Lithonate

Definition

Antipsychotic drugs are medicines used to treat psychosis and other mental and emotional conditions.

Purpose

Antipsychotic drugs are used to treat psychosis, a severe mental illness in which people lose touch with reality. People with psychosis may hear voices, see things that aren't really there, and have strange or untrue thoughts, such as believing that other people can hear their thoughts or are trying to harm them. They may also neglect their appearances and may stop talking or talk only "nonsense."

Some antipsychotic drugs also are used to treat other mental and emotional conditions, such as bipolar disorder (manic-depressive illness). People with this condition have extreme mood swings, ranging from a highly excited state -- sometimes with a false sense of well-being -- to depression.

Antipsychotic drugs do not cure mental illness, but can reduce some of the symptoms or make them milder. The medicine may improve symptoms enough for the person to undergo counseling and live a more normal life.

The type of antipsychotic medicine prescribed depends on the type of mental problem the patient has. For example, lithium is used to even out the high and low mood swings that people with bipolar disorder (manic-depressive illness) experience. Chlorpromazine (Thorazine) quiets the imaginary voices that some people with schizophrenia hear.

Description

Antipsychotic drugs are also known as neuroleptics or major tranquilizers. Several types of these drugs are available, such as haloperidol (Haldol), lithium (Lithonate), chlorpromazine (Thorazine), and thioridazine (Mellaril). The newer antipsychotics include risperidone (Risperdal), quetiapine (Seroquel) and olanzapine (Zyprexa). These medicines are available only with a physician's prescription.

Recommended dosage

The recommended dosage depends on the type of antipsychotic drug, the condition for which it is prescribed, and other factors. Check with the physician who prescribed the medicine for the correct dosage.

Always take antipsychotic drugs exactly as directed. Never take larger or more frequent doses, and do not take the drug for longer than directed. This is important for all patients, but especially for older people and children, who may be more sensitive to this type of medicine.

Several weeks may be needed for the effects of this medicine to be felt. Be sure to keep taking it as directed, even if it does not seem to be helping.

Do not stop taking this medicine suddenly after taking it for several weeks or more. Gradually tapering the dose may be necessary to reduce the chance of withdrawal symptoms. If it is necessary to stop taking the drug, check with the physician who prescribed it for instructions on how to stop.

Precautions

See a physician regularly while taking antipsychotic drugs, especially during the first few months. The physician will check to make sure the medicine is working as it should and will watch for unwanted side effects. The physician may also need to adjust the dosage during this period. This is true for all antipsychotic drugs, but it is especially important with lithium. If the dose is too low, the medicine will do the patient no good. But doses that are too high can cause lithium poisoning. Patients and physicians must work together to find the correct dosage to balance the beneficial effects of the drug with the side effects.

Patients taking long-lasting injectable forms of antipsychotic drugs should be aware that their effects can continue for up to 12 weeks after stopping the drug. All precautions should be observed during this period.

Patients who are taking lithium should check with their physicians before going on a low-sodium or low-salt diet or making any other diet changes. Too little sodium in the diet can lead to serious side effects in people taking this drug. Problems can also arise if people taking lithium lose too much water and salt from their bodies. This can happen when they exercise in hot weather or when they have illnesses that cause heavy sweating, diarrhea, or vomiting.

Lithium may not work properly in people who drink large amounts of coffee, tea, cola, or other beverages that contain caffeine.

The antipsychotic drugs classified as phenothiazines (such as chlorpromazine and thioridazine) should not be taken within 2 hours of taking antacids or medicine for diarrhea.

Because antipsychotic drugs work on the central nervous system, they may add to the effects of alcohol and other drugs that slow down the central nervous system, such as antihistamines, cold medicine, allergy medicine, sleep aids, medicine for seizures, other tranquilizers, some pain relievers, and muscle relaxants. Anyone taking antipsychotic drugs should check with his or her physician before using any of the products listed above.

Antipsychotic drugs may interact with medicines used during surgery, dental procedures, or emergency treatment. These interactions could increase the chance of side effects. Anyone who is taking antipsychotic drugs should be sure to tell the health care professional in charge before having any surgical or dental procedures or receiving emergency treatment.

Some antipsychotic drugs may change the results of certain medical tests. Before having medical tests, anyone taking this medicine should alert the health care professional in charge.

Some people feel drowsy, dizzy, or less alert when using these drugs, especially as doses increase. These effects may even occur the morning after taking the medicine at bedtime. Antipsychotic drugs may also cause blurred vision and other vision changes and may affect judgment. Because of these possible problems, anyone who takes these drugs should not drive, use machines or do anything else that might be dangerous until they have found out how the drugs affect them.

These medicines make some people feel lightheaded, dizzy, or faint when they get up after sitting or lying down. To lessen the problem, get up gradually and hold onto something for support if possible.

This medicine may increase sensitivity to sunlight. Even brief exposure to sun can cause a severe sunburn or a rash. While being treated with this medicine, avoid being in direct sunlight, especially between 10 a.m. and 3 p.m.; wear a hat and tightly woven clothing that covers the arms and legs; use a sunscreen with a skin protection factor (SPF) of at least 15; protect the lips with a sun block lipstick; and do not use tanning beds, tanning booths, or sunlamps. The sensitivity to sunlight and sunlamps may continue for 2 weeks to several months after stopping the medicine, so continue to be careful about sun exposure.

People taking antipsychotic medicines may sweat less, which can cause the body temperature to rise. Anyone who takes this medicine should be careful not to become overheated during exercise or hot weather and should avoid hot baths, hot tubs, and saunas. Overheating could lead to heat stroke.

Some antipsychotic drugs also make people more sensitive to cold. Anyone who takes this medicine should dress warmly in cold weather and take care to avoid long exposure to the cold.

Antipsychotic drugs may cause dry mouth. To temporarily relieve the discomfort, chew sugarless gum, suck on sugarless candy or ice chips, or use saliva substitutes, which come in liquid and tablet forms and are available without a prescription. If the problem continues for more than 2 weeks, check with a physician or dentist. Mouth dryness that continues over a long time may contribute to tooth decay and other dental problems.

Children may be especially sensitive to the effects of antipsychotic drugs. This sensitivity may increase the chance of side effects, especially muscle spasms and involuntary movements. Lithium may weaken the bones of children who take it. Consult with a physician if this is a concern.

Older people may also be more sensitive than others to the effects of this medicine. Side effects such as constipation, dizziness, drowsiness, fainting, thirstiness, dry mouth, and uncontrolled movements of the mouth, tongue, and other parts of the body are especially likely in this age group.

Special conditions

People with certain medical conditions or who are taking certain other medicines can have problems if they take antipsychotic drugs. Before taking these drugs, be sure to let the physician know about any of these conditions:

Anyone who has had unusual reactions to antipsychotic drugs in the past should let his or her physician know before taking the drugs again. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

Some antipsychotic drugs may cause problems in the mother, the fetus, or the newborn baby when taken during pregnancy. Women who are pregnant or who may become pregnant should check with their physicians before using antipsychotic drugs.

Some antipsychotic drugs pass into breast milk and may cause drowsiness and other problems in nursing babies whose mothers use the drugs. Breastfeeding is not recommended during treatment with antipsychotic drugs.

Before using antipsychotic drugs, people with any of these medical problems should make sure their physicians are aware of their conditions:

• Alcohol abuse
• Heart or blood vessel disease
• Lung disease
• Kidney disease
• Liver disease
• Brain disease
• Blood disease
• Breast cancer (now or in the past)
• Stomach ulcers
• Reye's syndrome
• Diabetes
• Overactive thyroid, goiter, or other thyroid disease
• Epilepsy or other seizure disorders
• Parkinson's disease
• Difficult urination or enlarged prostate
• Glaucoma
• Infection
• Psoriasis
• Leukemia (now or in the past).

Use of certain medicines

Taking antipsychotic drugs with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Side effects

Some antipsychotic drugs cause a movement disorder called tardive dyskinesia which may not go away when the patient stops taking the medicine. The problem is most common in older people, especially women. Signs of tardive dyskinesia include worm-like movements of the tongue and other involuntary movements of the mouth, cheeks, jaw, arms or legs.

Some other side effects of antipsychotic drugs will go away as the patient's body adjusts to the medicine. These side effects do not need medical attention unless they continue or they interfere with normal activities:

• Blurred vision
• Changes in menstrual period
• Breast pain or swelling or unusual secretion of milk
• Dry mouth or increased thirst
• Nasal congestion
• Mild nausea
• Constipation
• Increased frequency of urination
• Weight gain
• Slight trembling of the hands.

More serious side effects may also occur. If any of the following side effects occur, stop taking the medicine and check with a physician immediately:

• Seizures (convulsions)
• Breathing problems
• Fast or irregular heartbeat
• High or low blood pressure
• Fever
• Increased sweating
• Loss of bladder control
• Severe muscle stiffness
• Pale skin
• Unusual weakness or tiredness
• Lip smacking or puckering
• Puffing of the cheeks
• Rolling or jutting the tongue
• Uncontrolled chewing movements
• Uncontrolled movements of the arms or legs.

In addition, anyone who has these side effects while taking an antipsychotic drug should check with a physician as soon as possible:

• Mask-like face
• Inability to move the eyes
• Blurred vision, changes in color vision, or inability to see well at night
• Difficulty talking or swallowing
• Loss of balance control
• Movement problems such as shuffling walk, stiffness of arms and legs
• Muscle spasms, especially of the neck and back
• Involuntary movements such as tics, twitching, twisting of the body, trembling and shaking of the fingers and hands
• Severe restlessness
• Weakness of the arms and legs
• Weight gain.

Some side effects, such as trembling of the fingers and hands or involuntary movements of the mouth, tongue, and jaw, may occur after treatment with this medicine has ended. Check with a physician if any unusual symptoms occur after stopping the drug.

Patients who aretaking lithium should make sure that they and their families know the signs of taking too much of the medicine and should check with a physician immediately if any of the symptoms occur. These include:

• Drowsiness
• Dizziness
• Confusion
• Slurred speech
• Blurred vision
• Loss of appetite
• Nausea or vomiting
• Diarrhea
• Increased amount of urine
• Muscle weakness
• Clumsiness or unsteadiness
• Severe trembling
• Seizures (convulsions).

Other side effects may occur with any antipsychotic drug. Anyone who has unusual symptoms after taking this medicine should get in touch with his or her physician.

Interactions

Antipsychotic drugs may interact with a number of other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Any one who takes antipsychotic drugs should let the physician know all other medicines he or she is taking. Among the drugs that may interact with antipsychoticd rugs are:

• Other antipsychotic drugs
• Central nervous system (CNS) depressants such as medicine for allergies, colds, hay fever, and asthma; sedatives; other tranquilizers; narcotic pain medicine; muscle relaxants; medicine for seizures; sleep aids; barbiturates; and anesthetics.
• Antidepressants
• Epinephrine
• Levodopa (Larodopa), or levodopa-carbidopa (Sinemet)used to treat Parkinson's disease
• Blood pressure medicines such as reserpine
• Water pills (diuretics), such as furosemide (Lasix)
• Pimoline (Cylert), used to treat attention deficit disorder with hyperactivity
• Certain medicines for pain or inflammation
• Certain medicines for asthma, bronchitis, emphysema, and other lung diseases.

The list above does not include every drug that may interact with antipsychotic drugs. Be sure to check with a physician or pharmacist before combining antipsychotic drugs with any other prescription or nonprescription (over-the-counter) medicine.

Key Terms

Attention deficit disorder

A condition in which a person acts impulsively and has a short attention span. The disorder can lead to learning and behavioral problems.

Fetus

A developing baby inside the womb.

Glaucoma

A condition in which pressure in the eye is abnormally high. If not treated, glaucoma may lead to blindness.

Goiter

Enlargement of the thyroid gland.

Heat stroke

A severe condition caused by prolonged exposure to high heat. Heat stroke interferes with the body's temperature regulating abilities and can lead to collapse and coma.

Hyperactivity

Abnormally high activity level.

Inflammation

Pain, redness, swelling, and heat that usually develop in response to injury or illness.

Prostate

A donut-shaped gland below the bladder in males that contributes to the production of semen.

Psoriasis

A skin disease in which people have itchy, scaly, red patches on the skin.

Reye's syndrome

A serious and sometimes fatal disease that affects the liver and brain. Reye's syndrome is most common in young children and teenagers and often occurs after a virus infection, such as flu or chickenpox.

Schizophrenia

A severe mental disorder in which people lose touch with reality and may have illogical thoughts, delusions, hallucinations, behavioral problems and other disturbances.

Seizure

A sudden attack, spasm, or convulsion.

Spasm

Sudden, involuntary tensing of a muscle or a group of muscles

Further Reading

Gale Encyclopedia of Medicine. Gale Research, 1999.