Ziprasidone Quetiapine

Side Effect Clozapine Risperidone Olanzapine Quetiapine Ziprasidone Aripiprazole Haloperidol... 

Diabetes or family history of diabetes Aripiprazole, quetiapine, ziprasidone Risperidone... 

Antipsychotics in a few small studies have been shown to be helpful. To date this research is limited to typical antipsychotics. Nevertheless, the excellent track record of atypical antipsychotics in treating schizophrenia and the lower burden of side effects lead us to recommend atypical antipsychotics as a first-line treatment for STPD as well. Low doses of risperidone, olanzapine, quetiapine, ziprasidone, or aripiprazole are all reasonable options. If no therapeutic effect is observed, doses should be increased. 

Gl dysmotility Esophageal dysmotility and aspiration have been associated with antipsychotic drug use. Use quetiapine, ziprasidone, risperidone, olanzapine, aripiprazole, and others cautiously in patients at risk for aspiration pneumonia. Hypersensitivity reactions Patients who have demonstrated a hypersensitivity reaction (eg, blood dyscrasias, jaundice) with a phenothiazine should not be re-exposed to any phenothiazine unless the potential benefits of treatment outweigh the possible hazards. 

Although positive symptoms are usually the focus of acute intervention and are at least partially responsive to neuroleptics, cognitive, mood, and negative symptoms are generally more debilitating, are less responsive to conventional agents, and may be more responsive to novel antipsychotics (e.g., clozapine, risperidone, olanzapine, quetiapine, ziprasidone). 

Novel antipsychotics (NAPs) [e.g., clozapine, olanzapine, risperidone, quetiapine, ziprasidone, aripiprazole]... 

Drugs can not only be substrates for a cytochrome P450 enzyme or an inhibitor of a P450 enzyme, they can also be inducers of a cytochrome P450 enzyme and thereby increase the activity of that enzyme. This was discussed in Chapter 6 for CYP450 3A4, and the induction of 3A4 activity by the anticonvulsant and mood stabilizer carbamazepine was given as an example (Fig. 6—19). Since mood stabilizers may be frequently mixed with atypical antipsychotics, it is possible that carbamazepine may be added to the regimen of a patient previously stabilized on clozapine, quetiapine, ziprasidone, or sertindole. If so, the doses of these atypical antipsychotics may need to be increased over time to compensate for the induction of 3A4 by carbamazepine. 

FIGURE 11 —49. Several atypical antipsychotics are substrates for CYP450 3A4, including clozapine, quetiapine, ziprasidone, and sertindole. 

FIGURE 11—50. There are several inhibitors of CYP450 3A4 that may increase levels of some atypical antipsychotics. The inhibitors are shown here, and the atypical antipsychotics including clozapine, quetiapine, ziprasidone, and sertindole, are shown as well. 

FIGURE 11—51. The enzyme CYP450 3A4 can be induced by the anticonvulsant and mood stabilizer carbamazepine. If this agent is stopped in a patient who is receiving an atypical antipsychotic that is a substrate for this same enzyme (i.e., clozapine, quetiapine, ziprasidone, or sertindole), the doses of these antipsychotics may need to be reduced because the autoinduction of 3A4 by carbamazepine will reverse over time once it is discontinued. 

Second-generation antipsychotics (SGAs) (also known as atypical antipsy-chotics), except clozapine, are the agents of first choice in treatment of schizophrenia. Growing, but stiU controversial, evidence supports that the SGAs (e.g., clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole) have superior efficacy for treatment of negative symptoms, cognition, and mood. 

No placebo-controUed trials are currently available evaluating quetiapine, ziprasidone, or aripiprazole in psychosis of dementia. An open-label study suggests possible effect and good tolerability with quetiapine. For patients who respond inadequately, have elevated cardiovascular risk, or who have unacceptable side effects... 

Fluoxetine (Prozac) PHENOTHIAZINES Risperidone, Aripiprazole Clozapine, Quetiapine, Ziprasidone ... 

Fluvoxamine (Luvox) Nefazodone (Serzone) Paroxetine (Paxil) CLOZAPINE, THIORIDAZINE, HALOPERIDOL, OLANZAPINE, THIOTHIXENE PHENOTHIAZINES, Risperidone, Aripiprazole Clozapine, Quetiapine, Ziprasidone QUETIAPINE, Clozapine, Ziprasidone ... 

Other atypical antipsychotics commonly prescribed for treatment of autism include olanzapine, quetiapine, ziprasidone, and clozapine (Oswald and Sonenklar, 2007). Placebo-controlled trials of these agents in ASD populations have not been reported, with the exception of a small pilot study of olanzapine in which three of six children treated with olanzepine were rated as responders, compared to one of five in the placebo group (Hollander et al., 2006b). Open-label studies (reviewed by... 

The term neuroleptic is often applied to drngs that have relatively prominent experimental and clinical evidence of antagonism of D2-dopamine-receptor activity, with substantial risk of adverse extrapyramidal nenrological effects and inaeased release of prolactin. The term atypical antipsychotic is applied to agents that are associated with snbstantially lower risks of snch extrapyramidal effects. Representative examples inclnde aripiprazole, clozapine, quetiapine, ziprasidone, and low doses of olanzapine and risperidone. 

Although the term neuroleptic initially encompassed this whole unique syndrome and is still used as a synonym for antipsychotic, it now is used to emphasize the more neurological aspects of the syndrome i.e., the parkinsonian and other extrapyramidal effects). Except for clozapine, arip-iprazole, quetiapine, ziprasidone, and low doses of olanzapine and risperidone, antipsychotic drugs available in the U.S. also have effects on movement and posture and can be called neuroleptic. The more general term antipsychotic is preferable, as reinforced by the growing number of modern atypical antipsychotic drugs with little extrapyramidal action. 

A challenging special population is Parkinson s disease patients with psychotic symptoms related to dopaminergic therapy (see Chapter 20). Standard neuroleptics, risperidone (even in small doses), and olanzapine often produce unacceptable worsening of bradykinesia-akinesia. Clozapine is relatively well tolerated and effective, though more complicated to use. Use of moderate doses of newer agents withvery low risk of parkinsonism (aripiprazole, quetiapine, ziprasidone) requires further study. 

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