension, and dizziness
are the most common side
effects of quetiapine.

Amisulpride Acute psychosis. Amisulpride binds Phaeochromocytoma, Patient w/ history of epilepsy; Parkinson'sInsomnia,
disease, CVanxiety,
disease. Avoid abrupt withdrawal. Renal impairment
selectively to dopamine concomitant prolactin- Elderly. Pregnancy and lactation. agitation, drowsiness, wt
D2, D3 receptors in the dependent tumours (e.g. gain, acute dystonia,
limbic system, and has pituitary gland parkinsonism, akathisia,
no affinity for D1, D4, prolactinomas or breast tardive dyskinesia, QT
and D5 receptor cancer). Pre-pubertal prolongation, hypotension,
subtypes. Low doses childn. Combination w/ bradycardia, GI disorders
of amisulpride block levodopa. (e.g. constipation, nausea,
presynaptic D2, D3 auto vomiting, dry mouth),
receptors, thereby hyperglycaemia; breast
enhancing dopaminergic pain, erectile dysfunction,
transmission amenorrhoea,
gynaecomastia,
galactorrhoea. Rarely,
allergic reactions,
abnormal LFTs, seizures.
Potentially
Fatal: Neuroleptic
malignant syndrome.

Aripiprazole
ANTIDEPRESSANTS
Citalopram SSRI Major Depressive Citalopram is a selective Citalopram is May worsen depression, suicidal CNS: Drowsiness, May increase
Disorder serotonin re-uptake contraindicated with ideation and atypical behavior in insomnia, dizziness, anticoagulant effect w/
inhibitor, w/ little or no concomitant use of patients w/ psychiatric disorder. drugs affecting
 Depressive phase of effect on noradrenaline, monoamine oxidase headache (dose- hemostasis (e.g.
bipolar disorder dopamine and GABA inhibitors (MAOIs). History of seizure and mania; dependent) warfarin). Increased risk
Obsessive-compulsive re-uptake. hepatic impairment. CYP2C19 poor Dermatologic: Diaphoresis of hypomania w/
disorder (OCD) Concurrent use of metabolizers. Avoid withdrawal Gastrointestinal (GI): sibutramine. Increased
Panic disorder The inhibitory activity citalopram alongside an reactions by gradual dose reduction. Nausea, vomiting, lowering seizure
Generalized anxiety explains the MAOI can result in Pregnancy and lactation. xerostomia, constipation, threshold w/ TCAs and
disorder (GAD) antidepressant property serotonin syndrome diarrhea other SSRIs.
Social anxiety disorder of citalopram. It has no (serotonergic Sexual: Ejaculation
(SAD) or very low affinity for hyperactivity). Symptoms disorder (dose dependent) Potentially
Separation anxiety 5-HT1AA, 5-HT2A, of serotonin syndrome Fatal: Increased risk of
disorder D1 and D2 receptors, include rigidity, Less common serious severe adverse effects
Premenstrual dysphoric α1, α2, β-adrenergic, hyperthermia, autonomic adverse effects: (e.g. serotonin
disorder (PMDD) histamine H1, instability, mental status Cardiovascular: syndrome) w/ MAOI.
muscarinic, cholinergic, changes, and coma. Myocardial infarction, QT interval prolongation
benzodiazepine and Similar adverse reactions prolonged QT interval, w/ subsequent risk of
opioid receptors. are possible in patients Torsades de pointes torsade de pointes w/
who had abruptly switched Hematologic: QT-prolonging drugs
from an SSRI to an Hemorrhage, abnormal (e.g. pimozide,
MAOI; therefore, Neurologic: quinidine, procainamide,
recommendations are to Cerebrovascular accident chlorpromazine,
wait 14 days after Psychiatric: Suicidal thioridazine,
discontinuing citalopram ideation, suicide, induction amiodarone, sotalol,
to initiate an MAOI. of mania moxifloxacin,
Other: Serotonin pentamidine,
Citalopram is also syndrome methadone).
contraindicated in patients
with a history of
hypersensitivity to the
drug.

Sertraline SSRI First-line treatment of Sertraline is an Sertraline is Patients with family history of The primary side effects of May increase risk of
major depressive antidepressant contraindicated in patients bipolar disorder, mania or sertraline include syncope, hyponatremia with
disorder. medication within the with documented hypomania, schizophrenia; previous lightheadedness, diarrhea, diuretics. Increased risk
selective serotonin hypersensitivity to the seizure disorder or condition nausea, sweating, of QTc prolongation
drug or its components. predisposing to seizures (e.g. brain dizziness, xerostomia, and/or ventricular
Has also approved other
indications for sertraline,
including the treatment
of obsessive-compulsive
disorder, panic disorder,
post-traumatic stress
disorder, premenstrual
dysphoric disorder, and
social anxiety disorder.
reuptake inhibitors damage, alcoholism); volume confusion, hallucinations, arrhythmias with
(SSRIs) class. Concomitant use or within depletion, diabetes mellitus, history tremor, somnolence, specific antipsychotics
14 days of discontinuation of bleeding disorders, angle-closure impotence, a disorder of (e.g. ziprasidone,
Sertraline is an of MAOIs. Concurrent use glaucoma or history of glaucoma, ejaculation, fatigue, iloperidone,
antidepressant with with pimozide. risk factors for QTc prolongation. rhinitis, and female sexual chlorpromazine, specific
primarily inhibitory disorder. antibiotics (e.g.
effects on presynaptic Concomitant use of Avoid abrupt withdrawal. Hepatic There is a bleeding risk erythromycin), Class IA
serotonin reuptake. sertraline oral concentrate impairment. Children and elderly. associated with sertraline, antiarrhythmics (e.g.
solution with disulfiram. Pregnancy and lactation. CYP2C19 as it may inhibit platelet quinidine, procainamide,
This inhibition of ultrarapid and poor metabolizers. aggregation. Class III antiarrhythmics
serotonin reuptake Sertraline can prolong the (e.g. amiodarone,
results in an QT interval; however, the sotalol) and other drugs
accumulation of prolongation is dose- that prolong QTc
serotonin. dependent and is very interval (e.g.
modest. pentamidine,
Serotonin in the central Sertraline, like other methadone, halofantrine,
nervous system plays a antidepressants, may mefloquine, probucol,
role in the regulation of increase the risk of tacrolimus).
mood, personality, and suicidal ideation and
wakefulness, which is behavior in children, May increase serum
why blocking serotonin adolescents, and young concentration of
reuptake is thought to be adults with major phenytoin.
beneficial in disorders depression.
such as major May prolong
depression. neuromuscular blocking
effects of mivacurium or
other neuromuscular
blockers.
Potentially
Fatal: Increased risk of
serotonin syndrome with
other serotonergic agents
(e.g. triptans, TCAs,
fentanyl, lithium,
tramadol, buspirone,
 tryptophan,
amphetamines,
fenfluramine, serotonin
agonists); agents which
impair metabolism of
serotonin (e.g. MAOIs,
linezolid, IV methylene
blue); antipsychotics or
other dopamine
antagonists, and opiate
drugs. May enhance
adverse/toxic effect of
pimozide.

Enhanced adverse/toxic
effect of sertraline oral
concentrate solution
with disulfiram.

Increased risk of
bleeding with
anticoagulants (e.g.
aspirin, clopidogrel,
heparin, warfarin) and
NSAIDs (e.g. ibuprofen,
naproxen).

Drug Name Drug Classification Indications Mechanism of Action Contraindications Special Precautions Adverse Reactions Drug Interactions
(Generic)
Duloxetine SNRI Treatment of major Duloxetine inhibits the Hepatic impairment, Patient w/ HTN, Duloxetine has a very low Increased risk of
depressive disorder, reuptake of both severe renal impairment, gastroparesis, mania or anticholinergic side effect serotonin syndrome w/
generalized anxiety serotonin and uncontrolled HTN or hypomania, increased profile; adverse effects TCA, SSRI, SNRI,
disorder, fibromyalgia, norepinephrine, thus narrow-angle glaucoma. intraocular pressure or related to the lithium. May increase
chronic musculoskeletal combining two Concomitant use w/ cardiovascular, bleeding risk w/ aspirin,
at risk of acute narrow-
pain, and diabetic therapeutic mechanisms MAOIs or w/in 14 days of gastrointestinal, central NSAIDs, warfarin and
peripheral neuropathy. in one agent to treat discontinuing the MAOI. angle glaucoma, nervous system, such as other anticoagulants.
seizure, bleeding
Off-label (non-FDA depression and anxiety. Use w/ linezolid or IV disorders, mild to headache and drowsiness, Potentially
approved) use for As well, duloxetine methylene blue. moderate renal and fatigue are more Fatal: Increased risk of
duloxetine include enhances dopamine Concomitant use w/ potent impairment. Smokers. common. serotonin syndrome w/
chemotherapy-induced levels within the CYP1A2 inhibitors (e.g. MAOIs, linezolid and
Gradual dose reduction
peripheral neuropathy prefrontal cortex. ciprofloxacin) Serious adverse effects of methylene blue.
is recommended rather
and stress urinary duloxetine include: Increased serum levels
incontinence in both The mechanism of than abrupt withdrawal. Suicidality, Serotonin and risk of toxicity w/
men and women. action behind the Pregnancy and syndrome, Hepatoxicity, potent CYP1A2
increase in dopamine lactation. Mania, Syncope, SIADH inhibitors (e.g.
levels involves the Hyponatremia ciprofloxacin)
inhibition of Common adverse effects
norepinephrine of duloxetine include:
transporters. Headache, drowsiness,
fatigue, nausea,
These transporters have xerostomia, abdominal
a significant affinity for pain, weight loss,
dopamine, resulting in weakness, insomnia,
the pump’s ability to act dizziness, libido changes,
on both dopamine and diaphoresis and
norepinephrine. constipation

Therefore, inhibition of
norepinephrine
transporters can lead to
an increase in dopamine.
This increase in
dopamine specifically
takes place in the
prefrontal cortex where
dopamine transporters
are scarce, and reuptake
relies more heavily on
norepinephrine
transporters.
Venlafaxine SNRI Venlafaxine is FDA Venlafaxine works by Children. Concomitant use Patient with CV disease (e.g. recent Venlafaxine causes a Increased risk of
approved to treat and increasing the levels of with MAOIs (including history of MI, unstable heart lower frequency of hyponatremia with
manage symptoms of serotonin, methylene blue, linezolid) disease, cerebrovascular conditions anticholinergic, sedating, diuretics. Altered
depression, social norepinephrine, and or within 14 days of or hyperthyroidism), bipolar and cardiovascular side glycemic control of
anxiety disorder, and dopamine in the brain by therapy. Avoid alcohol disorder, diabetes, suicidal effects but a higher antidiabetic agents (e.g.
cataplexy. Off-label, blocking transport should not use venlafaxine ideation/behavior, at risk of acute incidence of insulin). Increased risk
venlafaxine can be used proteins and thus if there is a history of narrow-angle glaucoma, history of gastrointestinal of QTc prolongation
for attention deficit stopping its reuptake at anaphylaxis, and caution is convulsions, predisposing factors of complaints, sleep and/or ventricular
disorder, fibromyalgia, the presynaptic terminal. necessary when combining bleeding. Volume-depleted or impairment, and sexual arrhythmias with
diabetic neuropathy, This action leads to venlafaxine with other dehydrated patients. Renal and dysfunction than TCAs. concomitant use of other
complex pain more transmitter at the serotonin modulators. hepatic impairment. Elderly. Additionally, venlafaxine QTc prolonging agents
syndromes, hot flashes, synapse and ultimately contraindicated if it causes Pregnancy and lactation. CYP2D6 may impair sexual [e.g. class IA and III
migraine prevention, increased stimulation of worsening suicidal extensive and poor metabolizers. function, resulting in antiarrhythmics (e.g.
post-traumatic stress the postsynaptic ideation, depression, Avoid abrupt discontinuation. diminished libido, quinidine, amiodarone,
disorder, obsessive- receptors. SNRIs act anxiety, and psychosis. impotence, or difficulty in sotalol), antipsychotics,
compulsive disorder, primarily upon Venlafaxine is achieving orgasm. macrolides (e.g.
and premenstrual serotonergic and contraindicated in patients erythromycin),
dysphoric noradrenergic neurons with uncontrolled angle- Common side effects quinolone antibiotics
disorder. Venlafaxine but have little or no closure include: Headache, (e.g. moxifloxacin)].
may be used effect upon cholinergic glaucoma. Venlafaxine is nausea, insomnia, Increased serum
independently or as part or histaminergic a category C pregnancy dizziness, hypotension, concentration with
of combination therapy receptors drug. Venlafaxine has the anorexia, somnolence, CYP3A4 inhibitors (e.g.
with other drugs potential to pass into xerostomia, asthenia atazanavir,
breast milk and cause side HTN, constipation, weight clarithromycin,
effects in breastfed loss, itraconazole). Increased
children and thus should abnormal dreams, serum or plasma
not be used in pregnancy diarrhea, abdominal pain, concentrations of
and breastfeeding. blurred vision, anxiety, imipramine metabolite
tremor, (2-hydroxydesipramine),
hypercholesterolemia, haloperidol, risperidone,
hyponatremia, serotonin and metoprolol.
syndrome and seizures
Decreased serum
Venlafaxine also can cause concentration of
fatal skin conditions such indinavir. Increased risk
as Stevens-Johnson of bleeding with
 syndrome, toxic epidermal
necrolysis, and erythema
multiforme.
antiplatelet agents (e.g.
aspirin), anticoagulants
(e.g. warfarin), and
NSAIDs.
Potentially
Fatal: Increased risk of
serotonin syndrome with
concomitant use of other
serotonergic agents (e.g.
triptans, SSRIs, SNRIs,
amphetamines, lithium,
sibutramine, opioids),
MAOI (including
methylene blue,
linezolid), serotonin
precursors (e.g.
tryptophan),
antipsychotics or other
dopamine antagonists

MOOD STABILIZERS
Lithium Mood stabilizer Lithium was the first The mechanism of Severe renal and cardiac Monitor serum lithium levels (twice Lithium can cause several Reduced serum levels
carbonate mood stabilizer and is action of lithium is not disease; severe weekly or more frequently in acute adverse effects. Typically, with carbonic anhydrase
still the first-line known. dehydration, sodium phase; at least every 2 month during the side effects are dose- inhibitors,
treatment. commonly Lithium modifies depletion, debilitation. maintenance). Thyroid disorders, related. Notable side chlorpromazine, sodium-
prescribed drug for a sodium transport in not considered for mild to moderate renal or cardiac effects include: containing preparations,
manic episode in bipolar nerve and muscle cells. treatment during impairment. Marked fluid loss Cardiac: Bradycardia, theophylline, urea.
disorder as well as It alters the metabolism pregnancy due to a 2 to 3 (protracted sweating, diarrhea or flattened or inverted T Enhanced hypothyroid
maintenance therapy of of neurotransmitters, fold increase of significant prolonged fever). waves, heart block, and effects with iodine salts.
bipolar disorder in a specifically congenital disabilities Maintain normal fluid and salt sick sinus syndrome. Enhanced effects of
patient with a history of catecholamines and Ebstein's anomaly is a intake. Elderly. Monitor changes in CNS: Confusion, memory neuromuscular-blocking
a manic episode. The serotonin. cardiac defect in infants renal function. Patients with problems, new or agents. Reduced pressor
primary target symptoms associated with lithium suicidal tendency. May impair worsening tremor, response to
of lithium are mania and treatment during ability to drive or operate hyperreflexia, clonus, sympathomimetics.
unstable mood. also pregnancy. machinery. Children <12 yr. slurred speech, ataxia, Potentially
prescribed for major Pregnancy and lactation. stupor, delirium, coma, Fatal: Increased risk of
 depressive disorder as an and seizures (rarely).
adjunct therapy These effects are
theoretically due to excess
action on the same sites
that mediate
therapeutic action.
Renal: Nephrogenic
diabetes insipidus with
polyuria and polydipsia.
These side effects are due
to lithium's action on ion
transport.
Hematologic:
Leukocytosis and aplastic
anemia
Gastro: Diarrhea and
nausea
Endocrinal: Euthyroid
goiter or hypothyroid
goiter
Others: Acne, rash, and
weight gain. Lithium-
induced weight gain is
more common in women
than in men.
lithium toxicity with
ACE inhibitors,
angiotensin receptor
antagonists, loop
diuretics, metronidazole,
phenytoin. Increased
risk of neurotoxicity
with carbamazepine,
calcium-channel
blockers, haloperidol,
methyldopa,
phenothiazines, SSRIs,
TCAs. Increased serum
levels with COX-2
inhibitors, NSAIDs
(except sulindac,
aspirin), tetracyclines,
thiazide diuretics.
Increased risk of
encephalopathy with
haloperidol. Increased
risk of serotonin
syndrome with
sibutramine.
Fatal malignant
hyperpyrexia may occur
when used with MAOIs.

Valproic acid Anticonvulsant Valproic acid's primary Valproic acid exhibits its Pre-existing or family Patients with HIV, cytomegalovirus Serious reactions: Increased risk of toxicity
use is as an anti-seizure pharmacologic effects in history of hepatic (CMV) infection, SLE. Renal Valproic acid has multiple w/ bupropion. Increased
Carboxylic acid medication, as well as in a couple of ways, such dysfunction, porphyria, impairment. Children (<2 years on serious adverse reactions risk of convulsions w/
derivative migraine, bipolar, mood, as by acting on GABA urea cycle disorders, anticonvulsant polytherapy, with such as hepatotoxicity, mefloquine.
and anxiety disorders (γ aminobutyric acid) known mitochondrial congenital metabolic disorders, hallucinations, suicidality,
levels in the CNS, disorders caused severe seizure disorders, mental psychosis, toxic epidermal Increased risk of
blocking voltage-gated by POLG mutation and in retardation, organic brain disease). necrolysis, Steven Johnson hepatotoxicity and
 ion channels, and also children (<2 years) who Use in children ≥2 years of age who Syndrome, anaphylaxis,
by inhibiting histone are suspected of having a are suspected of having POLG- hyponatremia,
deacetylase. mitochondrial disorder. related disorder only after other thrombocytopenia,
alproic acid inhibits Hepatic impairment. anticonvulsants have failed. pancytopenia, bleeding.
GABA transaminase and Pregnancy (prophylaxis of Lactation. Abrupt discontinuation of
succinate semialdehyde migraine). the drug can cause
dehydrogenase, withdrawal seizures.
therefore increase the
GABA concentration by Common reaction:
reducing its degradation headache, abdominal pain,
somnolence, dizziness,
thrombocytopenia,
asthenia, nausea &
vomiting, diarrhea,
dizziness, tremor, weight
changes, alopecia,
constipation, emotional
lability, insomnia,
petechiae & rash, appetite
changes, ALT & AST
elevation, tinnitus, blurred
vision, myalgia, and
dyspnea.
carbamazepine toxicity
w/ a decrease in valproic
acid levels w/ concurrent
carbamazepine.
Decreased valproic acid
levels w/ carbapenems,
rifampicin, phenytoin,
phenobarbital (or
primidone) and
antineoplastic drug
regimens. Increased
valproic acid levels w/
felbamate and aspirin.
Increased risk of
absence status w/
clonazepam.. Increased
free valproic acid
concentrations w/ highly
protein bound drugs.
Potentially
Fatal: Concomitant
carbapenem is not
recommended as this
may decrease valproate
levels. Avoid concurrent
salicylates in children <3
yr. due too risk of
hepatotoxicity. Avoid
ethanol as this may
increase CNS
depression.

ANXIOLYTICS
Alprazolam Benzodiazepines Anxiety disorders- Alprazolam binds to Contraindications to Patients with depression, suicidal Significant: Suicidal Alprazolam is affected
generalized anxiety stereospecific alprazolam include tendencies, psychiatric or ideation, CNS depression, by drugs that inhibit or
disorder benzodiazepine patients with known personality disorder, respiratory anterograde amnesia, induce CYP3A4. Drugs
Panic disorders- with or receptors on the alprazolam or disease, history of drug abuse or psychiatric and that are potent inhibitors
without agoraphobia postsynaptic GABA benzodiazepine acute alcoholism. Patients who are paradoxical reactions, of CYP3A may lead to
Insomnia neuron at several sites hypersensitivity or known debilitated, obese, smokers, or at sleep-related activities an increase in plasma
Premenstrual syndrome within the CNS, allergies to any of its risk of falls. Concomitant use with (e.g. sleep-driving, concentrations, which
Depression including the limbic components in the drug opioids. Avoid abrupt withdrawal. cooking, eating or making may result in increased
system and reticular dosage form. Renal and mild to moderate hepatic phone calls while asleep), adverse events.
formation. Enhancement impairment. Elderly. Pregnancy and tolerance, abuse,
of the GABA inhibitory Alprazolam should be lactation. psychological and physical Medications known to
effect on neuronal avoided if possible by dependence; rebound or impact alprazolam
excitability results by anyone with pulmonary withdrawal symptoms include azole antifungals
increased neuronal disease. including seizures. (ketoconazole),
membrane permeability Palpitations, chest pain. cimetidine, certain anti-
to Cl ions, which results Using alprazolam with Blurred vision depressants (fluoxetine,
in hyperpolarization (a CNS depressants, Constipation, dry mouth, fluvoxamine, and
less excitable state) and especially opioids, nausea, vomiting, nefazodone), macrolide
stabilization. increases the risk of increased salivation antibiotics
respiratory depression, low Ataxia, lethargy, fatigue, (clarithromycin), seizure
Benzodiazepine blood pressure, and death. abnormal hepatic function, medications
receptors and effects hepatitis (carbamazepine,
appear to be linked to Decreased or increased phenytoin),
the GABA-A receptors appetite antihistamines and
but does not bind to Sedation, somnolence, muscle relaxants.
GABA-B receptors. headache, dizziness,
memory impairment,
balance disorder, abnormal
coordination, tremor
Sexual dysfunction,
Dermatitis, rash, pruritus
Hypotension

Clonazepam Benzodiazepines Seizure Disorders It exerts its Patient w/ acute angle Patient w/ open angle glaucoma, Drowsiness or sedation, Additive depressant
Panic Disorder pharmacological effects closure glaucoma, acute chronic pulmonary insufficiency, fatigue, muscular effect w/ TCAs, MAOIs,
Acute Mania by acting as a positive pulmonary insufficiency, porphyria, spinal or cerebellar hypotonia, behavioral sedative and hypnotics,
 Clonazepam is also a allosteric modulator on severe resp insufficiency, ataxia, history of alcohol or drug disturbances including barbiturates, anxiolytics,
side option for the GABA-A receptors. myasthenia gravis, sleep addiction, and depression and/or aggressiveness, agitation, antipsychotics, opiate
treatment of akathisia, The GABA-A receptor apnea syndrome. suicide attempts. Increased risk of hyperkinesis and agonists. May increase
restless leg syndrome, is a ligand-gated suicidal behavior and ideation. irritability; coordination serum phenytoin levels
rapid eye movement chloride ion-selective Avoid abrupt withdrawal. Renal disturbances, dizziness,
behavior disorder, and channel whose and hepatic impairment. Elderly or vertigo, anorexia, visual
bruxism endogenous ligand is debilitated patient. Pregnancy and disturbances, libido
GABA (gamma- lactation. changes; rhinorrhea, chest
aminobutyric acid). congestion and shortness
Benzodiazepines of breath; skin rash, hair
(BZDs) facilitate loss, hirsutism, and ankle
GABA-A action by and facial oedema;
increasing the frequency diarrhea, constipation, wt.
of chloride channel gain or loss, abnormal
opening resulting in thirst, encopresis, gastritis,
hyperpolarization of the increased or decreased
neurons and decreased appetite, dyspepsia,
firing, thus producing nausea, coated tongue, dry
calming effects on the mouth, sore gums;
brain by reducing the nocturia, dysuria, enuresis,
excitability of the urinary retention.
neurons.
Salivary or bronchial
hypersecretion leading to
resp problems (children).
Rarely, abnormal skin
pigmentation.

ANTI-EPS
Benztropine Anticholinergic Drug-induced In the CNS and smooth Generally speaking, if the Patient w/ tachycardia, obstructive Tachycardia, dry mouth, May cause heat
extrapyramidal muscles, benztropine ex patient has a history of disease of the GI tract (e.g. pyloric constipation, nausea, intolerance, fever and GI
symptoms erts its action through hypersensitivity to or duodenal obstruction), glaucoma, vomiting, paralytic ileus, complaints when
Adjunct in parkinsonism competing with other benztropine mesylate or prostatic hyperplasia and/or urinary toxic psychosis (including concomitantly used w/
Acute dystonia cholinergic substances any component of the stricture or retention. Use w/ exacerbation of pre- phenothiazines,
(especially formulation. Also, patients caution during hot weather (esp. in existing psychotic haloperidol or other
acetylcholine) at with specific syndromes patients concurrently taking symptoms, disorientation, drugs w/ anticholinergic
 muscarinic receptors. and diseases are atropine-like drugs to chronically confusion, memory or antidopaminergic
Consequently, it contraindicated from using ill, alcoholics, w/ CNS disease, impairment, visual activity. May cause
replaces cholinergic by benztropine as follows: those w/ prolonged outdoor hallucinations, paralytic ileus,
muscarinic effects that Urinary retention, bladder exposure). Not intended for nervousness, depression, hyperthermia or heat
appear to improve obstruction, and prostatic treatment of tardive dyskinesia. listlessness, finger), intolerance (sometimes
the symptoms of hypertrophy Pregnancy and lactation. blurred vision, dilated fatal) when
Parkinson disease Closed Angle Glaucoma: pupils, dysuria, urinary concomitantly used w/
Tachycardia: retention, allergic phenothiazines and/or
Tardive Dyskinesia reactions (e.g. skin rash), TCAs. Increased
Behavioral and fever. sedative effect w/ other
psychological changes Potentially Fatal: Severe CNS depressants (e.g.
Infants and Children anhidrosis which may lead sedatives and hypnotics,
to hyperthermia anxiolytics). May
interfere w/ oral
bioavailability of
ketoconazole. Additive
depressive effect on GI
motility or bladder w/
opiate agonists.
Antagonistic effect w/
parasympathomimetic
(including both direct
cholinergic receptor
agonists and
cholinesterase
inhibitors). Reduced
excretion and increased
effects w/ carbonic
anhydrase inhibitors.

REFERENCES:
Basit H, Kahwaji CI. [Updated 2020 May 4]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK556010/
Philippines. (n.d.). Retrieved October 09, 2020, from https://corporate.mims.com/country_office/philippines/