Virtual Medical Centre

Conventional Antipsychotics

• What are conventional antipsychotics?
• What are they used for?
• How do they work?
• Precautions
• Side effects

What are conventional antipsychotics?

Conventional antipsychotics (also called neuroleptics) are a class of drug mainly used in the treatment of psychotic disorders. They are generally used to relieve symptoms such as hallucinations, delusions or abnormal behaviour/thought, and also for sedative tranquillising effects in very disturbed or aggressive patients.

Members of this class include:

• Droperidol
• Fluphenazine
• Fluphenthixol
• Haloperidol
• Pericyazine
• Pimozide
• Thioridazine
• Thiothixene
• Trifluoperazine
• Zuclophenthixol

What are they used for?

Conventional antipsychotics are used for:

• Treatment of acute and chronic psychoses (eg schizophrenia)
• Acute mania
• Organic psychoses (eg dementia-associated agitation)
• Severe behavioural disorders in children
• Together with other treatments for psychotic depression
• Together with other treatments for alcoholic hallucination
• Tourette’s syndrome
• Persistent nausea and vomiting (haloperidol, droperidol)
• Persistent hiccups (chlorpromazine)

How do they work?

The exact basis is not fully understood, but it is widely believed that the conventional antipsychotics work by blocking certain receptors of chemical messengers called dopamine and thus help to relieve the symptoms of psychotic disorders.

Precautions

Hepatic impairment (liver disease)

The doctor may use a lower starting dose in patients who have liver impairment. Please inform your doctor if you have had any history of liver disease.

Elderly

The doctor may use a lower dose of an antipsychotic and more gradual increase because of greater risk of adverse effects in older patients.

Pregnancy

The doctor may choose to avoid prescribing antipsychotics for pregnant women or will prescribe the lowest possible dose. The doctor may consider lowering the dose of the antipsychotics under supervision or stop its use for 7-10 days prior to delivery. Speak to your doctor if you have any concerns.

Breastfeeding

The use of antipsychotics during breastfeeding should be avoided when possible. Speak to your doctor if you have any concerns.

Side effects

Schizophrenia Medication Tolerability Tool

This tolerability tool is based on a self-rating scale designed by Waddell and Taylor¹ to assess if you are experiencing undesirable side effects from your antipsychotic medication.

Male      Female 

Over the past week have you	Never	Once	A few times	Everyday	Tick this box if distressing
Felt sleepy during the day
Felt drugged or like a zombie
Felt dizzy on standing and/or fainted
Felt that you heart was beating irregularly or unusually fast
Had tense or jerky muscles
Had shaky hands or arms
Had restless legs and/or couldn´t sit still
Been drooling
Noticed your movements or walking being slower than usual
Had, or people have noticed uncontrollable movements of your face and/or body
Had blurry vision
Had a dry mouth
Had difficulty passing urine
Felt like you were going to be sick or have vomited
Wet the bed
Been thirsty and/or passing urine frequently
Had sore/swollen areas around your nipples
Noticed fluid coming from your nipples
Had problems enjoying sex
Had problems getting an erection
In the last 3 months have you noticed	No	Yes			Tick this box if distressing
A change in your periods
Weight gain

The side effects for each type of medication vary but listed below are the common and infrequent adverse effects of conventional antipsychotics.

Common (occur in more than 1% of patients):

• Sedation
• Orthostatic hypotension (a sudden fall in blood pressure)
• Tachycardia (rapid beating of the heart)
• Dry mouth
• Blurred vision
• Constipation
• Urinary retention (difficulty urinating)
• Sexual adverse effects
• Weight gain

Infrequent (occur in less than 1% of patients):

• Allergic reactions, including allergic skin reactions 
• Photosensitivity (chlorpromazine)
• Pigmentary changes of skin or eye (particularly thioridazine)
• Corneal and lens opacities
• Heat stroke or sun stroke
• Hypothermia (a condition in which the body’s temperature drops below that which is required for normal body function)

All medicines have side effects. Most commonly the side effects are minor, however some can be more serious. Usually the benefits of taking a medication outweigh the associated side effects. Your doctor would have considered these side effects before prescribing the medication.

Medication Adherence Rating Scale
(MARS)

Using the MARS tool, you and your patient can determine willingness and ability to take oral medication every day.

		Yes	No
1.	Do you ever forget to take your medication?
2.	Are you careless at times about taking your medicine?
3.	When you feel better, do you sometimes stop taking your medicine?
4.	Sometimes if you feel worse when you take the medicine, do you stop taking it?
5.	I take my medication only when I am sick.
6.	It is unnatural for my mind and body to be controlled by medication.
7.	My thoughts are clearer on medication.
8.	By staying on medication, I can prevent getting sick.
9.	I feel weird, like a ´zombie´, on medication.
10.	Medication makes me feel tired and sluggish.

Results

This individual has scored  out of 10 on the adherence rating scale.

It is likely they are adhering to their schizophrenia medication.

This individual has scored  out of 10 on the adherence rating scale.
They are not adhering to the prescribed medication schedule.

References:

1. Thompson K et al. Schizophrenia Research 2000;42:241-7.
2. Fialko L, et al. Schizophrenia Research 2008;100:53-9.

For information on related treatments and other relevant topics:

• Treatment - Atypical Antipsychotics
• Anatomy - Central Nervous System

Reference

1. Australian Medicines Handbook 2006, Adelaide, Pharmaceutical society of Australia, 2006.
2. Keks NA, Hope J. Long-term management of people with psychotic disorders in the community. Australian prescriber. 2007; 30(2):44-46.
3. Lazo J, Gilman A, Brunton L, Parker K. Goodman and Gilman’s the pharmacological basis of therapeutics. 11th ed. New York: McGraw-Hill; 2005
4. Sadock BJ and Sadock VA Kaplan & Sadock's Comprehensive Textbook of Psychiatry USA Lippincott Williams & Wilkins 2005
5. Warrell DA, Cox TA et al. Oxford Textbook of Medicine UK 2003

Drugs used in this treatment:

• Aldazine
(Thioridazine hydrochloride)
• Anatensol
(Fluphenazine hydrochloride)
• Droleptan
(Droperidol)
• Fluphenazine Decanoate Oily Injection BP (DBL)
(Fluphenazine decanoate)
• Haldol Decanoate
(Haloperidol decanoate)
• Largactil
(Chlorpromazine hydrochloride)
• Melleril
(Thioridazine; Thioridazine hydrochloride)
• Modecate
(Fluphenazine decanoate)
• Navane
(Thiothixene)
• Neulactil
(Pericyazine)
• Orap
(Pimozide)
• Serenace
(Haloperidol)
• Stelazine
(Trifluoperazine hydrochloride)

This treatment is used for the following diseases:

• Schizophrenia
• Bipolar Affective Disorder (Manic Depression)
• Tourette Syndrome (Gilles de la Tourette syndrome)

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Article Dates:

Created: 9/3/2008

Modified: 3/7/2009

Reviewed: 28/3/2008