Preparations And Dosage

Table 18-3 summarizes the large number of drugs currently marketed in the U.S. for the treatment of psychotic disorders or mania.

Prochlorperazine (compazine) has questionable utility as an antipsychotic agent and frequently produces acute extrapyramidal reactions. It is rarely employed in psychiatry, although it is used as an antiemetic. Thiethylperazine (torecan), marketed only as an antiemetic, is a potent dopaminergic antagonist with many neuroleptic-like properties. At high doses, it may be an efficacious antipsychotic agent. In the U.S., only the decanoates of fluphenazine and haloperidol and an injected carbohydrate microsphere preparation of risperidone are commonly employed as long-acting repository preparations.

TOXIC REACTIONS AND ADVERSE EFFECTS Antipsychotic drugs have a high therapeutic index and are generally safe agents. Most phenothiazines, haloperidol, clozapine, and queti-apine can be used over a wide range of dosages (Table 18-3). Although occasional deaths from overdoses have been reported, fatalities are rare in patients given medical care unless the overdose is complicated by concurrent ingestion of alcohol or other drugs. Adverse effects often are extensions of the many pharmacological actions of these drugs. The most important are those on the cardiovascular, central and autonomic nervous systems, and endocrine system. Other dangerous effects are seizures, agranulocytosis, cardiac toxicity, and pigmentary degeneration of the retina, all of which are rare (see below). Therapeutic doses of phenothiazines may cause faintness, palpitations, and anticholinergic effects including nasal stuffiness, dry mouth, blurred vision, constipation, worsening of glaucoma, and urinary retention in males with prostatism.

Selected Antipsychotic Drugs: Classes, Doses and Dosage Forms, and Side Effects*

Dose and Dosage Forms

Side Effects

Adult Antipsychotic Oral Dose Range (Daily)

Nonproprietary Name (trade name)

Usual, mg

Single IM Dose' Usual, mg

Sedative Extra-pyramidal

Hypotensive

Phenothiazines

Chloropromazine hydrochloride

(THORAZINE) Mesoridazine besylate (serentil)

Thioridazine hydrochloride

(MELLARIL) Fluphenazine hydrochloride Fluphenazine enanthate Fluphenazine decanoate (permitil and prolixin) (prolixin d) Perphenazine (trilafon)

Trifluoperazine hydrochloride

(stelazine)

Thioxanthenes

Chlorprothixene (taractan)

Thiothixene hydrochloride (navane)

Other Heterocyclic Compounds Aripiprazole (abilify)

Clozapine (CLOZARIL)

200-800 O, SR, L, 75-300 O, L, I 150-600 O, L 2-20 O, L, I

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