- psychotic illness under specialist care
- Regarded as the rescue medication in psychosis, if it wasn't so toxic some suspect it would be the agent of choice
Cautions and Interactions
Strong anticholinergic and antiserotonergic properties.
- Gastro-intestinal obstruction
Atypical antipsychotic clinical issues
Dementia is probably a contraindication for any antipsychotic (fair evidence for increased mortality in long term use) and has an interesting medicolegal potential as it is unclear if following recent changes in datasheets (SPCs) and warnings from the regulatory authorities (eg FDA) any manufacturer will share liability for out of licence use (off license) use in newly commenced patients. In the UK an urgent review is taking place as of 2008.
- Cardiovascular disease
- Dementia - increased risk stroke definite for olanzapine & risperidone
- Withdrawal should be gradual
- Associated with increased venous thromboembolic disease
- Weight gain
- Tardive dyskinesia
- Postural hypotension
- Diabetes mellitus
- Neuroleptic malignant syndrome