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

Seniors

• 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.

Children

Not recommended, but used by experts

Others

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

• Excessive dose of amphetamines  (speed, ecstasy)

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

• Anticonvulsants

>  In particular thioridazine (Mellaril, etc.) 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

• Haloperidol (Haldol) combined with methyldopa (Aldomet) can cause temporary symptoms of dementia

• 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

• insulin

> Chlorpromazine (Largactil)  interferes with the release of insulin

Others

• 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)

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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

Head

• 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)

Members

• 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)

Others

• 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)

Sleep

Sedation (low potency antipsychotics)

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Other side effects

Head

• 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)

Heart

• Acceleration of heart beats

• Arrhythmia (Largactil, etc.)

To be monitored in case of overdose 
(Mellaril, Orap, Serentil, etc.)

Abdomen

• Anticholinergic effects:

> Constipation

> Urinary retention

> Nausea

> Vomiting

• Decreased pulmonary secretions

• Liver problems: hepatitis

Sexuality

• Hormonal problems:

> Breast swelling

>  Cessation of menstruation

>  Disappearance of orgasm

> Milk production

> Decreased sexual desire

> Impotence

• Anticholinergic effects:

> ejaculation problems

Skin

• Exfoliative dermatitis

• Light sensitivity

• Severe sunburn

Weight

Weight increase (loxapine [Loxapac] and haloperidol [Haldol] do not seem to have this effect)

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Overdose Risks

Rarely fatal unless combined with other drugs or alcohol

The most dangerous in case of overdose are:

• Thioridazine (Mellaril)

• Loxapine (Loxapac)

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

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