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Table Reference Number

Note. CNS = central nervous system; ECG = electrocardiogram; EPS = extrapyramidal symptoms; FDA = U.S. Food and Drug Administration; NMS = neuroleptic malignant syndrome; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant.

aAgitation associated with psychosis: FDA-approved indication for intramuscular olanzapine only.

Typical (D2 antagonist) antipsychotics: overview

Efficacy

Schizophrenia (positive symptoms) (FDA-approved indication)

Tourette's disorder (pimozide; FDA-approved indication)

Mania (FDA-approved indication for chlorpromazine only)

Psychotic depression (with antidepressant)

Drug-induced psychosis

Agitation,a nausea, hiccups (not FDA approved for these purposes; off-label)

Side effects

EPS (more common in high-potency drugs)

NMS (rare)

Dry mouth, constipation, urinary retention, sedation, weight gain (more common in low-potency drugs)

Skin and eye complications

QT interval prolongation (thioridazine)

Dosage and administration

Individualize dosing.

50–150 mg chlorpromazine equivalents (see Table 4–2Table 4–2) to start, with maximum total daily dose of 300–600 mg chlorpromazine equivalents (e.g., 6–12 mg haloperidol).

Safety in overdose

CNS depression, hypotension, ECG changes, EPS. Manage with vital sign support, gastric lavage. Do not induce emesis secondary to aspiration risk.

Drug interactions

CNS depressants: sedation

Antacids: antipsychotic absorption

Carbamazepine: antipsychotic levels

SSRIs: antipsychotic levels

Nicotine: antipsychotic levels

Meperidine: sedation, hypotension

-Blockers: hypotension; may antipsychotic and -blocker levels

TCAs: may antipsychotic and TCA levels

Valproic acid: chlorpromazine may valproic acid levels

Table Reference Number
Table 4–5. Antiparkinsonian drugs: names, formulations and strengths, and dosage ranges
Table Reference Number
Table 4–6. Operational criteria for diagnosis of neuroleptic malignant syndrome

References

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