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Antipsychotic

Clozapine

💊 Clozapine is an FDA-approved atypical antipsychotic medication for treatment-resistant schizophrenia. ⁠

❌ Clozapine is not the first-line drug of choice due to its range of adverse effects including agranulocytosis (a serious condition with a severely low number of neutrophils – a type of white blood cell).⁠

⭐️ Due to this adverse effect, a patient must be enrolled in the clozapine REMS registry by a certified clinician in order to receive treatment. ⁠

⚖️ Clozapine is also associated with significant weight gain, diabetes type 2, diabetic ketoacidosis, and increased lipid levels-all due to increased insulin resistance.⁠

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Antipsychotics

💊 Antipsychotics, also known as neuroleptics, are a class of medications primarily used to manage psychosis in schizophrenia or bipolar disorder, hence the name anti-PSYCHOTICS or anti-PSYCHOSIS (including delusions, hallucinations, paranoia, or disordered thought) 👹⁠ ⁠ They are broken down into two generations which differ by their side effect profiles: ⁠ ⁠ 1️⃣ 1st generation also called typical antipsychotics are associated with significant extrapyramidal side effects (movement disorder). ⁠ 2️⃣ 2nd generation also called atypical antipsychotics have decreased risks of EPS side effects as compared to 1st generation antipsychotics but are associated with significant weight gain and the development of metabolic syndrome.⁠ ⁠ In addition, all of the antipsychotics block the following receptors with varying degrees leading to the common side effects seen: ⁠ ⁠ ⭐ Dopamine: EPS symptoms⁠ ⭐ Alpha: hypotension⁠ ⭐ Muscarinic: anticholinergic side effects ⭐ Histamine: sedation⁠ ⁠ 🧠 MOA: In schizophrenia, dopamine is tied to hallucinations and delusions. Certain areas in the brain that ‘run off’ of dopamine may become overactive leading to symptoms of psychosis. Both generations block dopamine receptors, but second generations tend to act on serotonin receptors as well.

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