Atypical Antipsychotics

Question 1

How it works

Answer 1

Schizophrenia is caused by an overactivity in chemicals that transmit messages in the brain.

Olanzapine / clozapine works by blocking the receptors that these chemicals bind to in the brain, and therefor block some of the messages.

Question 2

Timeline

Answer 2

Tablet daily or depot injection every 2-4 weeks

Question 3

How to take

Answer 3

Tablet or depot injection

Start at a small dose and build up gradually over a week or 2. Dose adjusted according to the patient’s response.

Question 4

Length of treatment

Answer 4

Long term (keeps symptoms from returning)

Tell doctor if wanting to get pregnant

Question 5

Effects- time before

Answer 5

Several days or weeks

Question 6

Tests

Answer 6

Occasional LFTs

Monitor weight and blood lipids at baseline, at 3 months and then yearly for antipsychotics. For clozapine, measure every 3 months in the first year.

Fasting blood glucose at baseline, at 4-6 months and then yearly

Question 7

Side effects

Answer 7

Dry mouth, constipation
Tremor, movement disorders
Weight gain, dizziness, drowsiness
Hypotension

Question 8

Complications and contraindications

Answer 8

Neuroleptic malignant syndrome (high fever and muscle rigidity)
Agranulocytosis (swelling of mouth, rash)

Liver failure, phaeochromocytoma
Epilepsy, DM, glaucoma, Parkinson’s…

Question 9

Clozapine Monitoring

Answer 9

Leucocytes and differential blood counts should be normal before starting: monitor every week for 18 weeks then every 2 weeks and if clozapine continued and blood counts stable after a year, at least every 4 weeks.

ECG may be required

Myocarditis / cardiomyopathy: persistent tachycardia in the first two months is suspicious