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14.

Psychosis
A handy chart to help you compare the medicine treatments to help the symptoms of psychosis and schizophrenia

Please note: You are unique and this is only a guide! Some of the main side effects – these are just a few of the main side effects.
This guide will be about right for most people, but not everyone. Some people Many are worse at higher doses, but most wear off after a few weeks.
may get better but some may stay the same. Some may improve quicker than ●●● = Most people will get this side effect
other people. Some may get all the side effects in the book, others none at all. ●● = Quite a few will get this side effect
What happens to you will depend on your unique brain and your genes. ● = Only a few people will get this side effect
However, this guide should help you to be able to choose between the many o = This is very rare or not known
medicines. There are many other ways you can be helped e.g. talking and The side effects here are:
family therapies, art therapy, help with coping with the symptoms, relaxation,  Drowsiness – feeling sleep, sedated or doped up
and self-help.  Muscle stiffness – can be stiffness or a slight shake or tremor
 Weight gain – feeling more hungry and putting on weight
No guide can be 100% unbiased, but we have tried hard to stick to the facts
about medicines. We hope you take this guide in the way in which it is  Dry mouth etc – plus blurred vision, constipation, poor memory, difficulty
intended i.e. an honest attempt to inform, educate and help. passing urine (sometimes called “anticholinergic side effects”)
 Sexual problems – lack of desire, performance or pleasure
What the sections in the table mean: There are many other possible side effects.
Medicine – these are the main medicines in UK to help treat the symptoms of Please see the website for more details of each of the medicines and side effects.
psychosis and schizophrenia, and a few other medicines that are How long you could or should take it for - how long you take any medicine for
sometimes used. will be up to you. Taking a medicine means remembering every day and may be
• These medicines are in no special order getting some side effects. It also often means you get well and stay well. You will
• We have listed them as their “generic name” (the name of the actual need to decide what helps you best and what helps you get on with your life.
drug). We have also mentioned the trade name where possible
How to stop it – some medicines can be stopped quickly. Others should be stopped
• This is only short guide. Please see the rest of the
slowly. It is best to try to stop all medicines slowly – it’s kinder on your brain.
www.choiceandmedication.org.uk website for more details
• Not all these medicines work as well as each other. Your clinician may Tips on how to get the best out of medication:
be able to help you choose which one (or ones) might be best for you. • Read the website to make sure you know what the medicine is for, when and how
• Some of these medicines might not be used in your area to take it and for how long to take it
Usual dose per day – this will depend on how well you do and what side • Try to get the best out of one medicine before trying another. Get the right dose
effects you get. Some people need higher, some need lower doses. It is for you, try taking it at different times, and try to cope with any side effects
usually best to start a drug slowly; it’s kinder to your brain. • Take it regularly every day, unless it is meant to be taken only when required
(find ways to remember e.g. leave the pack by your bed, in the kitchen, next to your
How we think it might work – this is how we think the medicine works in toothbrush, in your car if you have one, next to the TV or computer, but don’t forget to
the brain. There is more on this on the website. Taking two medicines with keep them out of the sight and reach of children)
the same way of working doesn’t often help much. • Although medicines can help most people’s symptoms, they are not always the only
answer. Please see the website for ideas for self-help, and help from others
How long it takes to work – this is just a guide as some people may get
better quicker or slower. But don’t give up too early.

These pages come from, and must be used with,


www.choiceandmedication.org.uk.
V2.02, dated 6.5.10 ©2010 Stephen Bazire, Choice and
Medication, Mistura Enterprise Page 1 of 2
A handy chart to help you compare the medicine treatments to help the symptoms of psychosis
Medicine Usual dose per How we think How long it Some of the main side effects * How long you How to stop it
day it might work takes to work Drowsi- Muscle Weight Dry mouth Sexual could or should
(probably) ness stiffness gain etc problems take it for
Newer ones (atypicals, second generation)
Risperidone 4-6mg a day Mainly blocks ● ●● ●● ● ●●
(Risperdal®) dopamine Usually there If taking one of
receptors may be an effect these medicines
in a few days, for a first
Olanzapine 10-20mg a day Blocks ●●● ● ●●● ● ●
with the effect episode of
(Zyprexa®) dopamine
building over 3-4 psychosis or
Quetiapine Around 600mg and other ●●● ● ●● ● ●
weeks possible Should be no
(Seroquel XL®) a day receptors
Aripiprazole 10-30mg a day Regulates As above but schizophrenia, problem but we
● ● O O O
taking it for at suggest that
(Abilify®) dopamine you might get a
bit more least 2 years will stopping it gently
agitated before reduce the over several weeks
getting better chances of the or months is the
Clozapine (Clozaril Usually around Blocks a wide symptoms safest way
●●● ● ●●● ●●● ● coming back.
®, Denzapine®, 300-600mg a range of
Zaponex®) Usually there
day receptors
- only for resistant may be an effect If taking it for
schizophrenia in a few days, schizophrenia
Paliperidone 6mg a day As with the effect that keeps
building over 3-4
● ●● ●● ● ●● coming back,
(Invega®) risperidone
Zotepine Up to 300mg a Blocks dopamine weeks then taking it
and other ●●● ● ●●● ● ●●● for at least 5
(Zoleptil®) day
receptors
years will much
Other antipsychotics reduce the
Haloperidol 5-20mg Usually have an ● ●●● ●● ● ●●● chances of the Should be no
Block effect in a few symptoms come problem but stopping
Amisulpride 400-800mg ● ●● ●● ● ●●●
dopamine days, with the back. it gently over several
Sulpiride 400-1600mg receptors effect building ● ●● ●● ● ●●● weeks or months is
over 3-4 weeks If for symptoms the safest way
Zuclopenthixol 10-25mg ●● ●● ●●● ●● ●●● of psychosis,
Phenothiazines then it may only
be needed for a
Chlorpromazine 75-300mg Blocks ●●● ●● ●● ●● ●●● Should be no great
few weeks or
dopamine Usually have an problem but we
Levomepromazine 100-200mg ●●● ●● ●●● ●● ●● months
receptors, effect in a few suggest that
Pericyazine 5-20mg some days, with the ●●● ● ●●● ●●● ●● stopping it gently
Perphenazine 12-24mg serotonin and effect building over several weeks
many other over 3-4 weeks ●● ●●● ●● ● ●●● or months is the
Trifluoperazine 5-15mg receptors ● ●●● ●● ● ●●● safest way
* See other page for more advice about these side effects. These pages come from, and must be used with, www.choiceandmedication.org.uk
V2.02, dated 6.5.10 ©2010 Stephen Bazire, Choice and Medication, Mistura Enterprise Page 2 of 3
A handy chart to help you compare the medicine treatments to help the symptoms of psychosis
Medicine Usual dose How we think How long it Some of the main side effects * How long you How to stop it
it might work takes to work Drowsi- Muscle Weight Dry mouth Sexual could or should
(probably) ness stiffness gain etc problems take it for
Depot and longer-acting injections
Risperidone 25-50mg every Mainly blocks At least 4 ● ●● ●● ● ●● Risperidone carries
(Risperdal two weeks dopamine weeks before on being released
Consta®) receptors any effect, for another 5-7
which will then weeks after the last
build over injection
several weeks
Olanzapine 210-405mg ●●● ● ●●● ● ●
pamoate every two or
(Zypadhera®) four weeks Block As with the other
Zuclopenthixol 200-500mg dopamine antipsychotics. Because the
●● ●● ●●● ●● ●●●
decanoate every two and many See previous medicine is
(Clopixol®) weeks other page for more released from a
Flupentixol 20-200mg receptors Usually takes a help. “depot” over
● ●● ●● ●● ●●●
decanoate every two week or so several weeks,
(Depixol®) weeks before it begins stopping is not a
Haloperidol 50-200mg a Blocks to work problem as the
● ●●● ●● ● ●●● medication slowly
decanoate four weeks dopamine
(Haldol receptors reduces. The main
decanoate®) problem is
Fluphenazine 25-100mg Block symptoms coming
● ●●● ●● ●● ●●● back.
decanoate every two dopamine
(Modecate®) weeks receptors,
Pipothiazine 25-50mg every some ● ●● ●● ●● ●●●
palmitate two weeks serotonin and
(Piportil®) many other
receptors
The advantages of depot or long-acting injections The disadvantages of depot or long-acting injections
• Regular contact with nurses and the service • You get an injection (usually into your bum) every two weeks or so, which can be
• You get steady blood levels of the medicine, so any side effects are painful and distressing
more stable • You can’t stop the drug suddenly (although if you do stop, your blood levels do
• There is a lower risk of becoming unwell again reduce slowly)
• You don’t have to worry about forgetting tablets, or even taking a double
dose by mistake
* See other page for more advice about these side effects. These pages come from, and must be used with, www.choiceandmedication.org.uk
V2.02, dated 6.5.10 ©2010 Stephen Bazire, Choice and Medication, Mistura Enterprise Page 3 of 3