Extrapyramidal side effects management

Clozapine, which is associated with higher risk of agranulocytosis and seizures, is indicated (25 mg once or twice daily) only in the management of schizophrenic patients who fail to respond adequately to standard antipsychotic drug treatment. On the other hand, it is relatively free from extrapyramidal side effects such as parkinsonism. Approximately 50% of the administered dose is excreted in the urine and 30% in the feces as inactive demethylated, hydroxylated, and N-oxide derivatives. Clozapine has anticholinergic properties and causes tachycardia, and hence poses a serious risk for a patient with compromised cardiovascular function (see also Table 23). 

Guo S-L, Lin C-J, Huang H-H, Chen L-K, Sun W-Z. Reversal of morphine with naloxone precipitates haloperidol-induced extrapyramidal side effects. JPain Symptom Manage (2006) 31, 391-2. 

Brown DJF, McArthur D, Moulsdale H. Subcutaneous midazolam as a cause of extrapyramidal side effects in a patient with prostate cancer. J Pain Symptom Manage 2007 34(2) 111-3. 

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