3. Principal risks and risk-reduction measures
This learning module discusses noteworthy risks for antipsychotics. Summaries of product characteristic1 and the BNF should be consulted for a fuller account of the adverse effects and warnings for individual antipsychotics.
The frequency of adverse effects often varies between different antipsychotics; more information is given in the discussion on individual risks
- Gastrointestinal adverse effects-including constipation, dry mouth, nausea
- Central nervous system adverse effects
- Sedation and sleep disturbances
- Extrapyramidal side effects-acute dystonia, akathisia, parkinsonism, tardive dyskinesia
- Neuroleptic malignant syndrome
- Convulsions
- Cardiovascular adverse effects
- Blood pressure changes
- Cerebrovascular events
- Cardiac rhythm disorders particularly QT interval prolongation
- Venous thromboembolism
- Metabolic adverse effects-including weight gain, dyslipidaemia, hyperglycaemia
- Hyperprolactinaemia and sexual adverse effects-including menstrual disturbances, sexual dysfunction, osteoporosis
- Blood disorders-including neutropenia, agranulocytosis
- Temperature regulation-hypothermia and hyperthermia
- Adverse effects on the skin-including rash, pruritus, photosensitivity
- Adverse effects on the eye-including precipitation of glaucoma, mydriasis, and pigmentation
- Antimuscarinic2 adverse effects-including constipation, nasal stuffiness, and urinary retention
- Dependence and withdrawal reactions
- Drug interactions-including interactions which increase adverse effects (hypotension, sedation, cardiac rhythm disturbances)
Precautions and risks associated with special uses of antipsychotics
- Use in elderly patients with dementia-increased risk of stroke and higher mortality rate
- Pregnancy and breastfeeding-need for careful weighing up of benefit and risk for mother and baby
- Prolonged-release antipsychotic injections-need for care to initiate treatment and for correct administration technique
- Antipsychotic injections for immediate effect-need for careful evaluation of circumstances for use, use of appropriate dose, close monitoring of patient
- Clozapine-special risks include agranulocytosis, myocarditis, cardiomyopathy, intestinal obstruction, hypersalivation
- Summary of product characteristics, a document that forms the basis of information for European Union health professionals on how to use a medicinal product safely and effectively; it reflects the data assessed for granting marketing authorisation↩
- Reduction or blocking of the effects of parasympathetic nerves; antimuscarinic effects include dry mouth, difficulty swallowing, blurred vision, confusion, palpitations, constipation, and urine retention↩