Medications

Medications

Atypical Antipsychotic Drugs

Seven atypical antipsychotic drugs are currently approved in the United States:

• Clozapine (Clozaril)
• Risperidone (Risperdal)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Aripiprazole (Abilify)
• Ziprasidone (Geodon)
• Paliperidone (Invega)

Clozapine was the first atypical drug approved (in 1989), and paliperodine the most recent approved (in 2007). Clozapine appears to have more side effects than the other atypical antipsychotics. Most of these drugs come in pill form, but some may come in liquid form or as an injection. In general, it may take up to 6 months before an atypical drug has an effect.

The atypical antipsychotics zotepine (Zoleptil) and amisulpride (Solian) are not approved for use in the United States.

Benefits of Atypical Antipsychotics.

• Affect both dopamine receptors and other neurotransmitters responsible for psychotic symptoms.
• Improve negative and positive symptoms.
• May even improve working memory and mental functioning.
• May reduce depression and hostility.
• May reduce the risk for suicide (clozapine may be particularly helpful for suicide prevention).
• These drugs, particularly the newer atypicals, have fewer extrapyramidal side effects than the typical antipsychotics.

Atypical antipsychotics have some significant limitations and complications, and their benefits compared to each other and to other antipsychotics are not always clear-cut. In-depth comparative studies are needed to determine which specific drugs are more effective and have fewer side effects than others.

Side Effects of Atypical Antipsychotics.

• Nasal congestion or runny nose
• Drooling
• Dizziness
• Headache
• Drowsiness -- although, sometimes the drugs may cause restlessness and insomnia
• Constipation
• Rapid heart beat
• Difficulty urinating
• Skin rash
• Increased body temperature
• Confusion, short-term memory problems, disorientation, and impaired attention

The following are more severe side effects or complications that may occur with these drugs:

• Diabetes ( See: Diabetes Risk and Atypical Antipsychotics).
• Weight gain and metabolic problems. The risk is highest for olanzapine, and lowest for aripiprazole and ziprasidone.
• Unhealthy cholesterol levels. Particularly with olanzapine, increased risk for high levels of trigylcerides and total cholesterol.
• Seizures.
• Heat stroke.
• Sudden drop in blood pressure (hypotension).
• A significant drop in white blood cell count (neutropenia) and neutrophils (agranulocytosis) occurs in 1% or more of patients, generally in the first 6 months after starting treatment. Patients should have their white blood count and absolute neutrophil count regularly monitored if they take clozapine.
• Extrapyramidal side effects ( See: Extrapyramidal symptoms).
• Cataracts and worsening of any existing glaucoma.
• Increased prolactin levels -- prolactin is a hormone associated with infertility and impotence. High levels can cause menstrual abnormalities and may increase the risk for osteoporosis and possibly breast cancer.