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Side effects of typical antipsychotics

The side effects of typical antipsychotics include:

1. Movement disorders
2. Endocrine effects
3. Sedation

Movement disorders:

• Movement Disorders also called Extrapyramidal Symptoms
• Caused by Blockage of Dopamine receptors in Nigrostriatal tract

Acute dystonia:

• Earliest Side Effect.
• Sudden contraction of a grp. of muscles [torticollis, trismus, deviation of eye]
• Mgt – I/V Anticholinergics [benztropine, promethazine, diphenhydramine]
• To prevent acute dystonia prophylactic use of anticholinergics suggested

Acute akathisia:

• Most common Side Effect.
• Inner sense of restlessness along with objective observable movements like fidgeting, pacing
• Mgt – Beta Blockers [DOC] such as propranolol, anticholinergics and benzodiazepines

Drug Induced Parkinsonism:

• Triad of Rigidity, bradykinesia and Resting Tremors
• T/T – Anticholinergics. Prophylactic Anticholinergics can be used to prevent it

Tardive dyskinesia:

• Develops after prolonged exposure [Tardive]
• Involuntary movements of tongue [twisting, protusion], jaw [Chewing], lips [smacking, puckering]
• Movement can be rapid jerky [Choreiform] or slow sinusoidal [athetoid]

Neuroleptic malignant disorder:

• Potentially fatal side effect
• Muscle Rigidity, Elevated Temperature, Increased CPK Levels, Leukocytosis and deranged LFT
• Other Symptoms – diaphoresis, tremors, confusion, autonomic disbalance
• D2 Receptors in corpus striatum [Muscle Contraction] and in Hypothalamus [Temperature regulation]
• Mgt – Dantrolene and Dopamine agonists like amantadine and bromocriptine + Supportive measures

Endocrine side effects:

• Due to blockage of tubero-infundibular tracts
• Hyperprolactemia causing galactorrhea, menstrual disturbance [Female] and impotence [Males]
• Movement can be rapid jerky [Choreiform] or slow sinusoidal [athetoid]

Other side effects:

• Sedation
• Orthostatic Hypotension
• Anticholinergic Side Effects