Micklemouse
17-11-2004, 20:18
Zyprexa is neither a benzo(though it is related) nor
safe, though produces a benzo like buzz in some people.
It is an Atypical Antipsychotic(Major Tranquiliser) and
should be treat with extreme caution.
From BNF 48(British National Formulary)
The 'atypical antipsychotics' amisulpride,
aripiprazole, clozapine, olanzapine, quetiapine,
risperidone, and zotepine may be better tolerated than
other antipsychotics; extrapyramidal symptoms may be
less frequent than with older antipsychotics.
Neuroleptic malignant syndrome (hyperthermia,
fluctuating level of consciousness, muscular rigidity,
and autonomic dysfunction with pallor, tachycardia,
labile blood pressure, sweating, and urinary
incontinence) is a rare but potentially fatal
side-effect of some drugs. Discontinuation of the
antipsychotic is essential because there is no proven
effective treatment, but cooling, bromocriptine, and
dantrolene have been used. The syndrome, which usually
lasts for 5-7 days after drug discontinuation, may be
unduly prolonged if depot preparations have been used.
Other side-effects include: drowsiness; apathy;
agitation, excitement and insomnia; convulsions;
dizziness; headache; confusion; gastro-intestinal
disturbances; nasal congestion; antimuscarinic symptoms
(such as dry mouth, constipation, difficulty with
micturition, and blurred vision); cardiovascular
symptoms (such as hypotension, tachycardia, and
arrhythmias); ECG changes (cases of sudden death have
occurred); endocrine effects such as menstrual
disturbances, galactorrhoea, gynaecomastia, impotence,
and weight gain; blood dyscrasias (such as
agranulocytosis and leucopenia), photosensitisation,
contact sensitisation and rashes, and jaundice
(including cholestatic); corneal and lens opacities,
and purplish pigmentation of the skin, cornea,
conjunctiva, and retina.
AMISULPRIDE = Solian Side-effects: see notes above;
also insomnia, anxiety, agitation, drowsiness,
gastro-intestinal disorders such as constipation,
nausea, vomiting, and dry mouth; hyperprolactinaemia
(with galactorrhoea, amenorrhoea, gynaecomastia, breast
pain, sexual dysfunction), occasionally bradycardia
Dose: acute psychotic episode, 400-800 mg daily in
divided doses, adjusted according to response; max. 1.2
g daily
Predominantly negative symptoms, 50-300 mg daily;
child under 15 years, not recommended
ARIPIPRAZOLE = AbilifySide-effects: nausea,
vomiting, dyspepsia, constipation, lightheadedness,
insomnia, akathisia, somnolence, tremor, headache,
asthenia, blurred vision; less commonly tachycardia,
postural hypotension, seizures
Dose: 15 mg daily; max. 30 mg daily; child and
adolescent not recommended
CLOZAPINE = Clozaril Side-effects: see notes above;
also constipation (see Gastro-intestinal Obstruction,
above), hypersalivation, nausea, vomiting; tachycardia,
ECG changes, hypertension; drowsiness, blurred vision,
headache, tremor, rigidity, extrapyramidal symptoms,
convulsions, fatigue, impaired temperature regulation,
fever; hepatitis, cholestatic jaundice, pancreatitis;
urinary incontinence and retention; agranulocytosis
(important: see Agranulocytosis, above), leucopenia,
eosinophilia, leucocytosis; rarely dysphagia,
circulatory collapse, arrhythmias, myocarditis
(important: see Myocarditis and Cardiomyopathy, above),
pericarditis, thromboembolism, confusion, delirium,
restlessness, agitation, diabetes mellitus; also
reported, intestinal obstruction, paralytic ileus (see
Gastro-intestinal Obstruction, above), enlarged parotid
gland, fulminant hepatic necrosis, thrombocytopenia,
hypertriglyceridaemia, cardiomyopathy, cardiac arrest,
respiratory arrest, interstitial nephritis, priapism,
skin reactions
Dose: schizophrenia, adult over 16 years (close medical
supervision on initiation?risk of collapse due to
hypotension) 12.5 mg once or twice on first day then
25?50 mg on second day then increased gradually (if
well tolerated) in steps of 25-50 mg daily over 14?21
days up to 300 mg daily in divided doses (larger dose
at night, up to 200 mg daily may be taken as a single
dose at bedtime); if necessary may be further increased
in steps of 50-100 mg once (preferably) or twice
weekly; usual dose 200-450 mg daily (max. 900 mg daily)
OLANZAPINE = Zyprexa, Zyprexa Velotab(oral dispersible)
Side-effects: see notes above; also mild, transient
antimuscarinic effects; drowsiness, speech difficulty,
exacerbation of Parkinson's disease, akathisia,
asthenia, increased appetite, raised triglyceride
concentration, oedema, hyperprolactinaemia (but
clinical manifestations rare), occasionally blood
dyscrasias, rarely bradycardia, rash, photosensitivity,
diabetes mellitus, priapism, hepatitis, pancreatitis,
and elevated creatine kinase concentration
Dose: schizophrenia, combination therapy for mania,
preventing recurrence in bipolar disorder, adult over
18 years, 10 mg daily adjusted to usual range of 5?20
mg daily; doses greater than 10 mg daily only after
reassessment; max. 20 mg daily
Monotherapy for mania, adult over 18 years, 15 mg
daily adjusted to usual range of 5-20 mg daily; doses
greater than 15 mg only after reassessment; max. 20 mg
daily
QUETIAPINE = Seroquel Side-effects: see notes above;
also drowsiness, dyspepsia, constipation, dry mouth,
mild asthenia, rhinitis, hypertension, tachycardia;
anxiety, fever, myalgia, ear pain, rash; leucopenia,
neutropenia and occasionally eosinophilia reported;
elevated plasma-triglyceride and cholesterol
concentrations, reduced plasma-thyroid hormone
concentrations; possible QT interval prolongation;
rarely oedema; very rarely priapism
Dose: schizophrenia 25 mg twice daily on day 1, 50 mg
twice daily on day 2, 100 mg twice daily on day 3, 150
mg twice daily on day 4, then adjusted according to
response, usual range 300-450 mg daily in 2 divided
doses; max. 750 mg daily; elderly initially 25 mg daily
in 2 divided doses, increased in steps of 25?50 mg
daily; child and adolescent not recommended
Mania, 50 mg twice daily on day 1, 100 mg twice daily
on day 2, 150 mg twice daily on day 3, 200 mg twice
daily on day 4, then adjusted according to response in
steps of up to 200 mg daily to max. 800 mg daily; usual
range 400-800 mg daily in 2 divided doses; elderly
initially 12.5 mg twice daily, increased in steps of
25-50 mg daily; child and adolescent not recommended
RISPERIDONE = Risperdal,Risperdal Quiklets(oral
dispersible) Side-effects: see notes above; also
insomnia, agitation, anxiety, headache, drowsiness,
impaired concentration, fatigue, blurred vision,
constipation, nausea and vomiting, dyspepsia, abdominal
pain, hyperprolactinaemia (with galactorrhoea,
menstrual disturbances, amenorrhoea, gynaecomastia),
sexual dysfunction, priapism, urinary incontinence,
tachycardia, hypertension, rash, rhinitis;
cerebrovascular accidents, neutropenia and
thrombocytopenia have been reported; rarely, seizures,
hyponatraemia, abnormal temperature regulation, oedema
Dose: psychoses, 2 mg in 1-2 divided doses on first day
then 4 mg in 1-2 divided doses on second day (slower
titration appropriate in some patients); usual dose
range 4-6 mg daily; doses above 10 mg daily only if
benefit considered to outweigh risk (max. 16 mg daily);
elderly (or in hepatic or renal impairment) initially
500 micrograms twice daily increased in steps of 500
micrograms twice daily to 1?2 mg twice daily; child
under 15 years not recommended
Mania, initially 2 mg once daily, increased if
necessary in steps of 1 mg daily; usual dose range 1?6
mg daily; elderly (or in hepatic or renal impairment)
initially 500 micrograms twice daily increased in steps
of 500 micrograms twice daily to 1-2 mg twice daily
SERTINDOLE = Serdolect. Cautions: see notes above;
hepatic impairment (Appendix 2); diabetes; correct
hypokalaemia or hypomagnesaemia before treatment;
monitor ECG during treatment; monitor blood pressure
during dose titration and early maintenance therapy
(risk of postural hypotension);
Contra-indications: see notes above; pregnancy ,
breast-feeding, severe hepatic impairment, QT interval
prolongation (ECG required before and during treatment?
consult product literature); concomitant administration
of drugs which prolong QT interval (see interactions);
uncorrected hypokalaemia or hypomagnesaemia
Side-effects: see notes above; prolonged QT interval,
peripheral oedema, dry mouth, rhinitis, nasal
congestion, dyspnoea, paraesthesia, abnormal
ejaculation (decreased volume); rarely seizures,
hyperglycaemia
Dose: initially 4 mg daily increased in steps of 4 mg
at intervals of 4?5 days to usual maintenance of 12-20
mg as a single daily dose; max. 24 mg daily; elderly
consider slower dose titration and lower maintenance
dose; child and adolescent not recommended
ZOTEPINE = Zoleptil. Cautions: see notes above;
personal or close family history of epilepsy;
withdrawal of concomitantly prescribed CNS depressants;
QT interval prolongation?ECG required (before treatment
and at each dose increase) in patients at risk of
arrhythmias; monitor plasma electrolytes particularly
before treatment and at each dose increase; hepatic
impairment; renal impairment ; prostatic hypertrophy,
urinary retention, angle-closure glaucoma, paralytic
ileus, pregnancy
Contra-indications: acute intoxication with CNS
depressants; high doses of concomitantly prescribed
antipsychotics; acute gout (avoid for 3 weeks after
episode resolves), history of nephrolithiasis;
breast-feeding (Appendix 5)
Side-effects: see notes above; constipation, dyspepsia,
dry mouth, tachycardia, QT interval prolongation,
rhinitis, agitation, anxiety, depression, asthenia,
headache, EEG abnormalities, insomnia, drowsiness,
hyperthermia or hypothermia, increased salivation,
blood dyscrasias (including leucocytosis, leucopenia),
raised erythrocyte sedimentation rate, blurred vision,
sweating; less frequently anorexia, diarrhoea, nausea
and vomiting, abdominal pain, hypertension,
influenza-like syndrome, cough, dyspnoea, confusion,
convulsions, decreased libido, speech disorder,
vertigo, hyperprolactinaemia, anaemia,
thrombocythaemia, increased serum creatinine,
hypoglycaemia and hyperglycaemia, hyperlipidaemia,
hypouricaemia, oedema, thirst, impotence, urinary
incontinence, arthralgia, myalgia, conjunctivitis,
acne, dry skin, rash; rarely bradycardia, epistaxis,
abdominal enlargement, amnesia, ataxia, coma, delirium,
hypaesthesia, myoclonus, thrombocytopenia, abnormal
ejaculation, urinary retention, menstrual
irregularities, myasthenia, alopecia, photosensitivity
Dose: initially 25 mg 3 times daily increased according
to response at intervals of 4 days to max. 100 mg 3
times daily; elderly initially 25 mg twice daily
increased according to response to max. 75 mg twice
daily; child and adolescent under 18 years not
recommended
This is a nasty class of drugs, and not to be messed
with, even at small doses.
Edited by: micklemouse