ANTIPSYCHOTIC MEDICATIONS (Atypicals Page 1) Used for ...

1 Kevin Leehey, 1980 E. Ft. Lowell Road, Suite 150 Tucson, Arizona 85719 (520) 296-4280 Fax: (520) 296-3835. ANTIPSYCHOTIC MEDICATIONS ("Atypicals" Page 1). Used for Psychosis, Schizophrenia, Bipolar Disorder, Severe Impulsive Aggression, Tourette's, Paranoia, Depression, Anxiety, Autism Medication Form Dose Schedule Dose Range Most Common Side Effects for Group Pros for Group Cautions for Group Brand/Generic tablets Sedation, weight gain or appetite increase. The " atypical " antipsychotics are often Prolactin increase and breast discharge .25mg, .50mg, 1mg, Extrapyramidal symptoms (EPS) less preferred over the "typicals" as first line happens more with Risperdal than other 2mg, 3mg, 4mg common than with "Typicals." Prolactin treatments for the above conditions. atypicals. Also Fanapt, olanzapine, Latuda, one quarter to 16mg/day increase also less common than typicals but and Invega, but less.

2 1-3 times depending on age, size, Risperdal M tabs also can occur especially with higher doses. daily, often diagnosis, and severity (risperidone) , 1, 2mg Sun sensitivity, heat intolerance, sexual The "Atypicals" have benefit for mood Appetite increase or sedation are often more of evening only side effects can occur but are uncommon. disorders and may work as mood a concern than EPS or TD. Youth and adults liquid Rarely negative effects on liver or blood stabilizers. Generic risperidone, Seroquel, 1mg/1ml count. Zyprexa, Abilify, and Geodon are available Weight gain and related metabolic health Consta IM Depot effects occur most often with Zyprexa, Fanapt 1, 2, 4, 6, 8, 10, 12 twice daily or Seroquel, and Risperdal but least with Geodon. 6-12 mg twice daily Fanapt shows no to little EPS and moderate Invega is an extended smoother release (iloperidone) mg tablets evening QTc, orthostasis, weight gain.

3 Dizzy, dry cousin of risperidone (OROS). Invega has a small chance of heart rhythm side Invega Sustenna IM Depot once a day or 3 to 12 mg/d (6 average) mouth, sleepy, increased heart rate, nasal effect. (paliperidone) 3,6, 9 mg caplets monthly congestion are most common but mild and tablets dose related. Risperdal and Zyprexa have been available Fanapt has no EPS, akathisia or tremor and , 5, , 10, 15, longest, studied the most, have the best similar QTc effect to Geodon. 20mg Zyprexa, Clozaril, and Seroquel have track records, are very effective (often Once to twice to 20mg/day lowest risks of EPS. rapidly) and have been used enough with Zyprexa linked to rare serious skin reaction Zyprexa a day, often kids and the elderly to have shown benefit called DRESS. (olanzapine) zydis evening only Youth and adults Zyprexa, Clozaril, Risperdal, and Seroquel and safety.

4 But side effects may be less in 5, 10, 15, 20mg cause the most sedation and weight gain. newer options. All antipsychotics block the dopamine (D2). Injection Abilify and Saphris are in the middle. receptor. The atypicals also somewhat block Geodon is lowest. Directly or indirectly No routine blood tests for any of the group serotonin (5HT). The atypicals also boost tablets weight gain can lead to diabetes, except clozapine. antidepressant and anti-anxiety meds (good). 25, 50, 100, 200, hypertension, and high cholesterol and 300, 400mg Twice daily, 25mg to 800mg/day total triglycerides. Latuda looks good so far. Seroquel is effective for bipolar mania, Seroquel, Risperdal, Zyprexa, Geodon, Seroquel sometimes bipolar depression, depression booster, and Abilify, and Clozaril are now available in a (quetiapine). XR only evening Youth and adults Seroquel has low risks of EPS.

5 This borderline personality disorder. generic. 50, 150, 200, 300, includes a low risk of Tardive Dyskinesia 400mg (TD) and Neuroleptic Malignant Syndrome In certain situations improved appetite and Cataract risk may be increased slightly by all (NMS). improved sleep are desired side effects. antipsychotics as well as by some other Sedation and weight gain occur often. Side effects are often less at lower doses. medicines and health conditions. Seroquel is not very potent. Thus higher Side effects can often be avoided doses are often needed. completely. Sedation is most common. capsules 20 to 160mg/day total, Twice a day, Geodon rarely, if ever, causes weight gain. Geodon may worsen or bring out abnormal Geodon 20, 40, 60, 80mg usually sometimes heart rhythm. Certain patients may thus be best (ziprasidone) injection once Geodon and Seroquel have shorter action off with one of the others.

6 Checking an EKG. 20mg/ml Youth and adults and are thus sometimes advised to be given may be worthwhile in some cases and higher and evenings. doses. Simultaneous use of alcohol or cigarettes and especially street drugs should be avoided. All MEDICATIONS should be avoided, if possible, in pregnancy. This chart is intended to be a summary guide, not a full and complete list. ANTIPSYCHOTIC MEDICATIONS ("Atypicals" Page 2). Used for Psychosis, Schizophrenia, Bipolar Disorder, Severe Impulsive Aggression, Tourette's, Paranoia, Depression, Anxiety, Autism Medication Form Dose Schedule Dose Range Most Common Side Effects for Group Pros for Group Cautions for Group Brand/Generic A wide range of nuisance and moderate to Clozaril not only does not cause EPS, I generally do not use Clozaril because of side 300 to 900mg a day, severe side effects render Clozaril a hassle especially Tardive Dyskinesia (TD), it effects although it may be the most effective.

7 Clozaril tablets, scored Once or twice usually often. Blood count suppression can be actually can treat TD. "Miraculous". (clozapine) 25, 100mg daily dangerous so that weekly blood tests are benefits have occured with some cases of Abilify, as with most atypicals, is often helpful Adults advised at least at first. schizophrenia. as a booster to improve benefit when added Abilify tablets Once or twice Child: 1 10 mg Sleepy, dizzy, weight gain, nausea, EPS to an antidepressant or antianxiety med. (aripiprazole) 2, 5, 10, 15, 20, daily Adoles: 1 20 mg can happen with most atypicals. Atypicals often help as mood stabilizers, 30mg Adult: 2 30 mg All Atypicals help psychosis, mania, and especially mania, but also depression and impulsive aggression. anxiety. Discmelt 10, 15mg Abilify may problematically increase some Oral solution liquid pleasure urges like dopamine agonists for 1mg/1ml parkinson's or RLS can occasionally.

8 Not common. Injection (IM). ml vial Long duration form of Abilify improves compliance, convenience, and may Aristada 441, 662, 882mg Monthly 441 to 882mg Same as Abilify improve benefit. May still require daily oral med to adjust or (Aripriprozole Extended release IM 882 mg lasts 4 Adults fine tune. Requires an IM injection. Once lauroxil) to 6 weeks given, it lasts a month. Wait 2 to 10 minutes to eat Sublingual tablets Brief occasional tongue numbness after or drink after taking dose. FDA approved for schizophrenia and Zyprexa, Risperdal, Abilify, Seroquel, Invega, 5, 10mg dosing (under tongue). Moderate weight Saphris Once to often Youth and adults gain and metabolic changes. Sedation, EPS, bipolar including adolescents. Saphris, Geodon are FDA approved for youth. (asenapine) twice a day 5 to 30 mg a day Let dissolve under akathisia, dizzy.

9 No prolactin, orthostasis usually 5 to 10 mg twice a tongue. or QTc effects. day Sedation, nausea, EPS, akathisia, though Tablets Adults Latuda is approved by FDA in 2011. Latuda evening with Latuda causes less. Less weight and EPS and heart (QTc, 20, 40, 60, 80, start 20-40mg Is often a good option, especially for Bipolar (lurasidone) food Take with food to prevent nausea and help orthostasis) with Latuda. 120mg max 160mg/day depression or major depression as a booster. absorb. Adults New, FDA approved 2015. Brand only. Start to 1 mg Another option to add to antidepressants to Tablets Once a day Sedation, weight gain, EPS (akathisia, boost effectiveness. Remember, all antipsychotics both typical and Rexulti , , 1, 2, 3, For depression booster Usually tremor) like other atypicals but at similar to atypical can cause a range of EPS and (brexpiprazole) 4mg 1-3 mg evening lower frequencies.

10 Chemically related to Abilify, both are D2 metabolic side effects. See my Medical not scored partial agonists. Education memo regarding ANTIPSYCHOTIC . For schizophrenia medicines. 2-4 mg Adults D3 preferring partial agonist which makes it Start mg different from other antipsychotics. New, FDA approved 2016. Brand only. Vraylar Capsules Once daily EPS/akathisia, weight gain. Less often Depression mg (cariprazine) , 3, , 6mg AM or evening sedation, nausea, constipation, insomnia Only Vraylar and quetiapine have been Steady state 2-4 days for cariprazine but 1-3. proven effective in all phases of bipolar weeks for DDCAR. Mania 3-6 mg disorder. Schizophrenia - 6mg Simultaneous use of alcohol or cigarettes and especially street drugs should be avoided. All MEDICATIONS should be avoided, if possible, in pregnancy. This chart is intended to be a summary guide, not a full and complete list.