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Clinician’s Corner: 2nd Generation Antipsychotic Drugs

ATYPICAL ANTIPSYCHOTICS (Second generation Antipsychotics)

DOSAGE EQUIVALENTS AND SIDE EFFECTS FOR “ATYPICAL” ANTIPSYCHOTICS

Antipsychotic Drug Usual Adult Dose Available strengths Sed EPS AC Weight gain
Clozapine (Clozaril®)

1989

300-900mg 12.5,25, 50,100 high none high Very

high

Risperidone (Risperdal®)

1993

4-16mg 0.25,0.5,1,

2,3,4mg

low high none Mod
Olanzapine (Zyprexa®)

1996

5-20mg 2.5,5.7.5,10,

15,20

mod low mod Very

high

Quetiapine (Seroquel®)

1997

50-800mg 25,50,100,200,

300,400, XR-50, 150,200,300,400

Mod none none Mod
Ziprisidone (Geodon®)

2001

40-200mg 20,40,60,80 mod low low Low
Aripiprazole (Abilify)

2002

10-30mg 5,10,15,20,30 mod low none Low
Paliperidone (Invega®)

2006

6-12mg 3,6,9mg tabs low high none low
Asenapine

(Saphris®)

2009

10-20mg 5 & 10mg  sublingual tab low low min low
Iloperidone

(Fanapt®)

2009

6-12mg BID 1,2,4,6,8,10,12 mg tablets low low none mod
Lurasidone

(Latuda)

2010

40-80mg 40mg, 80mg mod low low Low
Brexpiprazole

(Rexulti®) 2015

3-4mg/day Tablets: 0.25, 0.5, 1, 2 mg, 3 and 4 mg low low low Mod
Cariprazine

(Vraylar®)

2015

1.5-6mg/day 1.5,3,4.5,6mg caps low high low low

SIDE EFFECT ABBREVIATIONS:

EPS: extrapyramidal side effects

AC: anticholinergic side effects—note the more anticholinergic side effects, the less EPS

SED: sedation or drowsiness.

 

OVERVIEW of SECOND GENERATION (Atypical) ANTIPSYCHOTICS

  • The mechanism of action of most second-generation antipsychotic appears to be blocking the dopamine D2 receptors.

THE MOST COMMON DRUGS —-Highlights

Clozapine (Clozaril) Is considered to be the MOST EFFECTIVE treatment for schizophrenia.  However, it has the worst side effect profile.

Monitoring: white blood cells can be affected with a risk of (1%).  Reserve this drug for severely ill schizophrenic patients who fail on standard treatment or may be re-experiencing suicidal behavior. Worst for weight gain. Must be dispensed in a registered clinic, that monitors blood work.

Olanzapine (Zyprexa)- after clozapine, considered to be the most effective. More effective than other 2nd generation antipsychotics.  Weight gain almost as significant as clozapine.  Minimal effect on QT-interval

Risperidone (Risperdal)- most believe it is third in line with regard to efficacy.  Causes weight gain.  Worst drug for Parkinson’s induced psychosis. May affect hormone balance.

Aripiprazole (Abilify)- may cause some weight gain.  Can cause headache, constipation, sexual side effects and restlessness.  May cause compulsive sexual behavior, shopping and eating. Is the first antipsychotic approved for major depressive disorder, not just bipolar disorder. Can be added to antidepressants to augment their effects

In the chart above the drugs that are available as generics are in bold. Any drug older than Invega (paliperidone) are available generically.  We have more and better drugs available generically, which will save you big money.  Thompson Pharmacists are concerned about your physical and mental health.  Go Ahead and ASK, at Thompson Pharmacy its ALL for YOU!