This short presentation demonstrates important adverse effects of common anti-psychotic medications in clinical practice and how to effectively manage the adverse events.

1. Side effects of
Anti-Psychotic agents
Edited by:
Prithwiraj Maiti, MBBS
House physician
Department of Internal Medicine, R.G.Kar Medical College
Author: “An Ultimate Guide to Community Medicine”
Author: “A Practical Handbook of Pathology Specimens and Slides”
[Both published by Jaypee Brothers Medical Publishers, India]

2. Side effects of Anti-psychotic agents
Part 1: Autonomic side effects
Side effects Mechanism Maximum with Management
Dry mouth
Muscarinic cholinergic
blockade
Chlorpromazine
None
Constipation Laxatives
Cycloplegia None, occasionally Pilocarpine
(2%)
Urinary retention Occasionally catheterization
Delirium Physostigmine, occasionally
Diazepam
Mydriasis Thioridazine None, occasionally Pilocarpine
(2%)
Orthostatic hypotension α1 Adrenergic
blockade Chlorpromazine
Change in posture, raise legs;
plasma expanders (in severe
cases only)
Impotence Decrease dose/ change
medicationImpaired ejaculation Thioridazine

3. Side effects of Anti-psychotic agents
Part 2: Extrapyramidal side effects (EPSE)
Side effects Mechanism Maximum with Management
Parkinsonian side effects
(Ex: Tremor)
D2 receptor blockade
in brain
Haloperidol
Anti-Parkinsonian
medicationAcute dystonia
Rabbit syndrome
(Peri-oral tremor)
Akathisia (motor restlessness) Beta blockers
(Propranolol)/ BZDs
Neuroleptic Malignant
Syndrome
(Fever, EPS, High CPK,
catatonic symptoms and
autonomic dysfunction)
Sudden reduction in
dopamine activity due
to blockade of
Dopamine receptors
Haloperidol
Chlorpromazine
Bromocriptine,
Dantrolene,
Baclofen, Adequate
rehydration, Add-on
Lorazepam
Tardive Dyskinesia (Late onset
oro-facial dyskinesia)
D2 receptor
super-sensitivity
Chlorpromazine
Aripiprazole
Clonazepam

4. Side effects of Anti-psychotic agents
Part 3: CNS side effects
Side effects Mechanism Maximum with Management
Seizures Decreased seizure
threshold Clozapine
Chlorpromazine
Decrease dose/ Change to
a safer drug
Sedation Histaminergic
blockade
May be beneficial, if chief
complaint: Decrease dose

5. Side effects of Anti-psychotic agents
Part 4: Metabolic and Endocrine side effects
Side effects Mechanism Maximum with Management
Weight gain H1 blockade
Clozapine
Olanzapine
Change drug
Dietary restrictionDiabetes
Weight gain +
Inhibition of glucose
transport into muscle
Galactorrhea
Increased Prolactin
released due to
Dopaminergic
blockade in
hypothalamus
Haloperidol
Risperidone
Change drug

6. Side effects of Anti-psychotic agents
Part 5: Allergic side effects
Side effects Mechanism Maximum with Management
Cholestatic jaundice
Hypersensitivity
reaction
Chlorpromazine Change drug
Supportive care
Agranulocytosis Clozapine
Stop drug urgently
Treat infection
G-CSF (Filgastrim) may be
used

7. Side effects of Anti-psychotic agents
Part 5: Cardiac side effects
Side effects Mechanism Maximum with Management
ECG changes
(especially QT prolongation)
Anticholinergic effect
Calcium channel block
Thioridazine
Pimozide
Change the drug
in severe cases

8. Side effects of Anti-psychotic agents
Part 6: Ocular side effects
Side effects Mechanism Maximum with Management
Granular deposits in cornea
and lens Photosensitivity
Chlorpromazine
(Dose-related)
Change drug
Pigmentary retinopathy Thioridazine
(Dose-related)
Preventive: Never give
more than 800 mg/day

9. Side effects of Anti-psychotic agents
Part 7: Dermatological side effects
Side effects Mechanism Maximum with Management
Photosensitive reaction
Photosensitivity Chlorpromazine
(High dose)
Avoid sunlight
Use sunscreen
Blue-grey metallic
discoloration
Change drug