High Potency Least sedating Have no anticholinergic symptoms (dry mouth, constipation, hot, dry skin, tachycardia, delirium in elderly) High tendency for EPS Low Potency Most sedating Have more anticholinergic symptoms Lower tendency for EPS Mid Potency Well tolerated
Tend not to induce EPS Weight gain, induce onset DM (exp clozapine, olanzapine) Other SE, drooling, sedation, amenorrhea Clozapine may cause agranulocytosis WBC/ANC baseline qWk 6 months, q2wk 6 months, q4wk > 1 year Continue for qwk 1 month after d/c
EPS Begin several hours to weeks of start treatment Include acute dystonia (muscle spasm, stiffness), akinesia (parkinsonian-like, decreased movements), akathisia (restlessness, increased movements), tardive dyskinesia (facial, distal extremities involuntary movements) NMS Hyperpyrexia, muscle rigidity, agitation, increased WBC/CK/myoglobinuria Tx= supportive, dantrolene (muscle relaxant, binds ryanodine rec, dec Ca2+), bromocriptine (dopamine agonist)
Braunwald, E., et al. (2002). Harrison’s manual of medicine. International Edition: McGraw Hill. Bhushan, V., Le, T. (2011). First Aid for the USMLE Step 1 2011: A Student to student guide. McGraw Hill. Jann MW, Grimsley SR, Gray EC, Chang WH. Pharmacokinetics and pharmacodynamics of clozapine. Clin Pharmacokinet 1993; 24:161.