What Are Typical Antipsychotics?

Earlier generation drug still used in first-line therapy

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Typical antipsychotics, sometimes referred to as first-generation antipsychotics, are a class of psychotropic drug used to treat psychotic symptoms. Psychosis is defined as behavior in which a person loses touch with reality, often manifesting with hallucinations and delusions.

Typical antipsychotics have since been followed by a newer class of drug called atypical antipsychotics. Atypical antipsychotics were first introduced in the 1990s and are known to have fewer side effects than their predecessors.

Psychosis can be caused by psychiatric or physical illnesses that affect the brain and behavior. The mental illnesses most commonly associated a psychotic episode include:

Physical conditions most commonly associated with psychosis include epilepsy, advanced HIV infection, Parkinson’s disease, stroke, brain tumors, aging-related dementia, and methamphetamine abuse.

Brand and Generic Names

Typical antipsychotics were first developed in the 1950s to treat psychosis. Treatment today has been extended to include acute mania, agitation, and other serious mood disorders. The typical antipsychotics currently approved for use in the U.S. include:

  • Haldol (haloperidol)
  • Loxitane (loxapine)
  • Mellaril (thioridazine)
  • Moban (molindone)
  • Navane (thiothixene)
  • Orap (pimozide)
  • Prolixin (fluphenazine)
  • Serentil (mesoridazine)

With the introduction of newer class drugs, not all typical antipsychotics are used as they once were. Compazine (prochlorperazine), for example, is more often used to treat anxiety or to control severe nausea and vomiting.

Side Effects

Side effects can vary based on the drug or combinations of drug used.

Some of the side effects may be mild and short-lasting; others may compound over time and increase the risk of other undesirable effects. The most common side effects include:

  • Upset stomach
  • Dizziness
  • Vomiting
  • Seizure
  • Weight gain
  • Dry mouth
  • Tics and tremors
  • Drowsiness
  • Blurry vision
  • Restlessness
  • Constipation

Typical antipsychotics are more likely to cause certain "tell-tale" side effects when compared to the atypical counterparts. These include so-called extrapyramidal side effects which impact movement and speech.

Often referred to as "rabbit syndrome," extrapyramidal symptoms include restlessness, tremors, slurred speech, slowed thinking, sluggish movement, and involuntary muscle contractions. Roughly five percent of people treated with typical antipsychotics will develop some form of extrapyramidal symptom.

Tardive dyskinesia is another side effect primarily associated with long-term drug use. It is characterized by repetitive and involuntary facial movements such as sticking out one's tongue, grimacing, or making chewing motions.

Combination Therapy

When used to treat a mental illness, antipsychotics are typically prescribed in combination with other drugs such as mood stabilizers, antidepressants, and anti-anxiety medications.

  • Mood stabilizers are used to help alleviate a manic or hypomanic episode. Options include Tegretol (carbamazepine), Depakene (valproic acid), Lithobid (lithium), and Depakote (divalproex sodium).
  • Antidepressants, as per their name, are used to treat depression and can include any one of six classes of drug: selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and atypical antidepressants.
  • Anti-anxiety medications, also known as benzodiazepines, can help with sleep and anxiety but are usually only prescribed for a short period of time. Options include Klonopin (clonazepam), Valium (diazepam), Ativan (lorazepam), and Xanax (alprazolam).

    In addition, a two-in-one pill called Symbyax (fluoxetine/olanzapine) has been approved by the U.S. Food and Drug Administration, combining a typical antipsychotic with a SSRI antidepressant.

    Source:

    Kasper, D.; Fauci, A.; Hauser, S. et al. Harrison's Principles of Internal Medicine. New York: McGraw Hill Education, 2015. Print.

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