Neuroleptic Poisoning

Neuroleptic Poisoning is a topic covered in the 5-Minute Emergency Consult.

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  • Neuroleptics (antipsychotics) used for management of:
    • Psychotic disorders
    • Agitation
    • Dementia in the elderly
    • Autism and behavioral problems in children
    • Eating disorders
    • Antiemetic
    • Migraine headaches
  • Acute overdose:
    • Symptoms usually mild to moderate
    • CNS and cardiovascular symptoms predominate
    • CNS depression, seizure, and coma possible
  • Dystonic reactions (dystonia):
    • Most common adverse effect
    • Can occur at any time, often within 48 hr of starting medication
  • Akathisia:
    • Patient has motor restlessness and feels a need to pace or move constantly
    • Occurs within hours to weeks of starting medication
  • Neuroleptic malignant syndrome (NMS):
    • Idiosyncratic, life-threatening event
    • Can occur at any time but most commonly in overdose, dose increase, and during the 1st wk of usage
  • Tardive dyskinesia:
    • Movement disorder usually affecting patients after years of taking neuroleptics
    • Treated by decreasing, discontinuing, or changing the drug


  • Typical neuroleptics (phenothiazines, butyrophenones) strongly antagonize dopaminergic receptors, these include:
    • Haloperidol (Haldol)
    • Chlorpromazine (Thorazine)
    • Prochlorperazine (Compazine)
    • Thioridazine (Mellaril)
    • Fluphenazine (Prolixin)
    • Promethazine (Phenergan)
    • Droperidol (Inapsine)
    • Hydroxyzine (Atarax)
  • Typical neuroleptics also have varying degrees of antagonism for histamine, muscarinic, and α-adrenergic receptors.
  • Atypical neuroleptics have weaker dopaminergic antagonism and moderate serotonergic antagonism, these include:
    • Asenapine (Saphris)
    • Aripiprazole (Abilify)
    • Clozapine (Clozaril)
    • Paliperidone (Invega)
    • Risperidone (Risperdal)
    • Olanzapine (Zyprexa)
    • Quetiapine (Seroquel)
    • Ziprasidone (Geodon)

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