Adverse effect incidence ;Common (>1% incidence) adverse effects include: • Extrapyramidal side effects such as: (which
usually become apparent soon after therapy is begun or soon after an increase in dose is made) •
Muscle rigidity •
Hypokinesia •
Hyperkinesia •
Parkinsonism • Tremor •
Akathisia •
Dystonia • Dry mouth • Constipation • Hypersalivation – excessive salivation • Blurred vision • Diaphoresis – excessive sweating • Nausea • Dizziness •
Somnolence • Restlessness • Insomnia • Overactivity • Headache • Nervousness •
Fatigue •
Myalgia •
Hyperprolactinemia and its complications such as: (
acutely) • Sexual dysfunction • Amenorrhea – cessation of menstrual cycles • Gynecomastia – enlargement of breast tissue in males • Galactorrhea – the expulsion of breast milk that's not related to breastfeeding or pregnancy : and if the hyperprolactinemia persists
chronically, the following adverse effects may be seen: :* Reduced bone mineral density leading to
osteoporosis (brittle bones) :* Infertility • Dyspepsia – indigestion • Abdominal pain • Flatulence • Nasal congestion • Polyuria – passing more urine than usual ;Uncommon (0.1–1% incidence) adverse effects include: • Fainting • Palpitations ;Rare (2 receptor blockade. The symptoms include: •
Hyperthermia • Muscle rigidity •
Rhabdomyolysis • Autonomic instability (e.g.,
tachycardia, diarrhea, diaphoresis, etc.) • Mental status changes (e.g., coma, agitation, anxiety, confusion, etc.) ;Unknown incidence adverse effects include: • Jaundice • Abnormal liver function test results •
Tardive dyskinesia – an often incurable movement disorder that usually results from years of continuous treatment with antipsychotic drugs, especially
typical antipsychotics like flupenthixol. It presents with repetitive, involuntary, purposeless and slow movements; TD can be triggered by a fast dose reduction in any antipsychotic. • Hypotension • Confusional state • Seizures •
Mania •
Hypomania •
Depression • Hot flush • Anergia • Appetite changes • Weight changes • Hyperglycemia – high blood glucose (sugar) levels • Abnormal glucose tolerance • Pruritus – itchiness • Rash • Dermatitis • Photosensitivity – sensitivity to light • Oculogyric crisis • Accommodation disorder • Sleep disorder • Impaired concentration • Tachycardia •
QTc interval prolongation – an abnormality in the
electrical activity of the heart that can lead to potentially fatal changes in heart rhythm (only in
overdose or <10 ms increases in QTc) •
Torsades de pointes • Miosis – constriction of the pupil of the eye • Paralytic
ileus – paralysis of the bowel muscles leading to severe constipation, inability to pass wind, etc. • Mydriasis •
Glaucoma Interactions It should not be used concomitantly with medications known to prolong the QTc interval (e.g.,
5-HT3 antagonists,
tricyclic antidepressants,
citalopram, etc.) as this may lead to an increased risk of QTc interval prolongation. Neither should it be given concurrently with
lithium (medication) as it may increase the risk of lithium toxicity and
neuroleptic malignant syndrome. It should not be given concurrently with other antipsychotics due to the potential for this to increase the risk of side effects, especially neurological side effects such as
neuroleptic malignant syndrome. It should be avoided in patients on CNS depressants such as opioids, alcohol and barbiturates.
Contraindications It should not be given in the following disease states: •
Pheochromocytoma • Prolactin-dependent tumors such as pituitary
prolactinomas and
breast cancer •
Long QT syndrome • Coma • Circulatory collapse • Subcortical brain damage •
Blood dyscrasia • Parkinson's disease •
Dementia with Lewy bodies == Pharmacology ==