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Clinical Profile Comparison between SGA

SGA Dosage
Receptor affinities
Endocrine and Sexual Effects
• Hyperprolactinemia
– High: Risperidone, amilsupride
– Moderate: FGA
– Low: Clozapine, olanzapine, quetiapine,
ziprasidone
– None: aripiprazole
Endocrine and Sexual Effects
• Hyperprolactenemia can cause:
– Woman:
• menstrual disturbances,
• including anovulatory cycles and infertility,
• menses with abnormal luteal phases,
• frank amenorrhea and hypoestrogenemia.
• decreased libido and anorgasmia
• Ginecomastia
• Galactorhea
Endocrine and Sexual Effects
Hyperprolactenemia can cause:
• Man
– loss of libido, impotence, hypospermatogenesis,
– and erectile or ejaculatory disturbances.
– Ginecomastia
– Galactorrhea
Metabolic Effect
Weight gain Blood glucose Lipids Blood pressure
Clozapine Clozapine Clozapine Clozapine
Olanzapine Olanzapine Olanzapine Olanzapine
Risperidone Quetiapine
Risperidone
FGA low potency

Free of Metabolic side effect:


•Aripiprazole
•Ziprazidone
Cardiovascular effect
• Orthostatic hypotension • EEG abnormalities
– Low potency FGA – Chlorpromazine
– Clozapine, Olanzapine – Ziprasidone
– Thioridazine
• Tachycardia
– Chlorpromazine • Malignat arrythmia
– Clozapine – Ziprasidone
– quetiapine • Cardiomyopathy
– Clozapine
Gastrointestinal and hepatic SE
• Gi abnormality due to anticholinergic effect
– Dry mouth, constipation, paralytic ileus
– Low potency FGA, clozapine, olanzapine

• Transaminase elevation slightly occurs in all


antipsychotics, jaundice rarely
Hematological SE
• blood dyscrasias, including neutropenia,
leukopenia, leukocytosis, thrombopenia,
and agranulocytosis
– CPZ
– Clozapine (agranulocytosis)
• Usually reversible after discontinuation
Other SE
• Sedation
– Low potency FGA
– Clozapine
– Olanzapine
– Quetiapine
• Seizure
– Generally all antipsychotics lower the seizure
threshold
– Clozapine is the most
Depot Antipsychotic Medications
• Adherence to drugs is a big problems in
maintaining psychotic patients
• Depot is the answer of this problems
– Haloperidol decanoate (haldol decanote)
• 50 mg monthly, Z track IM
– Risperidone (Risperdal Consta)
• 25-50 mg 2 weely
– Fluphenazine decanoate
• 12,5-25 mg 4-6 weekly