Antipsychotic

Paliperidone (Invega)
Perphenazine (Trilafon)
Prochlorperazine
(Compazine)
Quetiapine (Seroquel,
Seroquel XR)
Risperidone (Risperdal,
Risperdal Consta,
Risperdal M-Tab)
Thioridazine (Mellaril)
Thiothixene (Navane)
Trifluoperazine
(Stelazine)
Ziprasidone (Geodon)

Antidepressants

Amitriptyline (Elavil)
Bupropion (Wellbutrin,
Zyban)
Citalopram (Celexa)
Desipramine (Norpramin)
Doxepin (Adapin)
Duloxetine (Cymbalta)
Escitalopram (Lexapro)
Fluoxetine (Prozac,
Sarafem)
Fluvoxamine (Luvox)
Imipramine (Tofranil)
Mirtazapine (Remeron)
Nefazodone (Serzone)
Nortriptyline (Aventyl,
Pamelor)
Paroxetine (Paxil)
Phenelzine (Nardil)
Selegiline, transdermal
(Emsam)
Sertraline (Zoloft)
Trazodone (Desyrel)
Venlafaxine (Effexor,
Effexor XR)

Aripiprazole (Abilify) [Antipsychotic/Psychotropic] WARNING:

Increased mortality in elderly with dementia-related psychosis
Uses: *Schizophrenia*
Action: Dopamine & serotonin antagonist
Caution: [C, –]Contraindicated in breast-feeding
SE: Neuroleptic malignant synd, tardive dyskinesia, orthostatic ↓BP, cognitive & motor
impair
Interactions: Effects W/ ketoconazole, quinidine, fluoxetine, paroxetine,
effects W/ carbamazepine
Labs: Glucose
NIPE: nausea Breast-feed, consume ethanol, or use during pregnancy; use barrier contraception; fluid intake

Chlordiazepoxide (Librium, Mitran, Libritabs) [C-IV] [Anxiolytic,

Sedative/Hypnotic/Benzodiazepine]
Uses: Anxiety, tension, ethanol withdrawal, & preoperative apprehension
Action: Benzodiazepine; antianxiety agent
Caution: [FDA fetal risk category D] Respiratory depression, CNS impair, history of drug dependence; avoid in hepatic impair
Contra: Preexisting CNS depression, NAG
SE: Drowsiness, CP, rash, fatigue, memory impair, xerostomia, wt gain
Interactions: Effects W/ antidepressants, antihistamines, anticonvulsants, barbiturates, general anesthetics, MAOIs, narcotics, phenothiazines cimetidine, disulfiram,
fluconazole, itraconazole, ketoconazole, OCPs, INH, metoprolol, propoxyphene, propranolol, valproic acid, ethanol, grapefruit juice, kava kava, valerian; effects OF digoxin,
phenytoin; effects W/ aminophylline, antacids, carbamazepine, theophylline, rifampin, rifabutin, tobacco;
effects OF levodopa Labs: LFTs, alkaline phosphatase, bilirubin, triglycerides; granulocytes
NIPE: nausea ethanol, pregnancy, breast-feeding; risk of photosensitivity—use sunscreen, orthostatic hypotension, tachycardia; erratic IM absorption

Clozapine (Clozaril & FazaClo) [Antipsychotic/Dibenzodiazepine Derivative]

WARNING: Myocarditis, agranulocytosis, Szs, & orthostatic BP associated w/ clozapine; mortality in elderly w/ dementiarelated psychosis
Uses: *Refractory severe schizophrenia*; childhood psychosis
Action: “Atypical” TCA
Caution: [FDA fetal risk category B, +/– Contraindicated in breast-feeding] Monitor for psychosis & cholinergic rebound
Contra: Uncontrolled epilepsy; comatose state; WBC <3500 cells/mm3 and ANC <2000 cells/mm3 before Rx or <3000 cells/mm3 during Rx
SE: Sialorrhea, tachycardia, drowsiness, wt, constipation, incontinence, rash, Szs, CNS stimulation, hyperglycemia
Notes: Avoid activities where sudden loss of consciousness could cause harm; benign temperature ↑may occur during the 1st 3 wk of Rx, weekly CBC mandatory 1st 6 mo, then
qowk
Interactions: Effects W/ clarithromycin, cimetidine, erythromycin, fluoxetine, paroxetine, quinidine, sertraline; depressant effects W/ CNS depressants, EtOH; effects OF
digoxin, warfarin; effects W/ carbamazepine, phenytoin, primidone, phenobarbital, valproic acid, St. John’s Wort, nutmeg, caffeine; effects OF phenytoin
Labs: Monitor WBCs
NIPE: Risk of developing agranulocytosis

Fluphenazine (Prolixin, Permitil) [Antipsychotic/Phenothiazine]

Uses: *Schizophrenia*
Action: Phenothiazine antipsychotic; blocks postsynaptic mesolimbic dopaminergic brain receptors
Caution: [FDA fetal risk category C, ?/– Contraindicated in breast-feeding]
Contra: Severe CNS depression, coma, subcortical brain damage, blood dyscrasias, hepatic Dz, w/ caffeine, tannic acid, or pectin-containing products
SE: Drowsiness, extrapyramidal effects
Interactions: Effects W/ antimalarials, BBs, CNS depressants, EtOH, kava kava; effects OF anticholinergics, BBs, nitrates; effects W/ antacids, caffeine, tobacco; effects
OF anticonvulsants, guanethidine, levodopa, sympathomimetics
Labs: LFTs, HMG, Hct, plts, WBC
NIPE: Photosensitivity—use sunscreen; urine may turn pink or red, ↑risk of heatstroke in hot weather; less sedative/hypotensive than chlorpromazine

Haloperidol (Haldol) [Antipsychotic/Butyrophenone]

Uses:*Psychotic disorders, agitation, Tourette disorders, hyperactivity in children*
Action: Antipsychotic, neuroleptic
Caution: [FDA fetal risk category C] Effects w/ SSRIs, CNS depressants, TCA, indomethacin, metoclopramide; avoid levodopa (antiparkinsonian effects)
Contra: NAG, severe CNS depression, coma, Parkinson Dz, BM suppression, severe cardiac/ hepatic Dz
SE: Extrapyramidal Sxs (EPS), BP, anxiety, dystonias
Interactions: ↑Effects W/ CNS depressants, quinidine, EtOH; hypotension W/ antihypertensives, nitrates; ↑anticholinergic effects W/ antihistamines, antidepressants,
atropine, phenothiazines, quinidine, disopyramide; ↓effects W/ antacids, carbamazepine, Li, nutmeg, tobacco; ↓effects OF anticoagulants, levodopa, guanethidine
Labs: LFTs
NIPE: Risk of photosensitivity—use sunscreen; do not give decanoate IV; dilute PO conc Liq w/ H 2O/juice; monitor for EPS

Lithium Carbonate (Eskalith, Lithobid, others) [Antipsychotic]

Uses: *Manic episodes of bipolar Dz*
Action: Effects shift toward intraneuronal metabolism of catecholamines
Caution: [FDA fetal risk category D]
Contra: Severe renal impair or CV Dz, lactation
SE: Polyuria, polydipsia, nephrogenic DI, tremor; Na retention or diuretic use may tox; arrhythmias, dizziness
Interactions: Effects OF TCA; effects W/ ACEIs, bumetanide, carbamazepine, ethacrynic acid, fluoxetine, furosemide, methyldopa,
NSAIDs, phenytoin, phenothiazines, probenecid, tetracyclines, thiazide diuretics, dandelion, juniper; effects W/ acetazolamide, antacids, mannitol, theophylline,
urea, verapamil, caffeine
Labs: Serum glucose, I-131 uptake, WBC; uric acid, T3, T4
NIPE: Several wk before full effects of med, fluid intake to 2–3 L/d
Mesoridazine (Serentil) [Antipsychotic/Phenothiazine] WARNING:
Can prolong QT interval in dose-related fashion; torsades de pointes reported
Uses: *Schizophrenia*, acute & chronic alcoholism, chronic brain synd Action: Phenothiazine
antipsychotic Dose: Initial, 25–50 mg PO or IV tid; ↑to 300–400 mg/d max
Caution: [C, ?/–] Contra: Phenothiazine sensitivity, coadministration w/ drugs that
cause QTc prolongation, CNS depression Disp: Tabs 10, 25, 50, 100 mg; PO conc 25
mg/mL; inj 25 mg/mL SE: Low incidence of EPS; ↓BP, xerostomia, constipation, skin
discoloration, tachycardia, lowered Sz threshold, blood dyscrasias, pigmentary
retinopathy at high doses Interactions: ↑Effects W/ antimalarials, BBs, chloroquine,
TCAs, EtOH; ↑effects OF antidepressants, nitrates, antihypertensives; ↑QT interval
W/ amiodarone, azole antifungals, disopyramide, fluoxetine, macrolides, paroxetine,
procainamide, quinidine, quinolones, TCAs, verapamil; ↓effects W/ attapulgite, barbiturates,
caffeine, tobacco; ↓effects of barbiturates, guanethidine, guanadrel, levodopa,
Li, sympathomimetics Labs: False + PRG test; ↑serum glucose, cholesterol; ↓uric
acid NIPE: Photosensitivity—use sunscreen

Molindone (Moban) [Antipsychotic] Uses: *Psychotic disorders*

Action: Piperazine phenothiazine Dose: Adults. 50–75 mg/d PO, ↑to max of 225
mg/d at 3–4 d intervals if necessary. Peds. 3–5 y: 1–2.5 mg/d PO in 4 ÷ doses.
5–12 y: 0.5–1.0 mg/kg/d in 4 ÷ doses Caution: [C, ?] NAG Contra: Drug/EtOH
CNS depression Disp: Tabs 5, 10, 25, 50 mg SE: ↓BP, tachycardia, arrhythmias,
EPS, Szs, constipation, xerostomia, blurred vision Interactions: ↑Effects W/ antihypertensives;
↑hyperkalemia W/ K-sparing diuretics, K supls, salt substitutes,
trimethoprim; ↑effects OF insulin, Li; ↓effects W/ ASA, NSAIDs Labs: ↑Serum K+, BUN, Cr; monitor lipid profile, fasting glucose, HgB A1-c NIPE: Take w/o
food; monitor for persistent cough

Olanzapine (Zyprexa, Zyprexa, Zydis) [Antipsychotic/

Thienobenzodiazepine] WARNING: Mortality in elderly w/ dementiarelated
psychosis Uses: *Bipolar mania, schizophrenia*, psychotic disorders,
acute agitation in schizophrenia Action: Dopamine & serotonin antagonist; Dose:
Bipolar/schizophrenia: 5–10 mg/d, ↑weekly PRN, 20 mg/d max; Agitation: 5–10 mg
IM q2–4h PRN, 30 mg d/max Caution: [C, –] Disp: Tabs 2.5, 5, 7.5, 10, 15, 20 mg;
PO disint tabs 5, 10, 15, 20 mg; Inj 10 mg SE: HA, somnolence, orthostatic ↓BP,
tachycardia, dystonia, xerostomia, constipation Interactions: ↑Effects W/ fluvoxamine;
↑sedation W/ CNS depressants, EtOH; ↑Szs W/ anticholinergics, CNS depressants;
↑hypotension W/ antihypertensives, diazepam; ↓effects W/ activated
charcoal, carbamazepine, omeprazole, rifampin, St. John’s wort, tobacco; ↓effects
OF dopamine agonists, levodopa Labs: ↑LFTs NIPE: ↑Risk OF tardive dyskinesia,
photosensitivity—use sunscreen, body temp impairment; takes weeks to
titrate dose; smoking ↓levels; may be confused w/ Zyrtec

Paliperidone (Invega) [Benzisoxazole] WARNING: Not for

dementia-related psychosis Uses: *Schizophrenia* Action: Risperidone metabolite,
antagonizes dopamine receptors Dose: 6 mg PO qAM, 12 mg/d max; CrCl
50–79; 6 mg/d max; CrCl 10–49 3 mg/d max Caution: [C; ?/–] w/ bradycardia, ↓
K+/Mg2+, renal/hepatic impair Contra: Risperidone hypersensitivity, w/ phenothiazine,
ranolazine, ziprasidone, prolonged QT, h/o arrhythmia Disp: ER Tabs 3, 6, 9 mg SE: Impaired temp regulation, ↑QT and HR, HA, anxiety, dizziness, N, dry
mouth, fatigue, EPS Interactions: ↑Risk of prolongation of QT W/ Class 1A &
III antiarrhythmics, chlorpromazine, chlorpromazine, thioridazine, gatifloxacin,
moxifloxacin, EtOH Labs: Monitor LFTs NIPE: Do not chew/cut/crush pill; monitor
for orthostatic effects