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medication / neuroleptics / third generation

3rd generation neuroleptics

Directions ​


Problems  mental health

  • Schizophrenia

  • Major depressive disorder in combination with an antidepressant (Rexulti)

  • Bipolar disorder

Contraindications ​


Physical health issues

  • Allergy to aripripazole (Abilify) and brexpiprazole (Rexulti), any ingredient in its preparation, or the composition of its container

  • Seizures

  • Lactose allergy

  • Epileptic seizures


Do not give to seniors

Pregnancy and breast feeding

Should not be used during pregnancy, or in women planning to become pregnant, or while breastfeeding

Children and teenagers

Not for use in children under 13 years old

Drugs interactions​

The list of medications is very long, it is important to consult the pharmacist, whether  prescription or over-the-counter or herbal medicines, as well as supplements, vitamins and contraceptives, nicotine, caffeine, etc.


Mental health problems

  • Certain MAOIs, tricyclic and heterocyclic antidepressants and SSRIs

  • Lithium

  • Amphetamines: destroamphetamine (Dexedrine), methylphenidate (Ritalin, Concerta, Biphentin)

  • Antipsychotics (Haldol, Seroquel, Largactil, Zyprexa, Risperdal)


Physical health issues

  • Antiepileptics

  • Antimigraine drugs (triptans)

  • Antihistamines

  • Macrolide antibiotics (azithromycin, erythromycin, clarithromycin)

  • Muscle relaxants

  • Statins to treat high cholesterol levels.

  • Medicines for high blood pressure



It is not advisable to consume alcohol and illicit and controlled drugs.

Side effects​

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



  • Headache

  • Drowsiness

  • Dizziness

  • Dry mouth



  • Sleep disorder

  • drowsiness



  • Tremors

  • Skin rash

  • Dorsalgia (back pain located at the level of the dorsal vertebrae) or muscle pain



Hypersexuality: continuous and persistent search for sexual pleasure



  • Nausea, vomiting

  • Constipation

  • Stomach pains

  • gastric pain

  • Constipation



Weight gain



  • Restlessness, anxiety

  • Risk of gambling addiction



Stop taking the drug if:

  • Seizures

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

  • Urticaria and breathing difficulties

  • Sudden feeling of weakness or numbness experienced in the face,  an arm or a leg

  • Difficulty speaking

  • Vision problems


Rarer side effects (call your doctor soon):


  • Muscle twitching or abnormal movements of the tongue or face

  • Difficulty swallowing

  • Symptom of an infection (cough, sore throat, fever, chills)



Extrapyramidal effects (abnormal body movements, shaking, stiffness)



Uncontrollable sexual behaviors



  • Signs of a blood clot

  • Symptoms of high blood sugar (increased thirst or hunger, weight loss, general weakness, increased urination)

  • Diabetes



  • Restlessness, anxiety

  • Compulsive gambling



  • Tardive dyskinesia

  • Neuroleptic malignant syndrome: characterized by altered mental status (confusion), muscle rigidity,  hyperthermia (high body temperature) and neurovegetative hyperactivity (sleep disturbance, irritability, difficulty  concentration, hypervigilance and startle reactions)

  • Low blood pressure

  • Epileptic seizures

  • Heart rhythm abnormality

  • Brownish or discolored urine

Monitoring and medical surveillance

  • Measure blood glucose and body weight before starting treatment

  • Clinical monitoring of weight, blood glucose and lipid parameters at regular intervals thereafter

  • Perform a complete blood count before implantation  en route to treatment and then periodically during treatment

  • Monitor white blood cell count

  • In order to reduce the risk of overdose, the smallest possible quantity compatible with an adequate therapeutic approach should be prescribed.

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 drug. 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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