Antipsychotic

Generic and Trade Names:

Chlorpromazine Thorazine
Chlorprothixene		Taractan
Clozapine			Clozaril
Fluphenazine		Prolixin
Fluvoxamine		Luvox
Haloperidol		Haldol
Lithium			Eskalith, Lithonate
Loxapine			Loxitane
Mesoridazine		Serentil
Molindone		Moban
Olanzapine		Zyprexa
Perphenazine		Etrafon
Perphenazine		Trilafon
Pimozide			Orap
Promazine		Sparine
Risperidone		Risperdal
Trifluoperazine		Stelazine
Thioridazine		Mellaril
Thiothixene		Navane

Description

Antipsychotics (or neuroleptics) form a group composed of several classes of drugs, including: Chlorpromazine (Thorazine), Chlorprothixene. The drugs are chemically different from one another, but have similar effects. They are used to reduce severe anxiety, agitation, and psychotic behavior e.g. schizophrenia.

Antipsychotic drugs inhibit or alter dopamine release. This combined with other CNS depression effects with these drugs may contribute to give antipsychotic effects. The actual mode of action is unknown.

Lithium is an example of an antipsychotic drug. It is classified as a tranquilizer. It is used to normalize mood and behavior in manic-depressive illness (see under bipolar disorder). The actual mode of action of lithium is unknown, but it may correct chemical imbalances in the brain.

Nutritional Considerations:

Nausea, loss of appetite, and dry mouth may occur during the first several days while your body adjusts to the medication. Weight gain has also been reported. (Facts and Comparisons 1999)

It is recommended to avoid consumption of alcohol while taking these medications. (Pronsky 1999)

Although no effective treatment for Tardive Dyskinesia has yet been established, the efficacy of vitamin E for TD has been tested in the USA, (one of the side effects of this class of drugs). (Inada, 1996)

Possible vitamin deficiencies include:

Vitamin B-2 (riboflavin)deficiency is possible. (Tinguely 1985)

Co-Q-10 deficiency is possible with the phenothiazines and butyrophenones. (Kishi 1980)

Avoid phenylalanine supplements while on phenothiazines because it could increase the risk of tardive dyskinesia. (Mosnik 1997) (Richardson 1990)

No typtophan supplements with Fluvoxamine. (Pronsky 1999)

Smoking can increase Fluvoxamine metabolism by 25% and Olanzapine clearance by 40%. (Pronsky 1999)

Do not take Perphenazine mixed with caffeinated drinks, tannin containing drinks, or pectinate (applejuice). (Pronsky 1999)

Avoid alcohol (enhanced sedative effect, or depression). (Pronsky 1999)

Avoid caffeine because the effect of these drugs may be changed if taken within 40 minutes of caffeine. (Brinker 1998)

Herbal Considerations:

While no Herbal Considerations are given in the medical literature, one might suspect a similar pattern to that for haloperidol.

The CNS depressant tendency of:
devil's claw, kava kava, lemonbalm, ma huang, meadowsweet, mullein, peppermint, pokeroot, European poplar, prickly ash, queen of the meadow and sassafras
- may be potentiated by haloperidol and others in this class. (Brinker 1998)(Newall 1996)

Ginkgo may help reduce some of the side effects of the antipsychotic medications. (Liu 1997)

Milk Thistle may protect against the liver toxicity associated with long term phenothiazine use. (Palasciano 1994)

There is a potential risk of seizure with the use of Evening Primrose Oil. (Newall 1996)

Yohimbe is contraindicated to be used with phenothiazines. (Brinker 1998)

The caffeine content in Guarana, Mate, Cola, Cocoa, and Tea may alter the effects of some of these antipsycotic medications. (Brinker 1998)

References

Angel, J.E. 1983. Physicians Desk Reference. Medical Economics Company, Inc. Oradell, New Jersey.

Brinker F. Herb contraindications and drug interactions, 2nd ed. Sandy, OR: Eclectic Medical Publications, 1998.

Davies A: Risperidone versus haloperidol: I. Meta-analysis of efficacy and safety. Clin Ther, 1998 Jan, 20:1, 58-71.

Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999.

Gebhart, G.F. et al: The effects of ethanol alone and in combination with phenobarbital, chlorpromazine, or chlordiazepoxide. Toxicol. Appl. Pharmacol. 1969, 15: 405-414.

Griffith, H. W. 1983. Complete Guide to Prescription and Non-Prescription. Fisher Publishing, Inc., Tucson.

Inada T: [Recent research trends in diagnosis, treatment, and prevention of drug-induced extrapyramidal symptoms seen in psychiatric patients.] Nihon Shinkei Seishin Yakurigaku Zasshi, 1996 Oct, 16:5, 181-5.

Kastrup, E.K., ed. 1981. Drug Facts and Comparisons, 1982 edition. Facts and Comparisons Division, J.P. Lippincott Co, Phila (St. Louis).Lieberman, S. & Bruning, N.: The Real Vitamin & Mineral Book. Avery, NY.

Kishi T. Inhibition of Myocardial respiration by Psychotherapeutic Drugs and Prevention of Co Enzyme Q. Biomedical and Clinical Aspects of Coenzyme Q. Elsevier North Holland Biomedical Press, Amsterdam. 1980 Vol. 2 139-54.

Liu P, et al. Combined use of Ginkgo biloba extracts on efficacy and adverse reactions of various antipsychotics. Zhongguo Linchuang Yaolixue Zaxhi 13(4): 193-198, 1997.

Mosnik DM, Spring B, Rogers K, and Baruah SL. Tardive dyskinesia exacerbated after ingestion of phenylalanine by schizophrenic patients. Neuropsychopharmacology 16(2): 136-146, 1997.

Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996

Osol, Arthur. 1980. Remington's Pharmaceutical Sciences. Mack Publishing Company, Pennsylvania.

Palasciano G, et al. The effect of silymarin on plasma levels of malondialdehyde in patients receiving long term treatment with psychotropic drugs. Curr Ther Res 55: 537-545, 1994.


Pinto, J.T. & Rivlin, R.S. : Drugs that promote renal excretion of riboflavin. Drug Nutrient Interactions, 1987, 5: 143-151.

Pronsky, Z Food Medication Interactions, 11th edition, 1999.

Richardson MA. Amino acids in psychiatric disease. Washington, DC: American Psychiatric Press, 1990.

Tinguely D, Jonzier M, Schopf J, et al. Determination of Compliance with Riboflavin in an Antidepressive Therapy. Arzneimittelforschung, 1985, 35(2):
536-8

Zirkle, G.A. et al: Effects of chlorpromazine and alcohol on coordination and judgment. JAMA. 1959, 171: 1496-1499.