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medication / neuroleptics / injectables

Slow release injectable neuroleptics
and long-acting

Directions ​


Physical health issues

  • Porphyria (disturbance of pigment metabolism)

  • Nausea, severe vomiting

  • Nausea, vomiting before chemotherapy for cancer

  • Irrepressible hiccups


Mental health problems

  • To relieve agitation, hallucinations, delusions and inconsistencies of thought in psychotic people

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

  • Schizophrenic disorders and related disorders such as:

> Brief reactive psychoses

> Schizophreniform disorders

> Schizoaffective disorders

  • Managing manic episodes or preventing them

  • People with an autism diagnosis

  • Depression, psychotic depression

  • Generalized anxiety

  • Obsessive Compulsive Disorder

  • Hostile impulses

  • Personality disorders

  • Alcoholism

Contraindications ​


Physical health issues

  • Allergic reaction to antipsychotics

  • Severe heart abnormality

  • Poorly controlled epilepsy

  • Angle-closure glaucoma (a disease of the eye characterized by an increase in  intraocular pressure which increases the hardness of the globe)

  • Problem related to urinary retention

  • Precaution for people with liver disease

  • Signs of dyskinesia

  • Consumption of substances likely to induce cholinergic delirium, such as scopolamine

  • History of neuroleptic malignant syndrome



  • Lower doses than adults

  • May increase mortality in dementia


Pregnancy and breast feeding

Abstain during the first trimester and while breastfeeding, but haloperidol is considered safe.



Not recommended, but used by experts



  • Coffee, tea, hallucinogenic drugs can trigger symptoms of psychosis

  • Excessive dose of amphetamines  (speed, ecstasy)

Drugs interactions​

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


Psychiatric drugs

  • Anticonvulsants

>  May increase the toxicity of phenytoin (Dilantin)

Barbiturates which act as anticonvulsants may affect the metabolism of antipsychotics and in  decrease therapeutic effects while increasing sedation


  • Antidepressants and antiparkinsonians

> Taken together, increased sedative and anticholinergic effects of tricyclic antidepressants and antipsychotics


  • Sleeping pills, tranquilizers, anesthetics, narcotics and antihistamines

> Increase the sedative effects of these substances

> Increase the risk of confusion, dry mouth, blurring of vision, decrease in  sweating and retention of urine


  • Lithium

> Slightly increases the side effects of antipsychotics


Other drugs

  • Painkillers

> Can cause deep drowsiness


  • Medications that lower blood pressure

> Antipsychotics increase hypotension


  • Drugs used for resuscitation

> Avoid epinephrine at all costs, use norepinephrine instead


  • Substances used to treat certain heart problems

> Antipsychotics may increase the risk of cardiac arrhythmia



  • caffeine

> Regular coffee intake can, in some cases, reduce the effect of antipsychotics and, unfortunately, the doses are then increased

> More than 2 to 3 cups of coffee: can sometimes lead to intoxication which results in symptoms of motor and verbal restlessness  resembling a mild psychotic crisis (per DSM-IV)

Side effects​

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


Neurological side effects


  • Odd facial expressions (dystonia)

  • Rapid but mild tremors of the lower lip (rabbit syndrome)

  • Repetitive and involuntary rhythmic movements of the tongue, lips and eyes, by grimacing, chewing, twitching of the nose,

  • sniffling and jerking of the neck (tardive dyskinesia)

  • Convulsions (if high doses or if dose escalation is rapid)



  • Exaggerated contraction of muscles, involuntary movements, strange postures (dystonia)

  • Muscle rigidity, jerky movements, shuffling gait, hunched back, tremors (parkinsonism)

  • Absence of certain movements (akinesia)

  • Irrepressible urge to move, which turns into motor restlessness (akathisia)



  • Affects the body's temperature regulation mechanism (loss of hot and cold perceptions)

  • Blood problems: decrease in white blood cells

  • Jerky movements of the fingers, arms, legs, pelvis and trunk (tardy dyskinesia)

  • Intense muscle rigidity (neuroleptic malignant syndrome: very rare)



Sedation (low potency antipsychotics)

Other side effects


  • Dry mouth

  • Dilation of the pupils

  • Blurring of vision

  • Appearance of spots on the retina of the eye and even blindness: large dose of thiodazine (Mellaril, etc.). Reversible

  • Pupil dilation (reversible)



Acceleration of heart beats


To be monitored in case of overdose 


  • Anticholinergic effects:

> Constipation

> Urinary retention

> Nausea

> Vomiting

  • Decreased pulmonary secretions

  • Liver problems: hepatitis



  • Hormonal problems:

> Breast swelling

>  Cessation of menstruation

>  Disappearance of orgasm

> Milk production

> Decreased sexual desire

> Impotence


  • Anticholinergic effects:

> ejaculation problems



  • Exfoliative dermatitis

  • Light sensitivity

  • Severe sunburn



Weight increase

Overdose Risks

Rarely fatal unless combined with other drugs or alcohol


Symptoms of overdose are:

  • Hustle

  • Deep sedation

  • Coma

  • Acceleration of heart beats

  • Cardiac arrythmia

  • Tremors

  • Involuntary contraction of muscles

  • Seizures

  • Drop in blood pressure when getting up

  • Hypothermia

  • Hyperthermia (sometimes)

  • Respiratory distress

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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