Antipsychotics learning module

3. Principal risks and risk-reduction measures

This learning module discusses noteworthy risks for antipsychotics. Summaries of product characteristic and the BNF should be consulted for a fuller account of the adverse effects and warnings for individual antipsychotics.

The frequency of adverse effects often varies between different antipsychotics; more information is given in the discussion on individual risks

  • Gastrointestinal adverse effects—including constipation, dry mouth, nausea
  • Central nervous system adverse effects
  • Sedation and sleep disturbances
  • Extrapyramidal side effects—acute dystonia, akathisia, parkinsonism, tardive dyskinesia
  • Neuroleptic malignant syndrome
  • Convulsions
  • Cardiovascular adverse effects
  • Blood pressure changes
  • Cerebrovascular events
  • Cardiac rhythm disorders particularly QT interval prolongation
  • Venous thromboembolism
  • Metabolic adverse effects—including weight gain, dyslipidaemia, hyperglycaemia
  • Hyperprolactinaemia and sexual adverse effects—including menstrual disturbances, sexual dysfunction, osteoporosis
  • Blood disorders—including neutropenia, agranulocytosis
  • Temperature regulation—hypothermia and hyperthermia
  • Adverse effects on the skin—including rash, pruritus, photosensitivity
  • Adverse effects on the eye—including precipitation of glaucoma, mydriasis, and pigmentation
  • Antimuscarinic adverse effects—including constipation, nasal stuffiness, and urinary retention
  • Dependence and withdrawal reactions
  • Drug interactions—including interactions which increase adverse effects (hypotension, sedation, cardiac rhythm disturbances)

Precautions and risks associated with special uses of antipsychotics

  • Use in elderly patients with dementia—increased risk of stroke and higher mortality rate
  • Pregnancy and breastfeeding—need for careful weighing up of benefit and risk for mother and baby
  • Prolonged-release antipsychotic injections—need for care to initiate treatment and for correct administration technique
  • Antipsychotic injections for immediate effect—need for careful evaluation of circumstances for use, use of appropriate dose, close monitoring of patient
  • Clozapine—special risks include agranulocytosis, myocarditis, cardiomyopathy, intestinal obstruction, hypersalivation

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Page last modified: 17 February 2015