Atypical Antipsychotics

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Atypical Antipsychotics - Interactions and Warnings

Because the majority of people who take this popular over-the-counter preparation do so without formal psychiatric evaluations, risk of hypericum-induced mania may be significant. Physicians should screen patients for a history of hypomania or mania before recommending use of St. John's wort.
- Biol Psychiatry 1999 Dec 15;46(12):1707-8 -- Mania associated with St. John's wort. -- Nierenberg AA, Burt T, Matthews J, Weiss AP.

St John's wort may cause serotonin syndrome in sensitive patients. For clinical reasons, it is important to recognize and report adverse reactions to herbal remedies and to document that these treatments have side effects commensurate with their potent action on brain neurochemistry.
- Can J Psychiatry 2001 Feb;46(1):77-9 -- Adverse reactions to St John's Wort. -- Parker V, Wong AH, Boon HS, Seeman MV.

A case in which a patient's clinical response to clozapine appears to correlate positively with his serum triglyceride concentrations. We propose that the observed clinical response may partly be the result of the physical interaction of clozapine with the very low-density lipoproteins. We base this supposition on our previous in-vitro study showing that the plasma distribution of clozapine is significantly altered by increases in plasma triglyceride concentrations. Although this case only represents one patient, it highlights the possibility that serum lipids may be potential contributors to the clinical effectiveness of clozapine.
- Int Clin Psychopharmacol 2002 Jul;17(4):197-9 -- Do triglycerides modulate the effectiveness of clozapine? -- Pande S, Procyshyn RM, Nazerali M, Attwood D, Chow K.

Viloxazine, fluoxetine, and fluvoxamine, may lead to higher serum levels of some antiepileptic drugs. Antiepileptic drugs may decrease the plasma concentrations of tricyclic antidepressants, many antipsychotics, including traditional compounds, i.e., haloperidol and chlorpromazine, and newer agents, i.e., clozapine, risperidone, olanzapine, quetiapine, and ziprasidone, and some benzodiazepines.
- Epilepsia 2002;43 Suppl 2:37-44 -- Clinical significance of pharmacokinetic interactions between antiepileptic and psychotropic drugs. -- Spina E, Perucca E.

The pharmacokinetics of clozapine are affected by wide interpatient variability and a potential for drug interactions. Other prospective noncomparative trials of the effects of clozapine on suicidal ideation or attempts endorsed these results, while results from retrospective trials are equivocal. black triangle Clozapine is commonly associated with sedation, hypersalivation, tachycardia, dizziness, constipation and orthostatic hypotension. Agranulocytosis, diabetes mellitus and weight gain may also occur.
- CNS Drugs 2003;17(4):273-80 -- Clozapine: in prevention of suicide in patients with schizophrenia or schizoaffective disorder. -- Wagstaff A, Perry C.

The FDA ordered the drugs' labels to include information on potential increased risk of hyperglycaemia and diabetes from using atypical anti-psychotics. Epidemiological studies suggested a link between treatment with the drugs and an increased risk of diabetes. The study, involving almost 20,000 schizophrenia patients treated at veterans' hospitals and clinics across the United States, showed patients taking Seroquel had 3.34 times as many cases of diabetes as those on older drugs. With Risperdal, the rate was 1.49 times, or 49 percent, greater than that of the older drugs. Patients on Zyprexa were 1.27 times more likely to become diabetic.

last update: November 2008

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