Adverse Effects of Psychotropic Medications
LyndaNP
For Your INPHARMATION
from:
http://www.bcmhs.bc.ca/library/newsletters/phjun99_psychtropic.htm
Volume 20, Issue #6 - June, 1999
ALPRAZOLAM (Xanax) See Benzodiazepines, causes less drowsiness and
ataxia than others.
AMANTADINE (Symmetrel) Common: Hallucinations (usually initially),
agitation, livedo reticularia, ankle edema, orthostatic hypotension
(usually initially). Occasional: Nausea, vomiting, constipation,
anorexia, depression, urinary retention, dry mouth, headache, insomnia,
slurred speech, fatigue. Rare: Convulsions, reversible leukopenia,
neutropenia, oculogyric episodes.
AMITRIPTYLINE (Elavil and others) See Tricyclic antidepressants. Highly
anticholinergic, very hypotensive.
AMOXAPINE (Asendin) See Tricyclic antidepressants.
BENZODIAZEPINES (Alprazolam,Triazolam,Chlordiazepoxide,Clonazepam,
Diazepam,Lorazepam, Oxazepam, Temazepam, Flurazepam) Common: Drowsiness,
ataxia Occasional: Confusion, amnesia, paradoxical excitement,
dizziness, withdrawal symptoms, including convulsions, on abrupt
discontinuance(withdrawal may be especially difficult with alprazolam),
rebound insomnia or excitement, behavioural disturbances, hypotonia and
hypersalivation with clonazepam. Rare: Hypotension, blood dyscrasia,
jaundice, allergic reactions, paradoxical rage reactions, stuttering
with alprazolam.
BENZTROPINE (Cogentin) Common: Anticholinergic effects, nausea.
Occasional: Vomiting, memory impairment (especially in the elderly),
toxic psychosis, abuse potential, worsening of tardive dyskinesia. Rare:
Numbness of the fingers, depression, hyperpyrexia.
BUPROPRION (Wellbutrin) Common: Agitation, nocturia, ataxia, dry mouth,
sweating, seizures, headaches, sleep disturbances, nausea, vomiting,
edema, worsening of depression, mania/hypomania. Occasional: Chest pain,
dyspnea, EKG changes, gynecomastia, dysphagia, thirst, GI disturbances,
genitourinary disturbances, dysphoria, paranoia. Rare: Flushing,
hirsutism, acne, glycosuria, anemia, diplopia, unmasking of tardive
dyskinesia.
BUSPIRONE (BuSpar) Common: Dizziness, headache, nausea, restlessness or
nervousness, drowsiness (with doses of more than 20 mg per day).
Occasional: Stomach upset, dry mouth, tinnitus, unusual tiredness or
weakness, trouble in sleeping. Rare: Confusion or mental depression,
vivid dreams or nightmares, tachycardia, numbness, tingling, pain, or
weakness in hands or feet, sore throat or fever, abnormal movement.
CARBAMAZEPINE (Tegretol) Common: Nausea, drowsiness, dry mouth, vertigo,
ataxia and diplopia (usually subside after one week or dose reduction).
Occasional: Transient leukopenia usually resolved within the first four
months of treatment. Rare: Bone marrow suppression, fever, sore throat,
mouth ulcers, easy bruising, petechiae or puerperal hemorrhage may be
early symptoms of blood disorder, dysarthria.
CHLORAL HYDRATE (Noctec and others) Common: Nausea, vomiting, stomach
pain. Occasional: Clumsiness or unsteadiness, diarrhea, dizziness or
lightheadedness, drowsiness. Rare: Confusion, hallucinations,
convulsions, difficulty in swallowing.
CHLORPROMAZINE (Largactil and others) See Phenothiazine, aliphatic.
Highly anticho1inergic, very hypotensive.
CITALOPRAM (Celexa) Common: Nausea, vomitting, somnolence, dry mouth,
increase perspiration, headache Occasional: Insomnia, anorgasmia,
tremor, delayed ejaculation Rare: Dizziness, hypotension, tachycardia,
bradycardia, paresthesia
CLOBAZAM (Frisium) Common: Drowsiness, ataxia, fatigue, dizziness,
blurred vision Occasional: Weight gain, depression, agitation, emotional
lability, confusion. Rare: Dry mouth, weight loss, constipation,
insomnia, bad dreams, sexual dysfunction, decreased appetite.
CLONAZEPAM (Rivotril) - see Benzodiazepines.
CLOZAPINE (Clozaril) Common: Sedation, dizziness, sialorrhea,
constipation, weight gain. Occasional: Nausea, syncope, tachycardia,
hypotension, headache, hyperthermia Rare: Agranulocytosis (can be
lifethreatening), leukopenia, seizures, EKG changes.
DESIPRAMINE (Norpramin, Pertofrane) See Tricyclic antidepressants. Less
anticholinergic than others.
DIAZEPAM (Valium and others) See Benzodiazepines. DIVALPROEX (Epival)
See Valproic Acid. Less GI side effects than Valproic Acid.
DONEPEZIL (Aricept) Common: GI disturbances (anorexia, nausea, vomiting,
diarrhea), headache Occasional: Agitation, tremor, myalgia, ataxia,
rash, rhinitis, weight loss, syncope Rare: Fatigue, asthenia, dizziness,
anxiety, insomnia, somnolence, constipation, abnormal dreams, frequent
urination.
DOXEPIN (Sinequan and others) See Tricyclic antidepressants
FLUOXETINE (Prozac) Common: Nausea, agitation, headache, insomnia
Occasional: Mania, rash, fever, leukocytosis, arthralgia, respiratory
distress, aminotransferase elevations, anorgasmia. Rare: Seizures in
patients with preexisting seizure disorder.
FLUPENTHIXOL (Fluanxol) Common: Parkinsonism, akathisia. Occasional:
Anticholinergic effects, drowsiness, dystonic reactions, orthostatic
hypotension, tachycardia, cardiac arrlythmia. Rare: ECG abnormalities.
(Note: Flupenthixol shares many of the pharmacologic properties of
Phenothiazines, especially thiothixene.)
FLUPHENAZINE (Moditen, Modecate, and others) See Phenothiazine,
piperazine.
FLUVOXAMINE(Luvox) Common: Nausea, headache, dry mouth, sedation,
fatigue Occasional: Anxiety, agitation, constipation, diarrhea, tremor,
dizziness, vomiting, anorexia Rare: Sexual dysfunction, sweating
GABAPENTIN (Neurontin) Common: Somnolence, dizziness, ataxia, fatigue,
nystagmus Occasional: Tremor, diplopia, amblyopia, nervousness,
dysarthria, amnesia, dyspepsia, constipation, dry mouth, rhinitis,
coughing, weight gain Rare: Depression, twitching, pruritis, abnormal
coordination, increased seizure frequency, decreased white blood cell
count, myalgia, impotence, peripheral edema
HALOPERIDOL (Haldol and others) Common: Extrapyramidal effects,
akathisia, dystonia(especially in young patients.) Occasional: Blood
dyscrasia, postural hypotension, sedation, menstrual changes,
galactorrhea, tardive dyskinesia. Rare: Cholestatic jaundice,
photosensitivity, rash, weight gain, convulsions, impotence,
neurotoxicity in hyperthyroid patients, neuroleptic malignant syndrome.
IMIPRAMINE (Tofranil and others) See Tricyclic antidepressants.
Anticholinergic and marked hypotension.
LAMOTRIGINE (Lamictal) Common: Rash, nausea, vomiting, dizziness,
ataxia, headache, diplopia, visual disturbances, blurred vision,
drowsiness, rhinitis Occasional: Behavioural, mood or mental changes,
diarrhea, insomnia, amnesia, pain, swelling or redness at joints,
slurred speech, gastrointestinal disturbances, tremors Rare: Increased
seizure frequency, sore throat, chills or fever, nystagmus, abnormal
coordination, asthenia, unusual bleeding or bruising, psychotic
episodes, delirium, panic attacks, delusions, Stevens-Johnson Syndrome
LITHIUM (Carbolith, Duralith and others) At therapeutic serum
concentrations: 0.5-1.2 mEq/L (0.3-0.8 mEq/L in the elderly): Thirst,
polyuria, fine tremor, GI irritation, mild diarrhea, weight gain, edema,
acne, leukocytosis. At toxic serum concentrations (above 1.5 mEq/L):
Confusion, vomiting, diarrhea, polyuria, muscle weakness, ataxia,
lethargy, slurred speech, tinnitus, blurred vision, nystagmus, stupor,
coma, convulsions. Occasional (at all serum concentrations): Goiter,
hypothyrodism, nephrogenic diabetes insipidus, renal tubular acidosis,
metallic taste, induction or exacerbation of psoriasis, folliculitio,
ECG changes, cardiac arrhythmias, extrapyramidal effects. Rare (at all
serum concentrations): Exophthalmos, nausea, vomiting, acute renal
failure, progressive decrease in renal function, Raynaud's phenomenon,
goiter, hypoglycemia, hair loss, pseudotumor cerebri, hyperthyrodism,
hyperparathyroidism. (Note: Serum concentrations and toxic effects
increased by dehydration, diuretics, sweating, fever, protracted
diarrhea or diminished intake of sodium, Lithium toxicity may occur at
therapeutic bloodlevels, thus medication should be withheld whenever
toxicity is suspected.)
LORAZEPAM (Ativan and others) See Benzodiazepines. Ataxia especially in
the elderly.
LOXAPINE (Loxapac) Common: Extrapyramidal effects, akathisia,
drowsiness. Occasional: Dystonia, hypotension, hypertension, convulsions
in susceptible individuals, anticholinergic effects, tardive dyskinesia,
weight gain. Rare: Rash, edema, hyperpyrexia, paraesthesia, neuroleptic
malignant syndrome.
MAO INHIBITORS (Phenelzine, Tranylcypromine) Common: Hypotension,
restlessness, insomnia, dizziness, brief daytime sleepiness. Occasional:
Mania, urinary retention, tremor, sexual disturbances, paraesthesia, dry
mouth, nausea, constipation, anorexia, weight gain, edema. Rare: Rash,
hepatitis, tinnitus, muscle spasm, lupus-like reaction, leukopenia,
hyperthermia, hypertension.
MAROTILINE (Ludiomil and others) Similar to tricyclics, but seizures
occur more commonly and anticholinergic effects may occur less commonly.
METHOTRIMEPRAZINE (Nozinan) See Phenothiazine,Aliphatic
MIRTAZAPINE* Common: Xerostomia, somnolence, increased cholestrol,
constipation, increased appetite, weight gain. Occasional: Anorexia,
polyuria, hypertension, vasodilation, dizziness, abnormal
thoughts/dreams, dyspnea, myalgia, arthralgia, tremor. Rare: Orthostatic
hypotension, seizures, agranulocytosis, neutropenia, liver function test
increases.
MOCLOBEMIDE (Manerix) Common: Dry mouth, headache, insomnia, agitation,
nausea, dizziness, tremor Occasional: Constipation, diarrhea,
tachycardia, hypotension Rare: Confusion, hallucinations, sweating,
blurred vision.
NALTREXONE (Revia) Common: Nausea, vomitting, abdominal cramping,
insomnia, nervousness, headache, arthralgia, muscle pain. Occasional:
Constipation, diarrhea, dizziness, polydipsia, anorexia, sneezing, rash.
Rare: Hepatotoxicity, insomnia, irritability, anxiety, thrombocytopenia,
agranulocytosis, hemolytic anemia, blurred vision.
NEFAZODONE (Serzone) Common: Headache, dizziness, asthenia, dry mouth,
nausea, vomiting, somnolence, amblyopia, constipation Occasional:
Insomnia, diarrhea, lightheadedness (unrelated to orthostatic
hypotension), agitation, tremor, anxiety, confusion Rare: Syncope, sinus
bradycardia, impotence, taste perversion
NORTRIPTYLINE (Aventyl) See Tricyclic antidepressants. Less hypotensive
than others.
OLANZAPINE (Zyprexa) Common: Weight gain, somnolence, dry mouth,
dizziness, akathisia, constipation, agitation, rhinitis, elevation of
hepatic transaminases, postural hypotension Occasional: Seizures,
syncope, tachycardia, hypertonia, nausea, vomiting, headache Rare:
Fever, insomnia, tremor, anxiety
XAZEPAM (Serax and others) See Benzodiazepines.
PAROXETINE (Paxil) Common: Nausea, vomiting, sedation, fatigue,
drymouth, headache. Occasional: Insomnia, agitation, tremor, diarrhea,
constipation, dizziness, sweating. Rare: Visual disturbances, anorexia,
urinary disturbances, taste perversion, sexual dysfunction.
PERPHENAZINE (Trilafon and others) See Phenothiazine, piperazine.
PHENELZINE(Nardil), see MAO inhibitors PHENOTHIAZINE, ALIPHATIC
(Chlorpromazine, Methotrimeprazine) Common: Drowsiness, anticholinergic
effects, postural hypotension. Occasional: Extrapyramidal effects,
dystonia, akathisia, galactorrhea, photosensitivity, menstrual changes,
cholestatic jaundice, rashes, skin pigmentation, convulsions, ECG
changes, tardive dyskinesia, weight gain. Rare: Lenticular deposits and
opacities, blood dyscrasia, gastritis, nausea and vomiting, dizziness
and tremulousness following withdrawal of high-dose therapy, disturbed
temperature regulation, lupus-like syndrome, neuroleptic malignant
syndrome.
PHENOTHIAZINE, PIPERAZINE (Fluphenazine, Perphenazine, Prochlorperazine,
Trifluoperazine) Common: Extrapyramidal effects, akathisia, dystonia.
Occasional:Anticholinergic effects, photosensitivity, galactorrhea,
menstrual changes, drowsiness, postural hypotension, anorexia, rash,
tardive dyskinesia, weight gain. Rare: Cholestatic jaundice, blood
dyscrasia, lenticular deposits and opacities, ECG abnormalities,
convulsions, gastritis, nausea and vomiting, dizziness and tremulousness
following withdrawal of highdose therapy, disturbed temperature
regulation, neuroleptic malignant syndrome.
PHENOTHIAZINE, PIPERIDINE (Thioridazine) Common: Drowsiness,
anticholinergic effects, postural hypotension, weight gain, inhibition
of ejaculation. Occasional: Extrapyramidal effects, akathisia, menstrual
changes, photosensitivity reactions, ECG abnormalities, galactorrhea,
tardive dyskinesia Rare: Pigmentary retinopathy (thioridazine has an
upper limit of recommended dosage because of a high incidence of
pigmentary retinopathy), cholestatic jaundice, blood dyscrasia,
dystonia, convulsions, rash, gastritis, nausea and vomiting, dizziness
and tremulousness following withdrawal of high-dose therapy, disturbed
temperature regulation, neuroleptic malignant syndrome.
PIMOZIDE (Orap) Common: Extrapyramidal and parkinsonian symptoms occur
in 10-15% of patients and may be reversed or controlled by dosage
reduction or concomitant administration of an antiparkinsonian drug.
Occasional: Hypotension, ECG changes, including prolongation of QT
interval, weakness, fatigue, skin reactions, blurred vision, dry mouth.
Rare: Tardive dyakinesia.
PRAMIPEXOLE (Mirapex) Common: Nausea, dizziness, asthenia, somnolence,
constipation. Occasional: Postural hypotension, tachycardia, dyskinesia,
insomnia, headache, urinary frequency, vision abnormalities. Rare: Dream
abnormalities, confusion, hallucinations, accidental injuries, elevated
liver transaminases.
PROCHLORPERAZINE (Stemetil) See Phenothiazine, piperazine
PROCYCLIDINE(Kemadrin) Common: Anticholinergic effects, nausea.
Occasional: Light-headedness, memory impairment (especially in the
elderly), toxic psychosis. Rare: Hyperpyrexia
PROPRANOLOL (Inderal) Common: Fatigue, lethargy, nightmares,
hallucinations, depression,bradycardia, hypotension, EKG changes,
diarrhea, eosinophilia (usually transient). Occasional: Nausea,
propranolol-induced hypoglycemia, dyspnea, wheezing. Rare: Vomiting,
erythemas
QUETIAPINE (Seroquel): Common: Somnolence, syncope, orthostatic
hypotension, tachycardia, agitation, dizziness Occasional: Agitation,
insomnia, headache, dry mouth, serum ALT increases. Rare: Tachycardia,
dyspepsia, constipation, weight gain, increases in total cholestrol and
triglycerides, lenticular formations (in dogs).
REBOXETINE (Edronex)* Common: Dry mouth, constipation, insomnia,
increased perspiration, increased heart rate. Occasional: Blood pressure
fluctuations, CNS effects Rare: Orthostatic hypotension, anticholinergic
effects
RISPERIDONE (Risperdal) Common: Orthostatic hypotension (initially),
concentration difficulties, fatigue, sedation, failing memory, nausea,
vomiting, dizziness, constipation, polyuria, polydipsia, reduced
salivation, accommodation disturbances, palpitation, weight gain/loss,
headache. Occasional: Agitation, diarrhea, micturition disturbances,
sweating, dyspepsia, amenorrhea, sexual dysfunction, migraines. Rare:
Epileptic seizures, gynecomastia, neuroleptic malignant syndrome
dyskinesia.
SERTRALINE(Zoloft) Common: Nausea, vomiting, agitation, diarrhea,
constipation, dyspepsia, confusion, asthenia, headache, fatigue,
insomnia, sedation, sexual dysfunction in males. Occasional: Ataxia,
vertigo, flushing, dizziness, tachycardia, acne, dysphagia,
hyper/hypotension. Rare: Pallor, gynecomastia, tinnitus, urinary
retention, sexual dysfunction in females.
TACRINE (Cognex) Common: Liver toxicity (elevated transaminase),
dyspepsia, anorexia, nausea, vomiting, diarrhea Occasional: Agitation,
tremor, myalgia, ataxia, rash, rhinitis Rare: Headache, fatige,
asthenia, dizziness, anxiety, insomnia, somnolence, constipation
TEMAZEPAM (Restoril) - see Benzodiazepines
TETRABENAZINE (Nitoman) Common: Fatigue, drowsiness, depression,
restlessness, anxiety, insomnia, sialorrhea, dysphagia, slowness,
tremor, GI disturbances Occasional: Parkinsonism, postural hypotension
THIORIDAZINE (Mellaril and others) See Phenothiazine, piperidine,
Anticholinergic and marked hypotension.
THIOTHIXENE (Navane and others) Common: Extrapyramidal effects,
akathisia, dystonia, anticholinergic effects Occasional: Galactorrhea,
menstrual changes, drowsiness, postural hypotension, anorexia, rash,
tardive dyskinesia Rare: Blood dyscrasia, lenticular deposits and
opacities (with long term high dosage), ECG abnormalities, convulsions,
neuroleptic malignant syndrome.
TOPIRAMATE (Topamax) Common: CNS effects, dizziness, fatigue,
parasthesias, ataxia, impaired concentration, confusion, abnormal
thinking, nystagmus. Occasional: Weight loss, depression, chest pain,
edema, dyspepsia, constipation, dry mouth. Rare: Nephrolithiasis,
decreased hearing, respiratory symptoms (pharyngitis, sinusitis,
epistaxis).
TRANYLCYPROMINE (Parnate and others) See MAO inhibitors
TRAZODONE (Desyrel and others) Common: Drowsiness Occasional:
Dizziness,orthostatic hypotension dystonia Rare: Anticholinergic
effects, headaches, ventricular arrhythmias, peripheral edema, priapism
in men can be serious, and increased libido in women.
TRICYCLIC ANTIDEPRESSANTS (Amitriptyline, Amoxapine, Clomipramine,
Desipramine, Doxepin, Imipramine, Nortriptyline, Trimipramine) Common:
Anticholinergic effects, orthostatic hypotension (less with
nortriptyline), drowsiness, dizziness, weight gain, tachycardia.
Occasional: Mania, psychosis, tremors, first-degree heartblock, other
ECG abnormalities, rash, sweating, confusion, insomnia, sexual
disturbances, especially with amoxapine, increase in dental caries,
gingivitis. Rare: Hepato toxicity, tinnitus, bone marrow depression,
including agranulocytosis, seizures, peripheral neuropathy, severe
cardiovascular effects in patients with cardiac disease,
photosensitivity, dysarthria, stuttering, withdrawal symptoms, nausea,
tremor, anorgasmia and seizures may be more common with clomipramine,
tardive dyskinesia and neuroleptic malignant syndrome with amoxapine,
renal failure with overdosage of amoxapine.
TRIFLUOPERAZINE (Stelazine and others) See Phenothiazine, piperazine.
TRIMIPRAMINE(Surmontil) See Tricyclic antidepressants
VALPROIC ACID (Depakene) Common: Nausea, vomiting, indigestion, weight
gain, increased appetite. Occasional: Diarrhea, transient alopecia.
Rare: Tremor, "spots before the eyes", ataxia, neutropenia,
thrombocytopenia, hepatotoxicity, pancreatitis.
VENLAFAXINE (Effexor) Common: Nausea, vomiting, asthenia, sweating,
constipation, anorexia, somnolence, elevated blood pressure,
palpitation. Occasional: Blurred vision, mania, hypomania, diarrhea, dry
mouth, nervousness, anxiety, tremor, agitation, confusion, abnormal
ejaculation/orgasm. Rare: Pruritus, depression, tinnitus.
ZIPRASIDONE (Zeldox)* Common: Somnolence, headache, nausea, dyspepsia,
asthenia, respiratory symptoms (Corysal symptoms not nasal stuffiness)
Occasional: Postural hypotension, tachycardia, dizziness, insomnia,
dystonia, akathisia. Rare: Weight gain, increased liver enzyme levels,
QTC prolongation, sexual dysfunction in males.
ZOPICLONE (Imovane) Common: Bitter metallic taste, dry mouth. In
geriatrics, vomiting, palpitation, anorexia, anxiety, tremor, sweating,
sialorrhea Occasional: Drowsiness, psychomotor impairment Rare:
Asthenia, confusion, memory impairment, euphoria, anxiety, depression,
hypotonia, constipation, diarrhea, increased appetite
ZUCLOPENTHIXOL (Clopixol, Acuphase) Common: Drowsiness, fatigue,
dizziness, anxiety, tremor, dry mouth, insomnia, extrapyramidal
symptoms, orthostatic hypotension, hypertonia, asthenia Occasional:
Constipation, depression, headache, dystonia, increased salivation,
tachycardia Rare: Anorexia, weight changes, diarrhea, sweating,
confusion, amnesia, visual disturbances, abnormal ejaculation/orgasm,
nausea, vomiting
NOTE:
1. The stated adverse drug reactions are not meant to be totally
inclusive. The healthcare professionals should report any unusual
adverse drug events to Health Canada.
2. The terms "common", "occasional", and "rare" refer to relative
frequencies of side effects within each drug or class of drugs and do
not necessarily correspond to the same rate of incidence between drugs.
3. * Denotes Emergency Drug Release Status in Canada.
4. Anticholinergic effects include dry mouth, mydriasis,
cycloplegia, blurred vision, urinary retention, decreased
gastrointestinal motility, constipation, and tachycardia in high doses.
5. It should be emphasized that all psychotropic medications have
the potential to be teratogenic when taken especially during the first
trimester of pregnancy.
Written by: James J.H. Kim, B.Sc. (Pharm.), B.Sc. (Bioch), Pharm.D.
Candidate Reviewed by: Dr. Sylvia Zerjav, Pharm.D. If you would like to
be added to the Inpharmation Newsletter mailing list, please call (604)
524-7012 or email btho...@bcmhs.bc.ca. Please ensure you include your
entire mailing address (including postal code).
--
Lynda