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Dr. Vijayakumar D.R MBBS, DPM, DNB (NIMHANS), CCST (UK)
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Antipsychotic (Neuroleptic) Drugs

PATIENT INFORMATION ON ANTIPSYCHOTIC (NEUROLEPTIC) DRUGS

The name of your medication is risperidone, olanzapine, quetiapine, amisulpride,aripiprazol, ziprazidone, paliperidone, haloperidol.

Use

The primary use of this medication is to treat symptoms of acute or chronic psychosis, including schizophrenia, mania, delusional disorders and organic disorders. There are several other uses for these drugs (e. g., Tourette’s Syndrome, impulsive/aggressive behavior, etc.)

What symptoms will this drug help control?

Symptoms of psychosis differ between individuals, both as to the type of symptom and severity. Some common symptoms which antipsychotics have been found to help include:

  • Hallucinations (e. g., hearing voices, smelling odors, feeling unusual body sensations)
  • Fixed beliefs, often of a paranoid nature ( I. e., someone is persecuting or following you; people are talking about you)
  • Disorganized thoughts (difficulty in focusing on a thought), or speeded-up thoughts
  • Irritability, agitation, hyper excitement, over-elated mood

Some antipsychotics may also help symptoms of social withdrawal, lack of interest oneself and in others, and poor motivation. 

How quickly will the drug start working?

Antipsychotics begin to relieve agitation in about 1week, help control mood changes in about 2 weeks, and help difficulties in thoughts and awareness in 6-8 weeks; voices (hallucinations) will decrease in intensity and frequency over 2-8 weeks.

Because antipsychotics require time to work, do not decrease or increase the dose or stop the medication without discussing this with your doctor.

How long should you take this medication?

Following the first episode of psychosis, it is recommended that antipsychotic medication be continued for 1-2 years; this decreases the chance of being ill again.

For individuals that have had a psychotic illness for several years, antipsychotic medication should be continued indefinitely. The physician will adjust will adjust the dose, from time to time, to determine the need continued treatment.

Preparations of antipsychotics

Antipsychotics are available in different forms:

  • Fast-acting injection-To help control symptoms quickly, when the patient is in distress
  • Oral liquid-Convenient for individuals who have difficulty swallowing tablets
  • Oral tablets- The usual, most common form
  • Long-acting (depot) injection- Convenient for patients who have been stabilized on an oral antipsychotic. An injection is given every 1 to 4 weeks; this eliminates the need for the patient to remember to take his/ her medications daily, helps in compliance with treatment and has been shown to lower the risk of relapse.

Side Effects

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. Most will decrease or disappear with time. If a side effect continues, speak to your doctor about appropriate treatment.

Common side effects that should be reported to your doctor IMMEDIATELY include:

  • Muscle spasms, excessive rigidity, shaking, or restlessness. These symptoms can be controlled with antiparkinsonian agents ( trihexyphenydyl)

Common side effects that should be reported to your doctor at the next appointment include:

  • Drowsiness and lethargy- This problem goes away with time. Use of other drugs that make you drowsy will worsen the problem. Avoid driving a car or operating machinery if drowsiness persists.
  • Dizziness- Get up from a lying sitting position slowly ; dangle your legs over the edge of the bed for a few minutes before getting up. Sit or lie down if dizziness persists or if you fell faint, then contact your doctor.
  • Dry mouth- Sour candy and sugarless gum help increase saliva in your mouth; try to avoid sweet, calorie-laden beverages. Drink water and brush your teeth regularly.
  • Blurred vision- This usually occurs at start of treatment and may last 1-2 weeks. Reading under a bright light or at distance may help; a magnifying glass can be of temporary use. If the problem continues, advise your doctor.
  • Constipation- Increase bulk foods in your diet (e. g., salads, bran) and drink plenty of fluids. Some individuals find a bulk laxative or a stool softener helps regulate their bowels. If these remedies are not effective, consult your doctor or pharmacist.
  • Stuffy nose- Increase humidity. Temporary use of a decongestant nose spray (e. g., Origin) may help.
  • Weight changes- Monitor your food intake; you may notice a craving for carbohydrates (e. g., sweets, potatoes, rice, pasta), but try to avoid foods with high fat content (e. g., cakes and pastry).
  • Nausea or heartburn- If this happens, take the medication with food.
  • Breast tenderness, liquid discharge from breasts, or missed periods.
  • Tardive dyskinesia can occur in some patients who have been treated with narcoleptics, usually for many years. It involves involuntary movements of certain muscles, usually those of the lips and tongue, and sometimes those of the hands, neck, and other parts of the body. Movements initially tend to increase over several years, but then stabilize and in many patients decrease with time; in a few patients symptoms worsen. Withdrawal of the antipsychotic at the first signs of tardive dyskinesia, or switching to an “ atypical” class of drug, improves the chance that this adverse effect will disappear with time. This has to be balanced against the risk of recurrent illness.

Rare side effects you should report to your doctor IMMEDIATELY include:

  • Skin rash or itching
  • Unusual headache, persistent dizziness or fainting
  • Nausea, vomiting, loss of appetite, lethargy , weakness, fever, or flu-like symptoms
  • Soreness of the mouth, gums , or throat
  • Yellow tinge in the eyes or to the skin; dark colored urine
  • Inability to pass urine (more than 24 hours)
  • Inability to have a bowel movement (more than 2-3 days)
  • Fever (high temperature) with muscle stiffness/rigidity

Let your doctor know as soon as possible if you miss your period or suspect you may be pregnant.

What should you do if you forget to take a dose of your medication?

If you take your total dose of antipsychotic at bedtime and you forget to take it, DO NOT take the dose in the morning, but continue with your schedule the next day. If you take the drug several times a day, take the missed dose when you remember, then continue with your regular schedule.

Interactions with other medication

Because antipsychotic drugs can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-the-counter medications such as cold remedies. Always inform any doctor or dentist that you see that you are taking an antipsychotic medication.

Precautions

  1. Do not increase or decrease your dose without consulting your doctor.
  2. Take your drug with meals or with water, milk or orange juice; avoid apple or grapefruit juice as they may interfere with the effect of the drug.
  3. This drug may impair the mental and physical abilities required for driving car or operating machinery . Avoid these activities if you feel drowsy or slowed down.
  4. This drug may increase the effects of alcohol, making you more sleepy, dizzy and lightheaded .
  5. Avoid exposure to extreme heat and humidity (e. g., saunas) since this drug may affect your body’s ability to regulate temperature changes.
  6. Antacids (e. g., Gelusil) interfere with absorption of these drugs in your stomach and therefore may decrease their effect. To avoid this, take the antacid at least 2h before or 1 lour after taking your antipsychotic drug.
  7. Some patients may get a serious sunburn with little exposure to sunlight. Avoid direct sun, wear protective clothing and use a sunscreen preparation on exposed areas.
  8. Excessive use of caffeinated beverages (coffee, tea, colas, etc.) can cause anxiety, agitation and restlessness and counteract some of the beneficial effects of your medication.
  9. Cigarette smoking can change the amount of antipsychotic that remains in your bloodstream; inform your doctor if you make any changes to your current smoking habit.
  10. Do not stop your drug suddenly as this may result in withdrawal symptoms such as nausea, dizziness, sweating, headache, sleeping problems, agitation and tremor, and also result in the return of psychotic symptoms.

Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children.

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse