• Etrafon
  
• Haldol
  
• Loxipax
  
• Mellaril
  
• Moban
  
• Navane
  
• Orap
  
• Prolixin
  
• Serentil
  
• Stelazine
  
• Thorazine
  

The neuroleptics are also known as antipsychotics. These medications are used to treat a wide variety of serious mental illnesses, but they are certainly not limited to the treatment of outright psychosis. Most of these medications affect dopamine production or absorption; some also work on serotonin or other neurotransmitters.

The very first neuroleptics were discovered in the 1950s and 1960s, and represented the first major breakthrough in medical treatment for mental illness. However, the excitement was muted when the results of long-term use and overdose were discovered. Although for some patients they may be the only viable choice, knowledgeable physicians no longer use these older neuroleptics first. The atypical neuroleptics (see "Neuroleptics: The Atypicals") are infinitely preferable if something this strong is needed.

Michael took Risperdal for psychosis, anger, and aggression. He stopped taking it because he had a rare side effect from it. He also put on a lot of weight with Risperdal. He then took Zyprexa. It did not work very well. Then he started taking Mellaril in place of the Risperdal, and it is working great. Cogentin is used in conjunction with the antipsychotics to control unwanted side effects. --Lynn, mother of 11-year-old Michael (diagnosed bipolar I disorder with mixed states and psychosis, OCD, tic disorder)

People involved in the care of institutionalized patients have noted that the older neuroleptics are used more often in these settings than one might think, possibly as a way to control patients in understaffed or poorly run facilities. Psychiatric nurses derisively refer to this approach as "using a chemical straitjacket." If your child is institutionalized, the potential for misuse or overuse of neuroleptics is something for which you should be on the lookout.

Side effects to watch out for with all neuroleptic drugs include: agranulocytosis (a dramatic drop in white blood cell count), neuroleptic malignant syndrome, tardive dyskinesia, and extrapyramidal side effects. Some patients also have withdrawal dyskinesias--temporary episodes that occur when the medication is stopped, and that have symptoms similar to tardive dyskinesia. Excessive weight gain is also a common problem.

Descriptions of the older neuroleptics follow:

Etrafon

Generic name: amitriptyline/perphenazine (Trilafon, however, includes only perphenezine)

Also known as: Trilafon, Triavil.

Use: Depression, panic disorder, chronic pain, eating disorders, severe PMS.

Action, if known: Neuroleptic with qualities similar to those of a tricyclic antidepressant--blocks norepinephrine and serotonin use, works against the hormone acetylcholine.

Side effects: Sedation, tremor, seizures, dry mouth, light sensitivity, mood swing in people with bipolar disorders. Danger of tardive dyskensia, extrapyramidal side effects, neuroleptic malignant syndrome.

Known interaction hazards: Alcohol, MAOIs, blood pressure medications (including clonidine and Tenex), thyroid medication. Potentiated by estrogen, bicarbonate of soda (as in Alka-Seltzer and other over-the-counter remedies), acetazolamide, procainamide, and quinidine. Cimetidine, methylphenidate, other neuroleptics, oral contraceptives, nicotine (including cigarettes), charcoal tablets, and estrogen may interfere with Etrafon's action in the body.

Tips: Avoid extreme heat when taking this drug. Not recommended for use in people with severe depression, lung disease, severe asthma, liver disease. Take with food if stomach upset occurs.

Haldol

Generic name: haloperidol

Also known as: Haldol Decanoate

Use: Psychosis, tics/ Tourette syndrome, schizophrenia.

Action, if known: Affects the hypothalamus gland in the brain, which in turn affects metabolism, body temperature, alertness, muscle tone, and hormone production.

Side effects: Lowers seizure threshold. Sedation, jaundice (this should pass), anemia, changes in blood pressure or heartbeat, dizziness.

Known interaction hazards: Avoid alcohol and other central nervous system depressants, narcotics, and tranquilizers (including over-the-counter sleep aids). Potentiated by lithium, causing a greater risk of encepholopathic syndrome. Potentiates tricyclic antidepressants. Anticholinergic medications may make Haldol less effective. Risk of tardive dyskensia.

Tips: Do not take if you have low blood pressure, Parkinson's disease, or diseases of the blood, kidneys, or liver.

Loxipax

Generic name: loxapine

Also known as: Loxitane

Use: Psychosis

Action, if known: Blocks or changes the use of dopamine in several areas of the brain.

Side effects: May suppress the gag or cough reflex. Sedation, depression, light sensitivity, jaundice (this should pass), anemia, changes in blood pressure or heartbeat, dry mouth. Lowers the seizure threshold. Danger of tardive dyskensia.

Known interaction hazards: Alcohol, any tranquilizer or central nervous system depressant (including over-the-counter sleep aids), antacids, lithium, tricyclic antidepressants.

Tips: The drugs Motipress and Motival contain both loxapine and the antianxiety medication nortriptyline.

Mellaril

Generic name: thioridazine hydrochloride

Use: Psychosis, depression with anxiety, aggression.

Action, if known: Phenothiazine neuroleptic--affects the hypothalamus gland in the brain, which in turn affects metabolism, body temperature, alertness, muscle tone, and hormone production.

Side effects: May suppress the gag or cough reflex. Sedation, depression, light sensitivity, jaundice (this should pass), anemia, changes in blood pressure or heartbeat, dry mouth. Lowers the seizure threshold. Danger of tardive dyskensia.

Known interaction hazards: Alcohol, any tranquilizer or central nervous system depressant (including over-the-counter sleep aids), antacids, lithium, tricyclic antidepressants. Loses effectiveness when you eat or drink items containing caffeine.

Tips: Avoid extreme heat when taking Mellaril. Do not take if you have blood, liver, kidney, or heart disease, low blood pressure, or Parkinson's disease. Take with food or juice if stomach upset occurs.

Moban

Generic name: molindone

Use: Psychosis

Action, if known: Neuroleptic

Side effects: Drowsiness, sedation, depression, nausea, dry mouth. Risk of tardive dyskensia.

Known interaction hazards: Alcohol and all other central nervous system depressants, tranquilizers (including over-the-counter sleep aids), barbiturates, anesthetics, tricyclic antidepressants, lithium. Moban may have negative interactions with many other medications, including other antipsychotics, Asendin, and Cylert.

Tips: People with liver disease or Parkinson's disease should not take Moban.

Navane

Generic name: thiothixene

Use: Psychosis

Action, if known: Thiothixene neuroleptic--affects the hypothalamus gland in the brain, which in turn affects metabolism, body temperature, alertness, muscle tone, and hormone production.

Side effects: Sedation, depression, light sensitivity, jaundice (this should pass), anemia, changes in blood pressure or heartbeat. Danger of tardive dyskensia.

Known interaction hazards: Alcohol, any tranquilizer or central nervous system depressant (including over-the-counter sleep aids), antacids, lithium, tricyclic antidepressants. Do not combine with propranolol. Effect may be reduced by use of anticholinergic medications.

Tips: Avoid extreme heat when taking Navane. Do not take if you have blood, liver, kidney, or heart disease, low blood pressure, or Parkinson's disease. Take with food or juice if stomach upset occurs.

Orap

Generic name: diphenylbutylpiperdine

Also known as: Pimozide

Use: Psychosis, severe tics/ Tourette syndrome, schizophrenia.

Action, if known: Neuroleptic--affects the amount and action of dopamine in the brain.

Side effects: Extrapyramidal side effects, such as restlessness and unusual movements. Risk of tardive dyskinesia, neuroleptic malignant syndrome (NMS).

Known interaction hazards: Do not take antihistamines (including over-the-counter cold and allergy remedies) or anticholinergic drugs. Alcohol, other central nervous system depressants, tranquilizers (including over-the-counter sleep aids.) Taking other neuroleptics increases your risk for tardive dyskensia, NMS, extrapyramidal side effects. Taking tricyclic antidepressants and many other medications with heart effects can increase your risk for heart problems with Orap. Your doctor may need to adjust dosages of other medications you take, especially antiseizure drugs.

Tips: You should have an EKG before starting Orap, and regular heart monitoring while taking it. Orap is considered more risky than some other old-line neuroleptics, not to mention the atypical neuroleptics. Make sure you have exhausted your other options first.

Prolixin

Generic name: fluphenazine

Also known as: Prolixin Decanoate

Use: Psychosis

Action, if known: Phenothiazine neuroleptic--affects the hypothalamus gland in the brain, which in turn affects metabolism, body temperature, alertness, muscle tone, and hormone production.

Side effects: May suppress the gag or cough reflex. Sedation, depression, light sensitivity, jaundice (this should pass), anemia, changes in blood pressure or heartbeat. Danger of tardive dyskensia.

Known interaction hazards: Alcohol, any tranquilizer or central nervous system depressant (including over-the-counter sleep aids), antacids, lithium, tricyclic antidepressants. Loses effectiveness when you eat or drink items containing caffeine.

Tips: Avoid extreme heat when taking Prolixin. Do not take if you have blood, liver, kidney, or heart disease, low blood pressure, or Parkinson's disease. Take with food or juice if stomach upset occurs.

Serentil

Generic name: mesoridazine

Use: Psychosis

Action, if known: Neuroleptic

Side effects: Drowsiness, dizziness, sedation, agitation, nausea, changes in appetite, weight gain or loss, sexual dysfunction. Lowers seizure threshold. Risk of tardive dyskensia and extrapyramidal side effects.

Known interaction hazards: Avoid alcohol and all central nervous system depressants, including tranquilizers, sedatives, over-the-counter sleep aids, narcotics. Potentiates atropine, phosphorus insecticides, quinidine.

Tips: Avoid extreme heat while taking this drug. You will need regular blood tests and eye exams while taking Serentil. Not recommended for people with severe depression, bone marrow depression, liver or heart disease. Those with high blood pressure should be carefully monitored while taking Serentil.

Stelazine

Generic name: trifluoperazine

Also known as: Vesprin

Action, if known: Phenothiazine neuroleptic--affects the hypothalamus gland in the brain, which in turn affects metabolism, body temperature, alertness, muscle tone, and hormone production. Blocks dopamine receptors in the mesolimbic system, increasing turnover of dopamine.

Side effects: May suppress the gag or cough reflex. Sedation, depression, light sensitivity, jaundice (this should pass), anemia, changes in blood pressure or heartbeat. Danger of tardive dyskensia.

Known interaction hazards: Alcohol, any tranquilizer or central nervous system depressant (including over-the-counter sleep aids), antacids, lithium, tricyclic antidepressants. Loses effectiveness when you eat or drink items containing caffeine.

Tips: Avoid extreme heat when taking Stelazine. Do not take if you have blood, liver, kidney, or heart disease, low blood pressure, or Parkinson's disease. If you have thyroid problems, use extreme caution. Take with food or juice if stomach upset occurs.

Thorazine

Generic name: chlorpromazine

Use: Psychosis, schizophrenia.

Action, if known: Phenothiazine neuroleptic--affects the hypothalamus gland in the brain, which in turn affects metabolism, body temperature, alertness, muscle tone, and hormone production. Interferes with the action of dopamine in the basal ganglia, mesolimbic area, and medulla. Anticholinergic.

Side effects: May suppress the gag or cough reflex. Sedation, depression, light sensitivity, jaundice (this should pass), anemia, changes in blood pressure or heartbeat, dry mouth. Lowers the seizure threshold. Danger of tardive dyskensia.

Known interaction hazards: Alcohol, any tranquilizer or central nervous system depressant (including over-the-counter sleep aids), antacids, lithium, tricyclic antidepressants. Loses effectiveness when you eat or drink items containing caffeine.

Tips: Avoid extreme heat when taking Thorazine. Do not take if you have blood, liver, kidney, or heart disease, low blood pressure, Reye's disease, or Parkinson's disease. Take with food or juice if stomach upset occurs.