Atypical antipsychotics: Uses, most common brand names, and safety information
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If you have been diagnosed with a mental health condition such as bipolar disorder or schizophrenia, you have probably been given an atypical antipsychotic drug. The first atypical antipsychotic, Clozaril (clozapine), was introduced in 1990 and used in the treatment of schizophrenia. These newer second-generation antipsychotics have mostly replaced the older typical antipsychotics which have been prescribed since the 1950s. This is because they are more effective against the positive and negative symptoms of schizophrenia while typically having fewer side effects. Typical antipsychotics are still used for severe psychosis. Here we will discuss in more depth the properties, brand names, pricing, and safety of atypical antipsychotics.
The list below includes FDA-approved atypical antipsychotics and their pricing:
List of Atypical antipsychotics
What are atypical antipsychotics?
Antipsychotic medications can be classified as typical or atypical. Typical antipsychotics such as Haldol (haloperidol), Trilafon (perphenazine), Prolixin (fluphenazine), and Thorazine (chlorpromazine) are also known as traditional or first-generation antipsychotics. Atypical antipsychotics, which are also known as second-generation antipsychotics, include Seroquel (quetiapine), Zyprexa (olanzapine), and Geodon (ziprasidone). They are used to treat psychiatric conditions that produce symptoms such as hallucinations, delusions, and disorganized thinking.
What is the mechanism of action of atypical antipsychotics?
The mechanism of action of atypical antipsychotics in treating symptoms of schizophrenia and other mental health conditions will vary with each medication. It is thought they work by inhibiting certain receptors in your brain to affect the concentrations of neurotransmitters such as serotonin and dopamine. Some also have activity at histamine and alpha receptors.
What conditions are atypical antipsychotics used to treat?
Atypical antipsychotics are used to treat mental health conditions such as:
- Bipolar disorder
- Treatment-resistant depression
- Schizoaffective disorder
- Tourette’s syndrome
- Borderline personality disorder (BPD)
- Parkinson’s disease psychosis
- Anxiety disorder
- Autism spectrum disorder
Are atypical antipsychotics safe?
The use of atypical antipsychotics is relatively safe and effective when taken as prescribed. Before beginning treatment with atypical antipsychotics, tell your healthcare provider if you have any of the following:
- Heart problems such as high blood pressure or arrhythmias
- Liver disease
- Suicidal thoughts and behaviors
- Pregnant, plan on becoming pregnant, or are breastfeeding
What are some common side effects of atypical antipsychotics?
The adverse effects you experience from atypical antipsychotics will depend on several factors including the medication and dose. Some side effects of atypical antipsychotics include:
- Dry mouth
- Impaired concentration
- High blood pressure (hypertension)
- Low blood pressure (hypotension)
- Sexual dysfunction
- Blurred vision
- Weight gain
- Increased liver enzymes
More rarely, atypical antipsychotics can cause more severe adverse reactions, including:
- Increased incidence of serious, life-threatening allergic reactions
- Neutropenia or agranulocytosis (low white blood cell count)
- Extrapyramidal symptoms (EPS) such as dystonia (uncontrolled muscle contractions), akathisia (restlessness), Parkinsonism (tremors, slow movements, and muscle rigidity), and tardive dyskinesia (abnormal, repetitive facial movements)
- Increased prolactin levels
- Myocarditis (inflammation of the heart)
- Increased risk of suicidal thoughts and behaviors
This is not a complete list of side effects and we encourage you to consult with your healthcare professional for medical advice about any possible side effects.
Who should not take atypical antipsychotics?
Atypical antipsychotics are contraindicated in patients with glaucoma, liver disease, severe neutropenia, and bone marrow depression, as well as older adults with dementia-related psychosis. They should also be avoided in patients with Parkinson’s disease, except for Nuplazid (pimavanserin).
What are some drug interactions with atypical antipsychotics?
The use of atypical antipsychotics with certain foods or medications can affect how they work or increase the frequency and severity of side effects. Make sure your healthcare provider is aware of all the over-the-counter and prescription medications you are taking, including:
- Macrolide antibiotics such as clarithromycin
- Fluoroquinolones antibiotics such as ciprofloxacin
- Antidepressants such as SSRIs
How long does it take atypical antipsychotics to work?
Atypical antipsychotic medications can help with symptoms such as agitation and confusion in a person with acute psychosis within hours or days, but they can take four or six weeks to reach their full effect.
What should be monitored while on atypical antipsychotics?
Newer atypical antipsychotics may carry more risk of metabolic side effects than typical antipsychotics. You should have baseline and periodic monitoring of your weight, HbA1c, blood pressure, fasting blood glucose, and lipids.
What is the difference between typical and atypical antipsychotics?
Typical antipsychotic drugs mainly work by blocking the D2 dopamine receptors. Atypical antipsychotics mainly affect the 5-HT2A serotonin receptors but also typically have some activity at dopamine, alpha, and histamine receptors.
How much do atypical antipsychotics cost?
Atypical antipsychotics are very expensive with an average cost of around $10,000 per year.
You can purchase Atypical antipsychotics for $49 per month from NiceRx if eligible for assistance. Prices at the pharmacy vary by location, strength, and quantity, as well as your insurance status.