TBI-ATYPICAL ANTIPSYCHOTIC AGENTS

SUMMARY

1. Risperidone (Risperdal): initial insomnia, agitation, hypotension, which resolves with time. Increased prolactin levels. Greatest evidence in the TBI population.

2. Quetiapine (Seroquel): very sedating; therefore, often used for sleep. Minimal motor side effects or prolactin elevation. Lower likelihood of inducing EPS. Initial anticholinergic side effects (syncope, hypotension).

3. Olanzapine (Zyprexa): dose-related EPS, though less than risperidone (above 7.5 mg). Somnolence and gait disturbances are common; therefore, best if given at bedtime. High rate of metabolic side effects and weight gain. Short-acting IM form.

4. Clozapine (Clozaril): serious side effects including agranulocytosis (monitor WBCs every 2 weeks), cardiac effects, lowered seizure threshold; intense monitoring required. Most anti-cholinergic activity of all atypical antipsychotics causing sedation. Most weight gain due to antihistamine properties.

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.