Reactions to Psychotropic Medication PDF
Preview Reactions to Psychotropic Medication
Reactions to Psychotropic Medication Reactions to Psychotropic Medication Frank L. Tornatore, Pharm.O. Assistant Professor of Clinical Pharmacy University of Southern California School of Pharmacy Los Angeles, California John J. Sramek, Pharm. O. Drug Information Specialist Department of Pharmaceutical Services and Assistant Director Clinical Research Unit Metropolitan State Hospital Norwalk, California Bette L. Okeya, Pharm. O. Clinical Pharmacist Department of Pharmaceutical Services UCLA Medical Center and Neuropsychiatric Institute Los Angeles, California and Edmond H. Pi, M.D. Associate Professor Department of Psychiatry University of Southern California School of Medicine Los Angeles, California PLENUM MEDICAL BOOK COMPANY NEW YORK AND LONDON Library of Congress Cataloging in Publication Data Reactions to psychotropic medication. Bibliography: p. Includes index. 1. Psychotropic drugs - Side effects. 2. Psychotropic drugs - Toxicology. I. Tornatore, Frank L. [DNLM: 1. Psychopharmacology. 2. Psychotropic Drugs adverse effects. QV 77 R282) RM315.R43 1987 615'.788 87-30056 ISBN-13: 978-1-4684-S414-7 e-ISBN-13: 978-1-4684-S412-3 DOl: 10.1oo7/978-1-4684-S412-3 © 1987 Plenum Publishing Corporation Softcover reprint of the hardcover 1st edition 1987 233 Spring Street, New York, N.Y. 10013 Plenum Medical Book Company is an imprint of Plenum Publishing Corporation All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Preface After thousands of clinical trials, the efficacy of psychotropic drugs in the treatment of psychiatric disorders has become well established. However, the very success of these drugs has meant that many patients with chronic illnesses will receive them for a significant part of their lifetime. Side effects and other adverse reactions are an unfortunate but unavoidable component of successful pharmacotherapy. In deed, the main emphasis in new drug development is often on the search for compounds that have fewer side effects, although no one has as yet found an effective drug without them. Therefore, it is important for clinicians to be aware of side effect reaction profiles, because they are often a major determining factor in the choice of therapy. After more than three decades of major breakthroughs in the development of psychotropic drugs, reactions to these medications are still frequently reported in the current liter ature, and information about well-known reactions is con stantly refined. This book is an attempt to systematically collect and organize this large body of data and present it in an easy-to-use form. All chapters follow the same reaction oriented logic, and each important reaction is discussed using the same consistent subdivisions. The more clinically impor tant reactions appear in the body of each chapter; the more unusual or rarely reported reactions are briefly characterized in the miscellaneous section at the end of each chapter. This manual is meant to supplement other sources of information in psychopharmacology, and we hope that it will serve as the impetus for further readings in this field. The v vi Preface authors will be pleased if clinicians find this work to be a handy reference in daily practice as an aid to improving patient care. John J. Sramek, Pharm.D. Frank L. Tornatore, Pharm.D. Contents Chapter 1 Reactions to Antipsychotics 1 Autonomic Effects ............................ . 1 Anticholinergic Effects ...................... . 1 Temperature Regulation ..................... . 5 Cardiovascular Effects ......................... . 7 Electrocardiographic Effects ................. :. 7 Postural Hypotension ........................ . 9 Dermatological Effects ........................ . 12 Photosensitivity ............................ . 12 Pigmentation .............................. . 13 Skin Rashes ............................... . 15 Hematological Effects ......................... . 16 Agranulocytosis ............................ . 16 Other Blood Dyscrasias ...................... . 18 Hepatic Effects: Jaundice ...................... . 19 Metabolic and Endocrine Effects ................ . 21 Amenorrhea and Galactorrhea ................. . 21 Appearance of Medication in Breast Milk ....... . 24 Gynecomastia ....... , ...................... . 25 Hyperglycemia ............................. . 25 Placental Transfer .......................... . 26 Sexual Dysfunction ......................... . 27 Weight Gain ............................... . 28 Breast Cancer .............................. . 30 Neuroleptic Malignant Syndrome ................ . 31 Neurological Effects .......................... . 34 vii viii Contents Anticholinergic Psychosis ..................... 34 Extrapyramidal Symptoms .................... 36 Psychotic Exacerbation Induced by Neuroleptics .. 39 Seizure Threshold Alteration . . . . . . . . . . . . . . . . . .. 40 Supersensitivity Psychosis . . . . . . . . . . . . . . . . . . . .. 44 Tardive Dyskinesia .......................... 45 Ocular Abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . .. 48 Corneal Lesions ............................. 48 Epithelial Keratopathy ........................ 49 Lesions of the Lens .......................... 50 Retinitis Pigmentosa ......................... 51 Pregnancy: Teratogenicity ....................... 52 Renal Effects ................................. 54 Sudden Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 55 Syndrome of Inappropriate Antidiuretic Hormone . . .. 56 Miscellaneous Effects .......................... 58 Chapter 2 Reactions to Antidepressants: Tricyclic and T etracyclic ........................ . . . . . . . . . . . . 61 Anticholinergic Effects ......................... 61 Blood Dyscrasias .............................. 63 Cardiovascular Effects . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Conduction Delays . . . . . . . . . . . . . . . . . . . . . . . . . .. 65 Orthostatic Hypotension ...................... 67 Dermatological Effects ......................... 69 Endocrine Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 70 Galactorrhea and Amenorrhea . . . . . . . . . . . . . . . . .. 70 Sexual Dysfunction .......................... 71 Weight Gain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 74 Hepatic Effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 76 Neurological Effects ........................... 78 Agitation and Insomnia .................... . .. 78 Central Nervous System Stimulation (Hypomania and Mania) ............................... 79 Electroencephalographic Changes . . . . . . . . . . . . . .. 80 Extrapyramidal Symptoms .................... 81 Seizure Threshold ........................... 82 Contents ix Teratogenic Effects ........................... . 85 Withdrawal Syndromes ......................... . 86 Worsening Schizophrenic Conditions ............. . 87 Miscellaneous Effects ......................... . 89 Chapter 3 Reactions to Antidepressants: Monoamine Oxidase Inhibitors ............................ . 93 Cardiovascular Effects ......................... . 93 Hypertensive Crisis ......................... . 93 Orthostatic Hypotension ..................... . 96 Endocrine Effects ............................. . 97 Sexual Dysfunction ......................... . 97 Weight Gain ............................... . 99 Hepatic Effects ............................... . 100 Neurological Effects .......................... . 102 Hypomania ................................ . 102 Paresthesias ............................... . 103 Stimulant Effects ........................... . 104 Withdrawal Effects ........................... . 105 Miscellaneous Effects 107 Chapter 4 Reactions to Lithium 109 Dermatological Effects ......................... 109 Cardiovascular Effects . . . . . . . . . . . . . . . . . . . . . . . . .. 111 Gastrointestinal Effects ......................... 113 Hematological Effects (Leukocytosis) ............. 115 Renal Effects ................................. 116 Diabetes Insipidus and Polyuria ................ 116 Structural Damage (Nephrotoxicity) ............. 118 Teratogenic Effects ............................ 120 Thyroid Effects (Hypothyroidism) ................ 121 Tremor ...................................... 122 Weight Gain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 124 Withdrawal Effects ............................ 126 Miscellaneous Effects .......................... 127 x Contents Chapter 5 Reactions to Benzodiazepines ................ . 131 Behavioral Effects ............................ . 131 Hostility .................................. . 131 Sedation .................................. . 133 Cardiovascular Effects ......................... . 134 Respiratory Effects ........................... . 137 Teratogenic Effects ........................... . 138 Withdrawal and Tolerance Effects ............... . 140 Miscellaneous Effects 143 Chapter 6 Reactions to Antiparkinson Agents ............. 145 Autonomic Effects ............................. 145 Cardiovascular Effects . . . . . . . . . . . . . . . . . . . . . . .. 145 Gastrointestinal Effects ....................... 146 Ocular Effects .............................. 146 Dermatological Effects ....................... 147 Urological Effects ........................... 147 Euphoric Effects .............................. 148 Teratogenic Effects ............................ 150 Miscellaneous Effects .......................... 151 Chapter 7 Major Psychotropic Drug Interactions .......... 153 Antipsychotics ................................ 153 Antidepressants ............................... 155 Tricyclic and Tetracyclic . . . . . . . . . . . . . . . . . . . . .. 155 Monoamine Oxidase Inhibitors ................. 157 Lithium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 158 Benzodiazepines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 160 Suggested Readings ............................ 161 Index ......................................... 163 Reactions to Psychotropic Medication
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