What Are Typical Antipsychotics?

Uses, Side Effects and Types of Typical Antipsychotics

antipsychotic medications in hand
What are typical antipscychotics, when are they used, and what side effects are common?. David Grossman/Photographer's Choice/Getty Images

What are Typical Antipscyhotics?

Typical antipsychotics, sometimes referred to as "first-generation" antipsychotics, are the first medications which were available to used treat psychotic symptoms. Psychotic symptoms are those in which a person loses contact with reality and may have delusions or hallucinations.

Typical antipscyhotics were not called "typical" until the newer generation of these drugs came out, called atypical antipsychotics.

Typical antipsychotics may also be referred to as major tranquilizers, classical neuroleptics, or traditional or conventional antipsychotics.

Typical vs Atypical Antipsychotics

Atypical antipscyhotics in contrast to typical antipscyhotics are a newer generation of drugs to treat pscyhosis with the first medications in this category having become available in 1990. Atypical antipsychotics, in general, have significantly fewer movement-related side effects.

Brand and Generic Names of Typical Antipsychotics

Typical antipsychotics approved for use in the United States include:

  • Haldol (haloperidol)
  • Loxitane (loxapine)
  • Mellaril (thioridazine)
  • Moban (molindone)
  • Navane (thiothixene)
  • Orap (pimozide)
  • Prolixin (fluphenazine)
  • Serentil (mesoridazone)
  • Stelazine (trifluoperazine)
  • Thorazine (chlorpromazine)
  • Trilafon (perphenazine)

Some of these antipsychotic medications are marketed in other countries under different brand names.

Uses of Typical Antipsychotics - What Do These Medications Treat?

Antipsychotics are used to treat psychotic symptoms. Psychosis is a symptom instead of the name of a specific medical conditions. Just as a fever may be a sign of many different infections or even conditions other than infections, psychosis can be a symptom of a number of different mental health  and physical health conditions.

Mental Health Conditions in Which Psychotic Symptoms May Occur

Rather than being a specific disease or condition, psychosis most often occurs as part of an underlying mental health condition. It may occur in people with:

Antipsychotics are usually used in combination with other medications, such as antidepressants, anti-anxiety medications or mood stabilizers.

Medical Conditions in Which Psychosis May Occur

Psychotic symptoms may also occur with several medical conditions including

  • As a side effect of a prescription drug such as steroids
  • Epilepsy
  • Dementia*
  • Strokes
  • Brain tumors
  • Parkinson's disease
  • Illegal drug use, particularly methamphetamines

*It's important to note than an FDA alert was made in 2008 that both typical and atypical antipsychotic medications are associated with an increased risk of death when used to treat dementia-related psychosis in elderly patients and should not be prescribed for this use.

Other Uses of Typical Antipsychotics

Some typical antipsychotics are rarely used to treat psychotic symptoms, including Compazine (prochlorperazine), which is used to treat nausea and vomiting, as well as schizophrenia and anxiety without psychosis.

Specific Side Effects of Typical Antipsychotics

Typical antipsychotics can be very effective, but they are more likely, and in some cases highly likely, than the atypical, or second-generation, antipsychotics to cause extrapyramidal side effects and tardive dyskinesia.

  • Extrapyramidal side effects include rigid muscles, a feeling of restlessness, tremors, slurred speech, slowed thinking and/or moving and involuntary muscle contractions. Akathisia is the medical term used to describe this restlessness, and the term "Parkinsonian movement" is used to describe the movement disorder which can appear similar to someone who is living with Parkinson's disease. Roughly 5 percent of people treated with typical antipsychotics develop a form of extrapyramidal side effect called "rabbit syndrome." The syndrome is named for oral movements which appear similar to a rabbits.
  • Tardive dyskinesia may occur when you've been on an antipsychotic for a long time. It involves involuntary facial movements that are repeated over and over, like sticking out your tongue, grimacing or making chewing motions.  

Common Side Effects of Typical Antipsychotics

More common side effects of antipsychotics in general include:

  • Upset stomach
  • Dizziness
  • Vomiting
  • Seizures
  • Low blood pressure
  • Weight gain
  • Low white blood count
  • Dry mouth
  • Tics and tremors
  • Drowsiness
  • Blurry vision
  • Feeling restless
  • Constipation

FDA-Approved Atypical Antipsychotics

As mentioned earlier, atypical antipsychotics are the newer, second-generation of antipsychotics and in general, they have fewer side effects. Atypical antipsychotics approved by the U.S. Food and Drug Administration (FDA) for use in the United States are:

  • Abilify (aripiprazole)
  • Saphris (asenapine maleate)
  • Clozaril (clozapine)
  • Latuda (lurasidone)
  • Zyprexa (olanzapine)
  • Fanapt (iloperidone)
  • Invega (paliperidone)
  • Seroquel (quetiapine)
  • Risperdal (risperidone)
  • Geodon (ziprasidone)

Other Medications Used to Treat Bipolar Disorder

If you have bipolar disorder, your doctor will likely prescribe you a combination of medications to help relieve your symptoms. You may which to review an overview of medications used to treat bipolar disorder. Besides antipsychotics, your doctor may prescribe one or any combination of the following:

  • Mood stabilizers 

These medications can help reduce your manic and/or hypomanic episodes. Common kinds are Tegretol (carbamazepine), Depakene (valproic acid), Lithobid (lithium) and Depakote (divalproex sodium).

  • Antidepressants 

There are different classes of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs), atypical antidepressants, tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).

Popular brands of antidepressants are Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Cymbalta (duloxetine), Wellbutrin (bupropion), Remeron (mirtazapine) and Tofranil (imipramine). 

  • Antipsychotic-Antidepressant Combo

Symbyax (fluoxetine/olanzapine) is an FDA-approved combination of Prozac and Zyprexa that works to both stabilize your mood and help your depressive symptoms.

  • Anti-Anxiety Medications

These medications, called benzodiazepines, can help with sleep and anxiety, but are usually only prescribed for a short time. Typical benzodiazepines are Klonopin (clonazepam), Valium (diazepam), Ativan (lorazepam) and Xanax (alprazolam).

Sources:

Jibson, M. First-Generation Antipsychotic Medications: Pharmacology, Administration, and Comparative Side Effects. UpToDate. Updated 02/04/16.

Kasper, Dennis L., Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Joseph Loscalzo. Harrison's Principles of Internal Medicine. New York: McGraw Hill Education, 2015. Print.

U.S. Food and Drug Administration. Information on Conventional Antipsychotics. Updated 06/11/16. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm107211.htm

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