| Side Effect |
Implicated Medication |
Symptoms |
Actions |
| Neuroleptic Malignant Syndrome (NPS) |
Anti-Psychotics |
Severe muscular rigidity; autonomic instability
including hyperthermia (high body
temperature), tachycardia (rapid heart beat),
increased blood pressure, tachypnea (rapid
respiration), diaphoresis (perspiration);
changing levels of consciousness. Elevated
creatine phosphokinease (CPK) often present.
Acute renal failure may occur. Mortality in
severe cases can be 20% to 30%. |
Immediate
medical attention
is required.
Anti-psychotics
must be stopped.
Hospitalization
may be needed. |
| Tardive Dyskinesia (TD) |
Anti-Psychotics
mainly low, intermediate,
and high potency |
Involuntary movements of mouth and
tongue such as lip smacking, sucking,
puckering and facial grimacing.Worm-like
(athetoid) movements of limbs, fingers,
and toes may occur. TD movements are
exacerbated when patient is aroused and
decline when relaxed. They are absent during
sleep. About 10% to 20% of patients on
anti-psychotics more than 1 year develop TD. |
Anti-psychotics
may have to be
stopped or Clozaril
considered. |
| Extrapyramidal Side
Effects (EPS) |
Anti-Psychotics
low, intermediate,
and high potency |
Dystonia (abnormal tissue tone), tremor,
akinesia (loss of voluntary movement),
bradykinesia (slow movements), rigidity
and akathisia (motor restlessness) are most
common. Patient may pace endlessly, feel
anxious or irritable because of restless feelings. |
Anticholinergic,
anti-parkinsonian
medications are
used to treat EPS. |
| Dose related seizures |
Clozaril especially;
other anti-psychotics lower risk |
Seizure threshold can be lowered with antipsychotics
and is particularly lowered with
Clozaril. Risk is 0.7% per 100 mg of
Clozaril/day. Seizures can occur at any point
during Clozaril treatment. |
Must be medically
evaluated; dose
may be lowered
or stopped. |
| Agranulocytosis |
Clozaril especially |
Risk of potential life threatening drop in
WBC count (below 3,000) and granulocyte
(below 1,500) is 1% to 2%. |
Clozaril must be
stopped and
patient treated by
hematologist often
in hospital. |
| Central Serotonin
Syndrome (CSS) |
SSRI’s and MAOI’s |
Abdominal pain, diarrhea, sweating, fever,
tachycardia, elevated blood pressure, altered
mental state (such as delirium), myoclonus
(muscle spasm or twitch), increased motor
activity, irritability, hostility and mood change.
Severe symptoms include cardiovascular shock
and death. Greatest risk of CSS comes from
switching patient from SSRI to MAOI. Must
have a wash out period between overlap of
these types of medications of at least 5 times
the half life of the SSRI; about 2 to 4 weeks. |
Immediate emergency
room care
is required. |
| Anticholinergic effects |
Anti-psychotics,
some anti-depressants |
Dry mouth, constipation, urinary retention,
blurred vision, memory impairment,
confusion. |
Readily managed
with medications. |
