Neuroleptic Poisoning
Basics
Description
Description
- Neuroleptics (antipsychotics) are used for a wide range of conditions:
- Schizophrenia and other psychotic disorders
- Major depression
- Posttraumatic stress disorder
- Agitation
- Dementia in the elderly
- Attention-deficit hyperactivity disorder
- Autism and behavioral problems in children
- Eating disorders
- Antiemetic
- Migraine headaches
- Most widely used classification system categorizes them as either typical or atypical antipsychotics
- Acute overdose:
- Symptoms usually mild to moderate
- CNS and cardiovascular symptoms predominate
- Toxicity may also develop in therapeutic dosing, manifesting as extrapyramidal syndromes:
- Symptom onset ranges from hours to years depending on syndrome
- Acute dystonia
- Akathisia
- Parkinsonism
- Neuroleptic malignant syndrome (NMS)
- Tardive dyskinesia
- Of these NMS is the most serious
Etiology
Etiology
- Primary mechanism of action is varying degrees of dopamine antagonism as well as potentially serotonergic, histaminic, muscarinic, and α-adrenergic blockade
- May also antagonize sodium and potassium channels
- Typical neuroleptics (phenothiazines, butyrophenones) usually have stronger antagonism of dopaminergic receptors, these include:
- Haloperidol (Haldol)
- Chlorpromazine (Thorazine)
- Prochlorperazine (Compazine)
- Thioridazine (Mellaril)
- Fluphenazine (Prolixin)
- Promethazine (Phenergan)
- Droperidol (Inapsine)
- Hydroxyzine (Atarax)
- Atypical neuroleptics usually have weaker dopaminergic antagonism and moderate serotonergic antagonism, these include:
- Asenapine (Saphris)
- Aripiprazole (Abilify)
- Clozapine (Clozaril)
- Risperidone (Risperdal)
- Serdolect (Serlect and Serdolect)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
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Citation
Schaider, Jeffrey J., et al., editors. "Neuroleptic Poisoning." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307516/all/Neuroleptic_Poisoning.
Neuroleptic Poisoning. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307516/all/Neuroleptic_Poisoning. Accessed November 8, 2024.
Neuroleptic Poisoning. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307516/all/Neuroleptic_Poisoning
Neuroleptic Poisoning [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 November 08]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307516/all/Neuroleptic_Poisoning.
* Article titles in AMA citation format should be in sentence-case
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T1 - Neuroleptic Poisoning
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ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
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ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
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PB - Lippincott Williams & Wilkins
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