The Side Effects Of Common Psychiatric Drugs: Antipsychotics
The Side Effects Of Common Psychiatric Drugs: Antipsychotics
(Called Major Tranquilizers or Neuroleptics)
Brand Names (Generic Names):
Older Antipsychotics
Compazine (prochlorperazine)
Haldol (haloperidol)
Lidone (molindone)
Loxitane (loxapine)
Mellaril (thioridazine hydrochloride)
Moban (molindone hydrochloride)
Novo-Trifluzine (trifluoperazine)
Nozinan (methotrimeprazine)
Orap (pimozide)
Permitil (fluphenazine)
Phenergam (promethazie)
Proketazine (carphenazine)
Prolixin (fluphenazine hydrochloride)
Repoise (butaperazine Maleate)
Serentil (mesoridazine besylate)
Sparine (promazine)
Stelazine (trifluoperazine)
Stemetil (prochlorperazine)
Taractan (chlorprothixene)
Thorazine (chlorpromazine)
Tindal (acetophenazine)
Trancopal (chlormezanone)
Trilafon (perphenazine)
Vesprin (triflupromazine)
Newer Atypical Antipsychotics
Abilify (aripiprazole)
Clozaril (clozapine)
Geodon (ziprasidone hydrochloride)
Invega (palperidone)
Leponex (clozapine)
Risperdal (risperidone)
Serlect (sertindole)
Seroquel (quetiapine)
Symbyax (fluoxetine and olanzapine –antidepressant/antipsychotic mix)
Zeldox (ziprasidone)
Zyprexa (olanzapine)
Side Effects:
Abnormal gait (manner of walking)
Agitation
Akathisia*
Anxiety
Birth defects
Blood-sugar abnormalities
Blurred vision
Breastmilk production
Cardiac arrest
Changes in behavior
Chest pain
Confusion
Constipation
Death from liver failure
Decreased sexual interest or ability
Depression
Diabetes
Diarrhea
Difficulty breathing, swallowing or fast
breathing
Difficulty falling asleep or staying asleep
Difficulty urinating or loss of bladder control
Dizziness
Dreaming more than usual
Drowsiness
Dry mouth
Dry or discolored skin
Excess sweating
Excessive weight gain
Extreme inner anxiety
Eye pain or discoloration
Fainting
Fast, irregular, or pounding
heartbeat
Fatal blood clots
Fever
Fine worm-like tongue movements
Flu-like symptoms
Headache
Heart arrhythmia
Heart failure
Heart palpitation
Heartburn
Heat stroke
Hemorrhage
High fever
Hostility
Hyperglycemia (abnormally high blood sugar)
Hypoglycemia (abnormally low blood sugar)
Impotence
Increased appetite
Increased salivation
Indigestion
Insomnia
Involuntary movements
Itching
Jaw, neck, and back muscle spasms
Joint pain
Lack of energy
Light-headedness
Loss of appetite
Manic reaction
Mood changes
Muscle or joint stiffness, pain, or weakness
Muscle twitching
Nausea
Nervousness
Neuroleptic Malignant Syndrome*
Nightmares
Pacing
Pain in arms, legs, back, or joints
Pain in the upper right part of the stomach
Painful erection that lasts for hours
Painful skin rashes
Pancreatitis (inflammation of pancreas, a gland near the stomach that helps digestion)
Poor concentration
Restlessness or pacing
Seizures or convulsions
Sexual dysfunction
Shakiness
Shaking hands that you cannot control
Sleepiness
Slow or difficult speech
Slow, jerky movements
Sore throat
Spasms
Suicidal thoughts
Swelling of the arms, hands, feet, ankles, or lower legs
Swollen and leaking breasts
Tachycardia (heart irregularity)
Tardive Dyskinesia*
Tremors
Unusual behavior
Unusual bleeding or bruising
Unusual tiredness
Violence
Vomiting
Weakness
Weight gain
Yellowing of the skin or eyes86
GENERAL WARNINGS AND STUDIES ON ANTIPSYCHOTICS:
2001: The Journal of Toxicology reported that the newer antipsychotics “will soon account for the majority of poisonings from antipsychotic agents that get presented to health care facilities in the U.S.”90 Researchers found, “[T]he ingestion of a single tablet of clozapine (Clozaril), olanzapine (Zyprexa) and risperidone (Risperidal) may cause significant toxicity in a toddler. Ataxia (involuntary muscular movement), confusions, EPS (extrapyramidal symptoms – nerve damage), coma and respiratory arrest have been reported following ingestion of 50-200 mg of clozapine in toddlers.”91
September 2003: The FDA requested the makers of six newer antipsychotic drugs add a caution to their labeling language about the potential risk of diabetes and blood sugar abnormalities.92
June 2004: The Australian Therapeutic Goods Administration published an Adverse Drug Reactions Bulletin reporting that the newer antipsychotics could increase the risk of diabetes.93
September 22, 2005: Dr. Jeffrey Lieberman of Columbia University and other researchers published a study in The New England Journal of Medicine that compared the older generation of antipsychotics with several newer ones. Far from proving effectiveness, of the 1,493 patients who participated, 74% discontinued taking antipsychotic drugs before the end of their treatment due to inefficacy, intolerable side effects or other reasons. After 18 months of taking Zyprexa, 64% of the patients stopped taking it—most commonly because it caused sleepiness, weight gain or neurological symptoms like stiffness and tremors.94
December 1, 2005: Researchers found that 18% of nearly 23,000 elderly patients taking the older antipsychotics died within the first six months of taking them.95
May 2, 2006: USA Today released the results of an analysis of FDA data that showed at least 45 children died between 2000 and 2004 from the side effects of antipsychotic drugs (Clozaril, Risperdal, Zyprexa, Seroquel, Abilify and Geodon). Despite an adults-only FDA approval for these drugs, according to USA Today, up to 2.5 million children were prescribed them. As the FDA’s Adverse Drug Reactions reporting database only collects 1% to 10% of drug-induced side effects and reported deaths, the true child death rate could be between 450 and several thousand. Further, there were 1,328 reports of other side effects, some life-threatening, such as convulsions and low white blood cell count.96
January 5, 2008: The Lancet (Britain) published a study where the authors concluded “that the routine prescription of antipsychotic drugs early in the management of aggressive challenging behavior, even in low doses, should no longer be regarded as a satisfactory form of care.”97
April 2008: The American Geriatrics Society published a study entitled, “Antipsychotic Drug Use and Risk of Pneumonia in Elderly People,” which reviewed 22,944 elderly people with at least one antipsychotic prescription. The results of the study showed that “antipsychotics were associated with an almost 60% increase in the risk of pneumonia…” concluding that elderly people are at greater risk of pneumonia, especially during the first week of antipsychotic drug treatment.98
April 9, 2008: Pharmacoepidemiology and Drug Safety published a study entitled, “The use of central nervous system [CNS] drugs and analgesics [painkillers] among very old people with and without dementia.” The study compared the use of CNS drugs in people aged 85 years or older, with and without dementia and concluded: “[T]he use of antipsychotics in people with dementia should arouse particular concern, because of the high risk of severe adverse events and the limited evidence of positive effects.”99
May 26, 2008: The Archives of Internal Medicine published a study about “Antipsychotic
Therapy and Short-term Serious Events in Older Adults With Dementia” that found:
“Serious events…are frequent following the short-term use of antipsychotic drugs in
older adults with dementia. Antipsychotic drugs should be used with caution even when
short-term therapy is being prescribed.”100
June 2008: The FDA issued a warning to healthcare professionals that conventional and
atypical antipsychotics are associated with an increased risk of mortality in elderly patients
treated for dementia-related psychosis. It specified that antipsychotics are not indicated
for the treatment of this condition. Additionally, the FDA required the manufacturers of
these drugs to add a boxed warning about this risk to the prescribing information. Older,
conventional antipsychotics were also to carry a “black box” warning about an increased
risk of death in some elderly people.101
April 2009: The Irish Medicines Board published in their Drug Safety Newsletter, a warning
about antipsychotics causing a risk of stroke and now increased risk of mortality in elderly
patients treated for dementia. This risk covers both typical and atypical antipsychotics.102
WARNINGS ON SPECIFIC ANTIPSYCHOTICS:
ABILIFY (aripiprazole):
Abilify and other antipsychotic drugs have caused a potentially fatal condition called
neuroleptic malignant syndrome. Patients who develop this may have high fevers, muscle
rigidity, altered mental status, irregular pulse or blood pressure, rapid heart rate, excessive
sweating, and heart arrhythmias (irregularities).103
Body temperature regulation—disruption of the body’s ability to reduce core body
temperature—has been attributed to antipsychotic agents such as Abilify.104
April 2003: The U.S. consumer advocacy group Public Citizen conducted a review of
information published on Abilify, basing their evaluation primarily on publicly available
FDA reviews of information submitted by the manufacturer to gain FDA approval for
Abilify. Approval was based on five trials only lasting four to six weeks. According to
Public Citizen, “…nothing in these five trials can lead one to believe that aripiprazole
(Abilify) is a meaningful advancement in the treatment of schizophrenia.”105
The information insert on Abilify lists hyperglycemia (abnormally high blood sugar—
usually associated with diabetes), hypoglycemia (abnormally low blood sugar) and diabetes
as possible side effects.106
Clozaril (clozapine):
May 2008: Medsafe (New Zealand) posted a prescriber update called “Clozapine and
Achy Breaky Hearts” warning that clozapine can cause myocarditis [inflammation of the
heart muscle] that may be fatal. It was also associated with cardiomyopathy [disease of
the heart muscle]. While risk factors are unknown, pre-treatment cardiovascular screening
was recommended.107
May 2008: Medsafe posted their June 2008 “Watching Briefs,” a report in which they
included a warning: “Use of clozapine in older patients carries a higher risk of adverse
reactions such as postural hypotension [low blood pressure], falls, sedation and constipation,
compared to use in younger patients. Therefore, increased clinical monitoring of the elderly
is necessary to ensure their safety.”108
Haldol (haloperidol):
September 17, 2007: The FDA issued an alert to Healthcare Professionals about
haloperidol (marketed as Haldol), stating: “Due to a number of case reports of sudden
death, TdP [Torsades de Pointes] and QT prolongation [TdP and QT prolongation are types
of heart abnormalities] in patients treated with haloperidol (especially when the drug is
given intravenously or at doses higher than recommended), the sponsor has updated the
labeling for haloperidol.” ECG (Electrocardiogram—a graphical recording of the cardiac
cycle produced by a special machine, a.k.a. EKG) monitoring was recommended if
haloperidol is given intravenously, even though haloperidol is not approved for intravenous
administration.109
ZYPREXA (olanzapine):
July 22, 2005: Eli Lilly & Co., the manufacturer of Zyprexa, agreed to pay $1.07 billion
to settle more than 8,000 claims against the drug, alleging it could potentially cause lifethreatening
diabetes.110
September 22, 2005: Dr. Jeffrey Lieberman of Columbia University and other researchers
published a study in The New England Journal of Medicine comparing an older generation
of antipsychotics with several newer ones.111 After 18 months of taking Zyprexa, 64%
of the patients stopped taking it, most often because it was not well tolerated and caused
sleepiness, weight gain or neurological symptoms like stiffness and tremors.112
October 5, 2007: Eli Lilly issued an important Safety Information update on its website
and product labels for Zyprexa and Symbyax (combination of Zyprexa and fluoxetine, or
Prozac) warning of the risk of weight gain, hyperglycemia (increased blood sugar) and
hyperlipidemia (elevated fats in the blood and cholesterol).113
2008: The current Zyprexa Safety Information includes a “black box” warning of increased
risk of death in elderly patients with dementia, as well as the following warnings: High
level of fats in the blood, weight gain, high blood sugar, strokes and “mini strokes” (in
elderly people with dementia), neuroleptic malignant syndrome, tardive dyskinesia, low
blood pressure, trouble with judgment, thinking, and reflexes, trouble swallowing, body
temperature problems…and “this is not a complete list….”114
*Akathisia: A, meaning “without” and kathisia, meaning “sitting,” an inability to keep still. Patients
pace about uncontrollably. The side effect has been linked to assaultive, violent behavior.87
*Neuroleptic malignant syndrome: A potentially fatal toxic reaction where patients break into
fevers and become confused, agitated and extremely rigid. An estimated 100,000 Americans have
died from it after taking the older antipsychotics.88
*Tardive Dyskinesia: Tardive, meaning “late” and dyskinesia meaning, “abnormal movement of
muscles.” Tardive Dyskinesia is a permanent impairment of the power of voluntary movement of
the lips, tongue, jaw, fingers, toes and other body parts.89
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114 ZYPREXA Safety Information, www.zyprexa.com.
115 Physicians’ Desk Reference, http://www.pdrhealth.com.
116 Tracey McVeigh, “Tranquilizers ‘more lethal than heroin,’” The Observer, 5 Nov. 2000.
117 Matt Clark, Mary Hager, “Valium Abuse: The Yellow Peril,” Newsweek, 24 Sept. 1979; Dr. Patrick Holford, “How to Quit
Tranquilizers,” www.patrickholdford.com, 2008.
118 Ibid.
119 Op. cit., Tracey McVeigh.
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122 Benzo.org.uk, citing Professor C. Heather Ashton, Benzodiazepines: How They Work and How To Withdraw, Feb. 2001.
123 “The Influence on the Pharmaceutical Industry,” House of Commons, UK, Health Committee, Vol. 1, Mar. 2005. p. 65.
124 Tarja-Brita R. Wahlin, et al., “Falls and fall risk among nursing home residents,” The Journal of Clinical Nursing, Vol. 17, pp. 126-
134, Jan. 2008.
125 “Europe-wide review recommends updates to product information for varenicline (brand name Champix),” MHRA, 14 Dec. 2008.
126 “Early Communication About an Ongoing Safety Review Varenicline (marketed as Chantix),” FDA, 20 Nov. 2007.
127 “Varenicline (marketed as Chantix) Information,” FDA Alert, 1 Feb. 2008.
128 Op. cit., House of Commons, UK, Health Committee, p. 65.
129 Anna Maria Dademan, “Flunitrazepam and violence—psychiatric and legal issues,” Department of Clinical Neuroscience,
Occupational Therapy and Elderly Care, Research Division of Forensic Psychiatry, Karolinska Institute, Sweden, 2000, p. 43.
130 “Zolpidem (‘Stilnox’) – Updated information – February 2008,” Theraputic Goods Administration, 21 Feb. 2008; “Club Drugs: An
Update,” Drug Intelligence Brief, Drug Enforcement Administration, Sept. 2001.
131 “FDA Safety Changes: Ambien, Primazin IM/IV, Hepsera,” Medscape, 28 Aug. 2008.
132 Peter Breggin, Toxic Psychiatry, (St. Martin’s Press, New York, 1991) p. 245.
133 Jerrold F. Rosenbaum, et al., “Emergence of Hostility During Alprazolam Treatment in Borderline Personality Disorder,” The
American Journal of Psychiatry, Vol. 141, No. 6 (June 1984), pp. 792-793.
134 David L. Gardner and Rex W. Cowdrey, “Alprazolam-Induced Dyscontrol in Borderline Personality Disorder,” The American
Journal of Psychiatry, Vol. 142, No. 1 (Jan. 1985), pp. 98-100.
135 “Xanax addiction extremely tough to kick,” MSNBC News Online, 2001.
136 Statement by Joseph A. Califano, Jr., Chairman and President, “Under the Counter: The Diversion and Abuse of Controlled
Prescription Drugs in the U.S.” The National Center on Addiction and Substance Abuse at Columbia University, July 2005.
137 Physicians’ Desk Reference, (Medical Economics Company, New Jersey, 1998), pp. 2822-2823; David L. Richman, M.D., Leonard
Roy Frank, and Art Mandler, Dr. Caligari’s Psychiatric Drugs (Alonzo Printing Co., Inc., California, 1984), p. 39.
138 Op. cit., David L. Richman, M.D., et al., pp. 38-39.
139 Ibid.
Source: http://www.cchrint.org/pdfs/The_Side_Effects_of_Common_Psychiatric_Drugs.pdf
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