Risperidone EPS dosage dpendent Wt gain (> in children than adult) N & V Anxiety Rhinitis Erectile & orgasmic

gasmic dysfx pigmentation Somnolences Hyperkinesias prolactin

Olanzapine Wt gain (> than other anTpsychotic) but plateau aftr 10 months Somnolence Dry mouth Dizziness Constipation Dyspepsia Akathisia Tremor appetite Dose related EPS 2% px transaminase serum lvl

Quetiapine Sedation Somnolence * Dizziness Postural hypotension * Syncope Dizziness* Tachycardia prolactin (rare) Hypotension Modest wt gain ECG Small in HR, constipation N & V Transient tranaminases Fatigue Cataract formation least likely to cause EPS regardls of Wt gain dosage GI disturbance (constipation) Useful tx o px w Parkinsons Anticholinergic effects who dvlp dopamine induced Subjective muscle wkns psychosis Sialorrhea * transient & mx by intial gradual 4 % o px taking > 60 mg/d seizures 1 % o px leukopenia, granulocytopenia, upward titration agranulocytosis, fever 1st yr o tx clozapine induced agranulocytosis 1st & 2nd yr of tx neutropenia Severe myocarditis Special indication : Tx o psychotic px who intolerant to EPS caused by other anTp Tx-resistant mania Sevre psychotic depression Idiopathic Parkinsons dz Huntingtons dz Suicidal px w schizophrenia or schizoaffective d/o Tx-resistant of pervasive dvlpmnt d/o, autism o childhood, OCD C/I : WBC < 3,500/mm3cells Prev BM d/o Hx o agranulocytosis during clozapine tx Use another drug that can cause BM suppression (carbamazepine)

Clozapine

Ziprasidone Somnolence h/ache dizzins nausea lightheadedns no significant effect outside CNS almost no wt gain no sustained prolactin elevation prolong QT complex C/I : + drug prolong QT (anTarrythmia,etc) Avoided in : congenital long QT syndrome hx o cardiac arrythmias

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Pharmacology

Risperidone 1) A benzisoxazole 2) Undergo 1st-pass hepatic mets to a metabolite with equivalent anTpsychotic actvt 3) Peak plasma lvl : Parent compound : 1 hr Metabolite : 3hrs 4) Combined T1/2 of risperidone & its metabolite : 20 hrs (effective 4 once daily dosage) 5) Is antagonist of : Serotonin 5-HT2A Dopamine D2 1-2 adrenergic histamine H1 receptors 6) Low affinity to : -adrenergic R muscarinic cholinergic R

Olanzapine Clozapine 1) 85% absorbed from GIT 1) Is a dibenzodiazepine 2) 40% inact by 1st pass hepatic mets 3) Peak [ ] : in 5 hrs 4) Average T1/2 : 31 hrs Given once daily 5) Is antagonist of : Serotonin (5-HT1, 5-HT2A) Dopamine (D1, D2, D4) Muscarinic (M1)

Quetiapine 1) Dibenzothiazepine 2) Rapidly absorb from GIT

Ziprasidone 1) Is a benzothiazolyl piperazine 2) Bioavailability doubles if taken wif food 3) Peak plasma [ ] : 2-6 hrs 4) Peak serum [ IM ziprasidone ] : I hr with T1/2 : 2-5 hrs 5) Steady state : 5-10 hrs Twice daily dosage

2) Rapidly absorb, peak 3) Peak plasma [ ] : 1-2 hrs plama [clozapine] : 2hrs 3) Steady state : < 1 wk 4) Elimination T1/2 : 12 hrs 4) Steady T1/2 : 7 hrs 5) Optimal dosage : 2-3 x

5) Is antagonist is : 6) Is antagonist of : Serotonin (5-HT2A) Serotonin (5-HT2, 5-HT6) Dopamine (D1, D3, D4) Dopamine (D1, D2) (xpecially 1) R Muscarinic (M1) potency as D2 R histamine H1 receptors antagonist x cause EPS -adrenergic R (1 & 2) R antagonist for quetiapine is generally than other anTp. X a/w EPS

Dosage

Available in : 1-,2-,3-,4-mg T 1mg/mL oral soln M-tab form Depo (IM) : every 2 wk

Available in Available in : 2.5-, 5-, 7.5-, 10-, 15-, 20-mg T 25-, 100-mg T 10-mg injection (acute agitation Initial dose : 25 mg in schizo + bipolar d/o) one/twice daiy raised 5-, 10-, 20-mg orally gradually (25mg/d every 2 disintegrating T (4 px diff or 3 d) to 300mg/d in swallow) divided dosage (2-3 times daily) Initial dose : 1-2 mg ON Initial dose : 5-10 mg (psychosis) raised 4mg/day OR 10-15 mg (acute mania) 10 mg/d *raise dose ONLY aftr 1 wk* > 6mg/d : EPS effect Tx-resistant : 30-40 mg/d dose = EPS s/e

6) Is antagonist of : Serotonin (5-HT1D,5-HT2A, 5-HT2C) Dopamine (D2, D3, D4) 1 adrenergic histamine H1 receptors 7) low affinity to : Dopamine D1 2 adrenergic Muscarinic M1 8) Agonist : Serotonin 5-HT1A SSRI NA reuptake inhibitor Has antidepressant-like effect in schizo Available in : Available in : 25-, 100-, 200-mg T 20-, 40-, 60-, 80- mg capsule IM as single-use 20mg/mL vial , Target dose : recommended IM dose : 10-20 Schizo : 400mg/d mg every 2 hrs for 10 mg dose & Mania : 800mg/d every 4 hrs for 20 mg dose ; max Bipolar depression :300 total dose/d = 40mg mg/d Insomnia : 25-300 mg at Oral : initiate at 40mg/d divided into 2 daily doses nite

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Interactions

Risperidone Olanzapine Risperidone + SSRi : Fluvoxamine (Luvox) & prolactin cimetidine (Tagamet) serum Galactorrhea [olanzapine] Breast enlargement Carbamazepine & phenytoin Paroxetine & fluoxetine serum [olanzapine] inhibit CYP 2D block Ethanol olanzapine absorp 4mation of act metabolite sedation effect

Clozapine Quetiapine Phenytoin quetiapine Lithium + clozapine : clearance risk of seizures Confusion Mvmnt d/o X be used in ox experience an epi. of neuroleptic malignant synd Risperidone, fluoxetine, paroxetine, fluvoxamine serum [clozapine] Cannot be used with other drug that is a/w dvlpmnt agranulocytosis or BM suppression such as : Carbamazepine Phenytoin Proplthiouracil Sulfonamides Captopril (Capoten)

Ziprasidone

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