4.2 Drugs used in Psychoses & related disorders

NHS IOW Choice and Medication Website

4.2.1 Antipsychotic drugs


Atypical antipsychotic drugs

NICE CG82 - Schizophrenia: Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care March 2009

1st     AMISULPRIDE       
1st     OLANZAPINE    Olanzapine Velotab are restricted to patients with swallowing difficulties or compliance issues  
1st     QUETIAPINE & XL      
1st     RISPERIDONE oral        
2nd     ARIPIPRAZOLE (Yellow)      
2nd     LURASIDONE (Yellow)   If patient has failed on 2 alternatives and has unacceptable weight gain  
      RISPERIDONE IM (Risperdal Consta)      
    SPC   ARIPIPRAZOLE Injection (Abilify Maintena)   Only for use in patients established on aripirazole but with poor oral compliance. Aripiprazole should be used when existing atypical is ineffective or not tolerated  
         NICE TA292   Bipolar disorder (adolescents) - aripiprazole Jul 13 
         NICE TA213   Schizophrenia - aripiprazole Jan 11
      CLOZAPINE   Use clozapine for treatment-resistant schizophrenia (specialist only)  

Extrapyramidal symptoms are generally less of a problem with atypical antipsychotics. Use an oral atypical antipsychotic first line for newly diagnosed schizophrenia (Risperidone or amisulpiride considered appropriate first line drugs locally)

There is little difference between atypicals in terms of efficacy (except clozapine).

Choice of atypical may also be governed by the need to avoid/reduce specific adverse affects. For the following problems:

Extrapyramidal symptoms, including secondary negative symptoms - consider quetiapine or olanzapine

Hyperprolactinaemia with others - consider quetiapine or aripiprazole

Sexual dysfunction with others - consider olanzapine, quetiapine or aripiprazole

Diabetes - consider amisulpride (caution with olanzapine, clozapine, quetiapine)

Weight gain - consider amisulpiride, sulpiride or aripiprazole

Postural hypotension - consider amisulpiride or sulpiride

Inadequate seadtion - consider quetiapine or olanzapine

4.2.2 Antipsychotic Depot Injections

      FLUPENTIXOL (Yellow)      
      FLUPHENAZINE (Yellow)    
      HALOPERIDOL (Yellow)    
      OLANZAPINE EMBONATE Depot inj (ZypAdhera)    
      PIPOTIAZINE (Yellow)    
      ZUCLOPENTHIXOL (Yellow)    
      PALIPERIDONE Depot inj (Xeplion)    

4.2.3 Antimanic Drugs

      LITHIUM (Amber) (order by brand name)    
        Lithium Prescribing Guidelines    


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