Neuroleptics

The neuroleptic agents or major tranquilizers (^ lIa,bl§.llll5.5.:!.. ) exert their antipsychotic activity by blocking dopaminergic

1124

TABLE 55-1 -- SELECTED NEUROLEPTICS

Nonproprietary/Trade Name

Sedative Effects

Extrapyramidal Effects

Hypotensive Effects

Phenothiazines

Chlorpromazine hydrochloride (Thorazine)

+ + +

+ +

+ + +

Mesoridazine besylate (Serentil)

+ + +

+

+ +

Thioridazine hydrochloride (Mellanl)

+ + +

+

+ + +

Fluphenazine hydrochloride (Prolixin)

+

+ + +

+

Perphenazine (Trilafon)

+ +

+ +

+

Trifluoperazine hydrochloride (Stelazine)

+

+ + +

+

Thioxanthenes

Thiothixene hydrochloride (Navane)

+ +

+ + +

+ +

Other Heterocyclic Compounds

Clozapine (Clozaril)

+ + +

0

+ + +

Haloperidol (Haldol)

+

+ + +

+

Loxapine succinate (Loxitane)

+

+ +

+

Molindone hydrochloride (Moban)

+ +

+ +

+

Pimozide (Orap)

+

+ + +

+

Risperidone (Risperdal)

+ +

+ +

+ + +

+ + +, very common; + +, moderately common; +, rare.

+ + +, very common; + +, moderately common; +, rare.

receptors at the level of the limbic system, forebrain, and basal ganglia. They also have antihistaminergic, anticholinergic, and anti-alpha 1 adrenergic properties. Many newer agents have some affinity for 5-HT2 serotonin receptors as well (clozapine, risperidone). As a class, they are associated with a variety of important neurological complications. These can be classified as acute, subacute, and chronic side effects (lllTab|e.l.l55-? ).

ENCEPHALOPATHY

Neuroleptics may cause a toxic confusional state, especially in the elderly, and confusion occurs more frequently with the low-potency, high-anticholinergic activity subclass (chlorpromazine, thioridazine, mesoridazine). These drugs can also produce profound sedation, especially with initiation of therapy. '1

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