Clozapine (Clozari): Atypical Antipsychotic

• Haloperidol serves as a benchmark against which other drugs are evaluated.

Clozaril (Clozapine)

• Clozaril stands out as a uniquely effective atypical antipsychotic.
• It matches the effectiveness of other antipsychotics.
• It's prescribed for patients with refractory conditions and severe psychosis.
• Clozaril can be used to alleviate negative symptoms.
• It can aid gains in social & occupational functioning.
• Clozaril benefits conditions like BD, schizoaffective disorder, and Parkinson's-related issues.
• Key side effect is low EPS and zero TD.
• Agranulocytosis, marked by high fever and a sudden drop in white blood cells, is a notable side effect.
• Weekly white blood cell count monitoring is essential for safety.
• Agranulocytosis incidence is super rare (0.8% at 1 year, 0.9% at 1.5 years)
• Continuous blood work testing is costly and affects medication compliance.
• Clozaril has risk of Sedation.
• Possible risk of seizures due to lowering of seizure threshold.

Seroquel (Quetiapine)

• Seroquel has uses for managing hostility and suspiciousness.
• It has a relatively weaker impact on negative symptoms.
• Sedation risk is large.
• Seroquel involves a narrow dose response curve.
• There is risk of stroke in elderly with dementia.
• Other side effects include NMS, high blood sugar (hyperglycemia), high fat levels in blood (increased cholesterol and triglycerides), and weight gain.
• Also, TD, and increased BP in children and teenagers are possible.

Risperdal (Risperidone)

• Risperdal’s chemical structure differs from other antipsychotics.
• It potently antagonizes serotonin 2A and 7, adrenergic 1 and 2, and histamine 1 receptors.
• D2 antagonism is comparable to haloperidol.
• Drug interactions are probable.
• Risperdal may cause OCD behaviors.
• Dose-related EPS is a risk, especially at doses above 10 mg.
• Dose-related TD as well.
• Orthostatic hypotension (BP drop upon standing) can occur.
• Sedation is another side effect.
• It can elevate prolactin levels.

Zyprexa (Olanzapine)

• Zyprexa has a broad receptor affinity.
• The most notable side effect is significant weight gain, linked to a lack of satiety.
• The possible outcome would be massive weight gain and diabetes.
• Mild sedation and dizziness are other side effects.
• EPS has also been reported.

Geodon (Ziprasidone)

• Geodon carries a black box warning for increased mortality in elderly patients with dementia-related psychosis.
• Sedation is a side effect.
• It can induce severe EPS.
• Also, anticholinergic effects can occur.
• It can also induce diabetes.
• 5% of patients may experience a rush, necessitating discontinuation.
• Geodon is associated with irregular heart rate issues.
• Low blood pressure (hypotension) risk may lead to accidents and death.
• Specific populations must be considered due to these risks.

Abilify (Aripiprazole)

• Side effects include NMS and TD.
• Minimal weight gain.
• There is a possibility of Seizures.
• Pancreatitis has also been reported.
• Agitation is more prevalent.

Invega (Paliperidone)

• Invega is the main active metabolite of risperidone.
• It works through central dopamine type 2 and serotonin type 2 receptor antagonism.
• Antagonizes adrenergic receptors 1 and 2, and histamine 1 receptors.
• The main side effects include:
• Restlessness
• Muscle stiffness
• EPS
• Other side effects include NMS, TD, high blood sugar/diabetes, cardiac arrhythmias, orthostatic hypotension, and weight gain.

Latuda

• Has minimal anticholinergic effects.
• 4th most likely to cause EPS compared to other antipsychotics
• Common side effects include somnolence, akathisia, panic attacks, nausea, parkinsonism, and weight gain.
• Less common side effects:
• Dystonia
• Seizure
• Suicidal ideation
• Stroke
• Agranulocytosis
  • TD
• Second-generation drugs are not more effective, exhibit fewer side effects, or are more cost-effective than first-generation drugs, but physicians are more inclined to prescribe second-generation options.