Posted by ed_uk on November 5, 2005, at 18:49:35
In reply to Trilafon, posted by med_empowered on November 5, 2005, at 17:38:19
Hi Med!
>I just thought Trilafon since its a little better studied than the other old ones...
As far as I can tell, haloperidol is one of the most thoroughly studied APs of all. It's become the 'gold standard' treatment for schizophrenia, all new drugs are compared with haloperidol.
>the CATIE study made it seem like a viable option in some cases
I agree. Perphenazine is reasonably well tolerated by some patients at low doses. Of course, the risk of TD is high. Haloperidol resembles perphenazine quite closely: potent D2 antagonism, minimal anticholinergic effects, minimal alpha blockade etc.
>I imagine Haldol side effects are largely due to dosing...that said, there are supposedly differences among the old drugs; Mellaril causes less EPS
Thioridazine causes less EPS because it's strongly anticholinergic. Chlorpromazine (Largactil) is second in line. Haloperidol, perphenazine, and similar drugs cause the most EPS ........because their anticholinergic properties are minimal. Due to the long-standing tendency of doctors to routinely (and often inadvertently) 'overdose' patients on haloperidol, it has aquired a particularly sinister reputation for causing serious side effects. In reality, at comparable doses, haloperidol causes a similar incidence of side effects to the other medium/high potency typical neuroleptics.
All typical APs are relatively potent D2 antagonists, the degree of acute EPS is largely determined by how anticholinergic they are. This does not apply to atypical APs. Anticholinergic APs, such as chlorpromazine, are probably just as likely to cause TD as the less anticholinergic APs, despite the lower incidence of acute EPS.
As a side note, I've had some very bad experiences with neuroleptics myself. I have discovered (the hard way) that the clinical effects of neuroleptics are intensely dose dependent.
Kind regards
Ed x
poster:ed_uk
thread:574968
URL: http://www.dr-bob.org/babble/20051031/msgs/575736.html