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medication / neuroleptics / second generation (atypical)

2nd generation or atypical neuroleptics

Directions ​


physical health problem

Huntington's chorea


Problems  mental health

  • Acute and chronic symptoms of psychosis (schizophrenia, manic phase of bipolar disorder, schizoaffective disorder)

  • Prevention of schizophrenia, bipolar disorder

  • Agitation associated with psychoses

  • Tourette syndrome (motor tics, uncontrollable movements, growling and licentious language)

  • Autism

  • Behavioral problems in children

Contraindications ​


Physical health issues

  • Allergic reactions to antipsychotics

  • Angle-Closure Glaucoma

  • Precautions for people with Parkinson's disease

  • Tardive dyskinesia

  • Tardive dystonia

  • Late akathisia

  • Neuroleptic malignant syndrome (very rare)

  • Precautions for people with liver, kidney, heart disease, epilepsy, respiratory disease

  • Precautions for people who have had a stroke

  • People with or with a history of diabetes, high blood sugar, high cholesterol and triglycerides

  • Zyprexa contains lactose



Contraindicated in the elderly suffering from dementia, because increases  the risk of stroke and death


Pregnancy and breast feeding

Should not be prescribed to pregnant or breastfeeding women



Used by experts only

Drugs interactions​

Be careful not to take any medicine, with or without a prescription, without consulting a doctor or pharmacist to identify the risks of interaction.


Psychiatric drugs

  • Atypical antipsychotics may increase the effects

> certain classic antipsychotics

> certain antidepressants  (tricyclics and SSRIs)

> anxiolytics and hypnotics

> narcotics

> barbiturates

  • Tegretol decreases the effect of Risperdal

  • All antipsychotics decrease the effectiveness of antiparkinsonians, such as levodopa


Physical health drugs

  • May increase the effects

> sedative antihistamines (medicines for allergies)

> antihypertensives (medicines for high blood pressure)

> antiarrhythmics and beta-blockers  (heart medications)


  • Ciprofloxacin (antibiotic) may increase the toxic effects of clozapine and olanzapine (Zyprexa)


Natural products and food

  • Avoid taking:

> valerian

> ginseng

> melatonin

> St. John's wort

> nutmeg

> sage



May increase the effects of alcohol

Side effects​

They depend on the dosage and duration of treatment, the metabolism of the individual and the context in which he lives.



  • Antipsychotic malignant syndrome  (very rare)

  • Dizziness

  • Dry mouth

  • Headache

  • Seizures



Can cause a drop in blood pressure when the person stands up, which can lead to dizziness, falls



  • Constipation

  • Diarrhea

  • Difficulty urinating

  • Frequent need to urinate



Effects less common with second-generation antipsychotics

  • Tardive dyskinesia (TD). The risk of developing TD and the likelihood of it becoming irreversible increases with duration of treatment and total cumulative amount  antipsychotics administered to the person.  Older women are most at risk  for DT

  • Tardive dystonia. May be irreversible

  • Late akathisia. May be irreversible

  • Akinesia

  • Parkinsonism



  • Sexual problems including low libido, ejaculation problem, erection problem

  • Cessation of menstruation

  • Priapism (persistent and painful erection appearing without sexual arousal)



Weight gain that can be rapid, significant, irreversible and lead to obesity. More common with antipsychotics  the second generation



  • May cause type 2 diabetes, hyperglycemia  (more common with Zyprexa)

  • May raise cholesterol



  • Shortened or lengthened duration of sleep

  • Insomnia

  • Drowsiness

  • Having more dreams or nightmares



  • Dysphoria (mood disturbance characterized by an unpleasant and disturbing feeling of sadness, anxiety, tension, irritability; opposite of euphoria)

  • Asthenia. Weariness, feeling tired.

  • Very similar to depressive symptoms  to varying degrees in many people taking antipsychotics

  • Difficulty concentrating

  • Memory problems

  • Psychosis

Monitoring and medical supervision

Actions one can take to avoid iatrogenic effects (which are caused by medicine)


  • All persons receiving atypical antipsychotics should be monitored for symptoms of diabetes, hyperglycemia, such as frequent urges to drink, urinate, eat, and  feeling weak. Fasting blood glucose testing is recommended before and during treatment. Closer follow-up for people who  combine several risk factors.

  • Weight gain must be assessed and managed. Professional monitoring of nutrition and exercise is recommended.

  • Evaluation before and during treatment of cholesterol and triglyceride levels.

  • Individuals should be assessed at least once a year and preferably by a neurologist for dyskinesia, dystonia and akathisia.

  • The liver, kidneys, heart, lungs and eyes should be evaluated before and at regular intervals during treatment.

Withdrawal symptoms

Psychotropic drugs act in the brain just as they do in the rest of the body; and as we have seen, each person reacts differently. It's the same with weaning; the person's metabolism, the type of drug, the dose as well as the duration of the intake and its half-life, explain that the withdrawal effects are varied. We have listed the potential and main withdrawal symptoms of each class of psychotropic drugs. This list is incomplete, as not all withdrawal effects are listed; moreover, knowledge is rapidly evolving in this field. A person may have no withdrawal symptoms or experience one, a few, or even many. The medication reduction journey is specific to each person, just as each process is unique. For example, a person can take the same medicine twice at the same dose and the effects will be different. Gradual reduction, like removing 10  % of dose per week/month, reduces the frequency or intensity of withdrawal symptoms and the incidence of rapid relapses. It is very important to undertake this process with the collaboration of your doctor. The pharmacist also plays a key role and can provide guidance to monitor withdrawal effects for each medication. Most people who will have withdrawal symptoms will tolerate them without problems for the short duration of these symptoms.

Common and frequent withdrawal symptoms for all classes: anxiety, nervousness, restlessness, sleep problems, greater need to rest, sleep, irritability, fatigue.

Withdrawal symptoms for neuroleptics :

Withdrawal symptoms appear a few days after the dose is reduced. In the process of progressive reduction according to the method of 10  %, the last step can be particularly difficult. It can be lengthened or split to reduce withdrawal symptoms.

Main psychological withdrawal symptoms:

  • Withdrawal psychosis

  • Nervousness or restlessness

  • Insomnia

Main physical withdrawal symptoms:

  • Muscle stiffness; body aches (sore all over)

  • Tremors

  • Sweat

  • Runny nose

  • Nausea, vomiting

  • Cramps, abdominal pain

  • Diarrhea

  • Salivation

  • Headaches (headaches)

  • Nightmares

  • Palpitations

  • Hypertension

  • Discovery of tardive dyskinesia (Definition: abnormal and involuntary movements of the tongue, jaw, trunk or extremities whose appearance is related to the taking of neuroleptic drugs. tardive dyskinesia may become irreversible.)


Clozaril carries a higher risk in relation to withdrawal psychosis because its duration of action is short.

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