Sections
Sedation | Autonomic Effects | Endocrine Effects | Skin and Eye Complications | Other or Rare Complications | Neurological Effects | Use of Antiparkinsonian Drugs | Tardive Dyskinesia | Neuroleptic Malignant Syndrome
Excerpt
Sedation, often accompanied by fatigue, can be useful early
in treatment but a liability after the patient has improved. All
antipsychotics can be sedating in some patients at some dosage,
but chlorpromazine is generally the most sedating. Its sedative
effects are often judged to be very unpleasant by non–psychiatrically ill
volunteers receiving even 25 mg or 50 mg of the drug in a single
dose, but these effects are sometimes accepted or even welcomed
by some patients with psychosis or personality disorders. Thioridazine,
chlorprothixene, and loxapine are also often relatively sedating, whereas
the other high-potency antipsychotics are often less or not at all
sedating. In one acute-dosing strategy, the antipsychotic dosage
is gradually raised until the psychosis is controlled; at that point
the patient develops increased sedation, which then requires dosage
reduction. In chronic administration, sedation and fatigue overlap
with akinesia, a side effect characterized by inertia, inactivity,
and lack of spontaneous movement. Akinesia will often abate when
an antiparkinsonian drug is added; it will often abate more slowly
when the dosage is lowered. When antipsychotics are used as prn
medication (orally or parenterally), it is likely that sedation is
the main effect produced, even though a decrease in psychosis may
be desired. As has been discussed, a benzodiazepine (e.g., lorazepam
1–2 mg) may be more appropriate for this purpose. Unfortunately, the
short-term (or long-term) utility of prn medication of any sort
has never been seriously studied.