Indications

• Bipolar Disorder-Acute Manic or Mixed (see Bipolar Disorder, [[Bipolar Disorder]])
• Irritability Associated with Autism
• Psychosis (see Psychosis, [[Psychosis]])
• Schizophrenia, see Schizophrenia, [[Schizophrenia]])

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Contraindications

• Dementia-Related Psychosis
  • Increased Risk of Cerebrovascular Accident (CVA) When Used in Elderly Patients with Dementia-Related Psychosis
  • Increased Mortality in When Used in Elderly Patients with Dementia-Related Psychosis

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Pharmacology

• Atypical Anti-Psychotic Agent
  • Dopamine D2 Receptor Antagonist
  • Serotonin 5HT2 Receptor Antagonist
  • Also binds to α1/α2 adrenergic and H1 histamine receptors

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Administration

• PO (acute mania): starting dose of 1 mg BID -> increase dose qday by adding 0.25 mg BID to max dose of 6 mg/day

Dose Adjustment

• Patient >65 y/o: lower starting dose to 0.5 BID
• Hepatic: lower starting dose to 0.5 mg PO BID
• Renal: lower starting dose to 0.5 mg PO BID

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Adverse Effects

Cardiovascular Adverse Effects

• Hypotension/Orthostatic Hypotension (see Hypotension, [[Hypotension]])

Endocrinologic Adverse Effects

• Hyperglycemia (see Hyperglycemia, [[Hyperglycemia]])
• Hyperlipidemia (see Hyperlipidemia, [[Hyperlipidemia]])
• Hyperprolactinemia (see Hyperprolactinemia, [[Hyperprolactinemia]])
• Weight Gain (see Weight Gain, [[Weight Gain]])

Gastrointestinal Adverse Effects

• Esophageal Dysmotility/Dysphagia (see Dysphagia, [[Dysphagia]])
• Nausea/Vomiting (see Nausea and Vomiting, [[Nausea and Vomiting]])

Hematologic Adverse Effects

• Leukopenia/Neutropenia (see Leukopenia, [[Leukopenia]] and Neutropenia, [[Neutropenia]])

Neurologic Adverse Effects

• Akathisia (see Akathisia, [[Akathisia]])
• Dizziness (see Dizziness, [[Dizziness]])
• Extrapyramidal Symptoms/Dystonia
• Increased Risk of Cerebrovascular Accidents (CVA) in Elderly Patients with Dementia-Related Psychosis (see Ischemic Cerebrovascular Accident, [[Ischemic Cerebrovascular Accident]])
• Parkinsonism (see Parkinson’s Disease, [[Parkinsons Disease]])
• Seizures (see Seizures, [[Seizures]])
• Somnolence: may be associated with impaired cognition, judgement, and motor skills
• Tardive Dyskinesia
• Tremor

Renal Adverse Effects

• Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]])

Rheumatologic/Orthopedic Adverse Effects

• Rhabdomyolysis (see Rhabdomyolysis, [[Rhabdomyolysis]])

Other Adverse Effects

• Hypothermia (see Hypothermia, [[Hypothermia]])
• Increased Mortality in Elderly Patients with Dementia-Related Psychosis
• Neuroleptic Malignant Syndrome (see Neuroleptic Malignant Syndrome, [[Neuroleptic Malignant Syndrome]])
• Priapism

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References

• Atypical Antipsychotic Drugs and the Risk for Acute Kidney Injury and Other Adverse Outcomes in Older Adults: A Population-Based Cohort Study. Ann Intern Med. 2014;161(4):242-248. doi:10.7326/M13-2796