Side-effects of antipsychotics
Tremors, muscle stiffness and tics can occur. The higher the dose, the more severe these effects. The risk of these effects may be lower with the second generation medications than with the older drugs. Other drugs (e.g., benztropine [Cogentin]) can be used to control the movement effects.
Feelings of dizziness may occur, especially when getting up from a sitting or lying position.
Some of the second generation drugs are thought to affect people’s sense of having had enough to eat. They can also be sedating. These two effects can result in weight gain, which can increase a person’s risk of diabetes and heart disease.
Schizophrenia is a risk factor for diabetes. Antipsychotic drugs can increase this risk.
Agitation and sedation
Some people feel “wired” and unable to stop moving when taking antipsychotics. This effect may be mistaken for a worsening of illness rather than a side-effect of the medication. These same drugs can also have the opposite effect, making people feel tired. Some people may feel either wired or tired, and some may feel both at the same time.
For every year that a person takes anti-psychotic medication, there is a five per cent chance of developing tardive dyskinesia (TD), a condition that causes people to have repetitive involuntary movements. The risk of TD is highest with the first generation antipsychotics, although it can occur with the second generation drugs. TD can worsen when you stop taking medication and can be permanent.
Neuroleptic malignant syndrome
This rare but serious complication is usually associated with the use of high doses of typical antipsychotics early in treatment. Signs include fever, muscle stiffness and delirium.
Antipsychotic medication can cause unpleasant side-effects, especially when the symptoms are severe and a higher dose of medication is used. Side-effects should become mild or at least tolerable when the dose is reduced and as your body adjusts to the presence of the drug. Most side-effects will go away when you stop taking the drug. There is a risk, however, of a condition that causes people to make involuntary movements, known as tardive dyskinesia, which can be permanent.
Some people accept the side-effects as a trade-off for the relief these drugs can bring. Others find the side-effects distressing and may choose not to take the medication.
Check the information given to you by your doctor or pharmacist to find out the specific side-effects of any drug you have been prescribed. If you are troubled by any of these effects, it is best to continue to take your medication as prescribed and let your doctor know as soon as possible. Your doctor may:
- adjust your dose
- prescribe other medications to help control side-effects
- change your medication.
You can help to control possible side-effects on your own by: getting regular exercise and eating a low-fat, low-sugar, high-fibre diet (e.g., bran, fruits and vegetables) to reduce the risk of diabetes and help prevent weight gain and constipation, using sugarless candy or gum, drinking water and brushing your teeth regularly to increase salivation and ease dry mouth, getting up slowly from a sitting or lying position to help prevent dizziness.
Will antipsychotics interact with other medications?
Antipsychotics may interact with other medications prescribed by your doctor or dentist or purchased at a drug store, and with herbal remedies or street drugs. Make sure you tell your doctor about all drugs you are taking.
Always ask your doctor or pharmacist about potential interactions before taking any medications or herbal remedies, including cold or allergy tablets or cough syrups.
Antacids can interfere with absorption of antipsychotics and decrease their effect. If you are taking antacids, you can avoid this by taking them at least two hours before or one hour after taking your medication.
What if I smoke cigarettes or drink coffee or alcohol while taking antipsychotics?
Smoking cigarettes can increase how quickly some antipsychotics are broken down by the body, meaning that people who smoke heavily may need more medication than those who do not. Drinking coffee has the opposite effect, slowing down the breakdown of antipsychotics. If you change how many cigarettes you smoke or how much coffee you drink, let your doctor know as he or she may need to adjust your dose.
Antipsychotic drugs may increase the effects of alcohol, making you more sleepy, dizzy and lightheaded. Having one or two drinks on occasion should be okay—but remember that one drink may have the effect of two or even three drinks.
Smoking and problems with alcohol are more common among people with schizophrenia than they are in the general population. The reason for this is unclear; what is clear is that smoking reduces life expectancy and alcohol can make it even more challenging to manage the symptoms of schizophrenia. Being open and honest about your smoking and drinking lets your doctor know how you are doing and helps him or her to determine whether your medication needs to be adjusted. Talking to your doctor can also give you a chance to think about whether you want to cut down or stop smoking or drinking.
What if I use street drugs while taking antipsychotics?
Some street drugs, such as marijuana, cocaine and amphetamines, may have effects that feel good in the short term, but they can cause symptoms to return or worsen. Using these drugs increases the risk of psychosis, even in people who do not have schizophrenia or another mental health problem. Street drugs may also interfere with your medication or worsen side-effects.
Will taking antipsychotics affect my ability to drive safely?
Antipsychotic drugs can be sedating, so it’s a good idea not to drive or operate other machinery until you know how the medication affects you.
Will taking antipsychotics affect my sex drive and function?
People who take antipsychotics can experience decreased sex drive or even problems in sexual functioning. Men may have difficulty getting or keeping an erection or ejaculating. Women may be unable to have an orgasm. Let your doctor know if you experience these side-effects. Often an adjustment in dose or change of medication can help.These drugs can also cause irregular periods and false-positive pregnancy results in women.
Is it safe to take antipsychotics while pregnant or breastfeeding?
Each woman’s situation is unique and should be discussed with her doctor. For any pregnant woman with a history of psychosis, the question of taking antipsychotics during pregnancy usually comes down to a risk-benefit analysis. Psychosis can affect prenatal care and a mother’s ability to parent her newborn child. When treatment with an antipsychotic helps to avoid a relapse or to reduce distress, the benefits of continuing the medication may outweigh the risks.
Antipsychotics are relatively safe to use during pregnancy and while breastfeeding. If used in high doses close to delivery, the baby may be born with temporary breathing difficulties and/or withdrawal symptoms (e.g., restlessness, feeding problems). Antipsychotic medications pass into breast milk and, depending on the dose, may cause drowsiness in the baby. There are ways, however, to minimize and manage the short-term symptoms that may occur. Your doctor can help you to choose the safest type of medication to take during pregnancy and breastfeeding and to find a dose that will provide the maximum benefits with the minimum risk.
If you decide to stop taking medications during pregnancy or while breastfeeding, it is a good idea to see your doctor more often to help you monitor for a return of symptoms.
Is age an issue?
The effectiveness and risks of antipsychotic medication can vary depending on the age of the person taking it.
Children and teens
Antipsychotics can be used to treat children and teens with severe psychiatric disorders such as psychosis, bipolar disorder, Tourette’s syndrome, autism or severe aggression. Most often, psycho-therapy also has an important role. Children and teens are more likely than adults to experience side-effects from these medications, especially the second generation (atypical) antipsychotics.
As people age into their 60s and older, they become more sensitive to medication and may require a lower dose. Being more sensitive also means that older people are more likely to experience side-effects than when they were younger. They are also more likely to have other medical problems and to be taking other medications, which could interact with antipsychotic drugs. Antipsychotics can increase the risk of falls, especially when taken with other drugs.
Tardive dyskinesia and other movement-related side-effects can develop in older adults who have used antipsychotics over a long period. Women are twice as likely as men to experience these effects.
Antipsychotic medications are sometimes used to calm older adults with psychosis related to dementia. However, use of antipsychotics by older adults has been associated with an increased risk of stroke. Other ways of calming the person should always be tried first, and when antipsychotics are needed, they should only be used until symptoms are relieved.