Extra-pyramidal side effects

Amoxapine is a demethylated metabolite of loxapine and, as a result of its postsynaptic receptor DA-blocking effects, may be associated with extra-pyramidal side effects. 

EPS, extra pyramidal side effects. Relative side-effect risk , negligible +, low ++, moderate +++, moderately high ++++, high. °Side effects shown are relative risk based on doses within the recommended therapeutic range, individual patient risk varies depending on patient-specific factors. 

Q45 is indicated in agitation and restlessness in the elderly, despite the high incidence of extra pyramidal side-effects... 

Flupentixol is an antipsychotic classified as a thioxanthene. Thioxanthenes have pronounced extra pyramidal side-effects. 

Amoxapine, which has a mild neuroleptic effect, can cause extra-pyramidal side effects, akathisia, and even tardive dyskinesia. 

Dhavale HS, Pinto C, Dass J, Nayak A, Kedare J, Kamat M, Dewan M. Prophylaxis of antipsychotic-induced extra-pyramidal side effects in east Indians cultural practice or biological necessity . J Psychiatr Pract 2004 10 200-2. 

Ritchie CW, Chiu E, Harrigan S, Hall K, Hassett A, Macfarlane S, Mastwyk M, O Connor DW, Opie J, Ames D. The impact upon extra-pyramidal side effects, clinical symptoms and quality of life of a switch from conventional... 

LITHIUM CLOZAPINE, HALOPERIDOL, PHENOTHIAZINES, SULPIRIDE T risk of extra-pyramidal side-effects and of neurotoxicity Uncertain Watch for development of these symptoms... 

Anti-psychotic drugs are used in the treatment of schizophrenia and there are many in use. The choice of drug depends on the severity of the condition and the diagnosis of positive or negative symptoms. Other factors to take into consideration are whether sedation is required and how susceptible the individual is to Parkinsonian (extra-pyramidal) side effects. Most drugs are more effective at relieving the positive symptoms and all provide better results in acute schizophrenia. Long-term treatment may be necessary to prevent relapse and chronic illness. Withdrawal of treatment must be cautious to prevent relapse. 

Many anti-psychotic drugs have what are called Parkinsonian or extra-pyramidal side effects. These are abnormalities of movement that resemble Parkinson s disease (see page 211) and are due to the blocking of dopamine D2 receptors in the basal nuclei. Anti-psychotics that also have anti-cholinergic activity (for example pericyazine) cause fewer Parkinsonian side effects. 

Extra-pyramidal side effects - abnormalities of movement due antipsychotic side effect First pass metabolism - metabolism on first passage through the liver Fungicidal - kills fungi Fungistatic - inhibits fungal growth... 

Prommer EE. Midazolam-induced extra-pyramidal side effects. J Pain Symptom Manage 2008 36(5) e5-6. 

Sinpson GM, Angus JWC. (1970) A rating scale for extra pyramidal side effects. Acta Psychiatrica Scandinavica 212 (supplement) 11-19. 

---