Medication Explained 💊

Antipsychotics

What are atypical antipsychotics?

Atypical antipsychotics are antipsychotics that are less likely than traditional antipsychotics to cause certain side effects, such as extrapyramidal symptoms (EPS). EPS are drug-induced movement disorders and include tremor, Parkinson’s-like symptoms (walking with a shuffle, mask-like facial features) and tardive dyskinesia this describes abnormal, repetitive facial movements such as lip smacking or poking the tongue out).

Most atypical antipsychotics were discovered recently; however, clozapine is often referred to as atypical antipsychotic even though it was discovered more than 60 years ago. Atypical antipsychotics are also known as second generation antipsychotics.

Experts aren’t exactly sure how atypical antipsychotics work but they appear block certain chemical receptors in the brain, affecting levels of various neurotransmitters such as dopamine, acetylcholine, noradrenaline, or serotonin. Atypical antipsychotics appear to have a higher affinity for serotonin receptors and a lower affinity for dopamine receptors than typical antipsychotics.

What are atypical antipsychotics used for?

Atypical antipsychotics are used to relieve symptoms such as delusions (mistaken beliefs), hearing voices, seeing things that aren’t there (hallucinations), or paranoid or confused thoughts typically associated with some mental illnesses.

They may be used to treat the symptoms of schizophrenia or a psychotic episode; in the treatment of severe depression; severe agitation or for stabilizing episodes of mania in people with Bipolar Disorder. Some are FDA-approved in children to treat irritability associated with Autistic disorder.

What are the differences between atypical antipsychotics?

Atypical antipsychotics differ in the way that they are absorbed into the body, how they are metabolized, the length of their effect, and how they are excreted. There are also differences between them with regards to:

• Weight gain: Clozapine appears to have the highest risk followed by olanzapine and quetiapine

• Reduction in the risk of suicidal events and behavior: Clozapine appears superior to olanzapine

• Discontinuation because of adverse effects: Clozapine has the highest rate of discontinuation in the short-term but the lowest rate out of any antipsychotic in the long-term (two years or more)

• Risperidone appears to have higher rates of EPS than olanzapine

• Risperidone may have higher rates of sexual dysfunction compared with quetiapine, but similar rates when compared with ziprasidone

• Women may be more responsive to clozapine and olanzapine than men.

With regards to the difference between atypical antipsychotics and typical antipsychotics, atypical antipsychotics are less likely to produce EPS but more likely to cause weight gain. Recently, no difference in effectiveness regarding symptom improvement between atypical antipsychotics and typical antipsychotics has been shown.

Quetiapine: An In-depth Look

Quetiapine is an antipsychotic medicine that is used to treat schizophrenia in adults and children who are at least 13 years old.

Quetiapine is used to treat bipolar Disorder (manic depression) in adults and children who are at least 10 years old.

Quetiapine is also used together with antidepressant medications to treat major depressive disorder in adults.

Warnings

Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Quetiapine is not approved for use in older adults with dementia related psychosis.

Precautions

Quetiapine may increase the risk of death in older adults with dementia-related psychosis and is not approved for this use.

Quetiapine is not approved for use by anyone younger than 10 years old.

Tell your doctor if you have ever had:

• liver disease;

• heart problems;

• high or low blood pressure;

• low white blood cell (WBC) counts;

• abnormal thyroid tests or prolactin levels;

• constipation or urination problems;

• an enlarged prostrate;

• a seizure;

• glaucoma or cataracts;

• high cholesterol or triglycerides;

• diabetes (in you or a family member); or

• trouble swallowing.

Quetiapine may cause you to have high blood sugar (hyperglycemia). If you are diabetic, check your blood sugar levels on a regular basis.

Drink plenty of liquids while you are taking quetiapine.

Blood pressure may need to be checked often in a child or teenager taking quetiapine.

You should not stop using quetiapine suddenly. Stopping suddenly may make your condition worse.

This medicine may affect a drug-screening urine test and you may have false results. Tell the laboratory staff that you use quetiapine.

What should I avoid while taking quetiapine?

Avoid drinking alcohol. Dangerous side effects could occur. Avoid driving or hazardous activity until you know how quetiapine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Avoid becoming overheated or dehydrated during exercise and in hot weather. You may be more prone to heat stroke.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

• uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement);

• mask-like appearance of the face, trouble swallowing, problems with speech;

• a light-headed feeling, like you might pass out;

• severe constipation;

• painful or difficult urination;

• blurred vision, tunnel vision, eye pain, or seeing halos around lights;

• severe nervous system reaction–very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, fainting;

• high blood sugar–increased thirst, increased urination, dry mouth, fruity breath odor; or

• low white blood cell counts–fever, chills, mouth sores, skin sores, sore throat, cough, trouble breathing, feeling light-headed.

Common side effects may include:

• speech problems;

• dizziness, drowsiness, tiredness;

• lack of energy;

• fast heartbeats;

• stuffy nose;

• increased appetite, weight gain;

• upset stomach, vomiting, constipation;

• dry mouth; or

• problems moving.

Upsides

• Quetiapine calms and sedates and is used to help reduce the incidence of psychotic thoughts in people with schizophrenia.

• Quetiapine also helps to calm acute manic episodes in people with bipolar I disorder. It may be used as the sole therapy or in addition to lithium or Divalproex. When used as maintenance therapy for manic episodes in bipolar 1 disorder, it is best used in addition to lithium or Divalproex.

• Quetiapine may be used as the sole therapy for the treatment of depressive episodes in people with bipolar I or bipolar II disorder.

• Quetiapine may also be used off-label for other conditions such as generalized anxiety disorder.

• Trials have established that quetiapine is effective in adolescents aged 13 to 17 with schizophrenia; however, quetiapine should only be used after careful consideration of the risks versus benefits involved with treatment.

• Quetiapine is also approved for the treatment of manic episodes in children aged 10 to 17 with bipolar I disorder.

Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Weakness, lack of energy, headache, dry mouth, constipation, weight gain, changes in cholesterol, and triglyceride levels.

• Drowsiness or dizziness that may affect your ability to drive or operate machinery or perform hazardous tasks. Alcohol may enhance these effects.

• Other common side effects include chills, cold sweats, confusion, and agitation.

• Some people, such as seniors, the frail, and those with a predisposition to low blood pressure may be more sensitive to the effects of quetiapine. A slower rate of dose titration and lower target dosages may be needed.

• A drop in blood pressure on standing, particularly during the initial dose-titration period. To counteract this effect, the dosage of quetiapine may need to be reduced then titrated back up slowly. May not be suitable for people with known cardiovascular disease (history of a heart attack, angina, heart failure, or arrhythmia), stroke, or people at risk of dehydration. May increase blood pressure in adolescents.

• May not be suitable for people with diabetes or may precipitate diabetes especially in those with pre-existing risk factors (such as obesity and lack of physical activity).

• People with liver disease or taking other medications that may interact with quetiapine may need a dosage adjustment. Only one-sixth of the quetiapine dose is needed when taken with drugs that are CYP3A4 inhibitors (for example, ketoconazole, ritonavir, or nefazodone). A dosage increase of up to fivefold is recommended when quetiapine is taken with CYP3A4 inducers (such as phenytoin, carbamazepine, rifampin, or St John’s wort).

• The use of antipsychotics in elderly patients with dementia has been associated with an increased risk of death, mostly due to cardiovascular or infectious causes. Quetiapine is not FDA-approved for use in elderly patients with dementia.

• May not be suitable for some people including those with cataracts, heart disease, high cholesterol, thyroid dysfunction, abnormal blood counts, high prolactin levels, or liver disease.

• Antipsychotics such as quetiapine have been associated with a serious syndrome called Neuroleptic Malignant Syndrome; symptoms include high body temperature, muscle rigidity, and mental disturbances. Seek urgent medical advice if these symptoms develop.

• As with other antipsychotics and antidepressants, quetiapine may increase the risk of suicidal thoughts or behavior, particularly in adolescents.

• May cause a discontinuation syndrome if abruptly stopped; symptoms include nausea, insomnia, headache, diarrhea, vomiting, irritability, and dizziness. Gradual withdrawal is advised.

Published by Rochdalestu

I’m a 38 year old male who has recently been diagnosed with bipolar disorder. I have found it as a new chapter in my life that has opened my eyes to a whole new perspective on myself and everything around me.

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