# \[e-drug\] Anti-psychotics & extra-pyrimidal reactions **URL:** \ **Category:** e-drug\ **Created:** [January 24, 2005, 7:05pm UTC](https://talk.edrugplus.org/t/e-drug-anti-psychotics-extra-pyrimidal-reactions/21472 "2005-01-24T19:05:20Z")\ **Posts on this page:** 1\ **Page:** 1
**Author:** ![Olutayo\_Adetokunbo](https://avatars.discourse-cdn.com/v4/letter/o/4da419/32.png) [@Olutayo\_Adetokunbo](https://talk.edrugplus.org/u/Olutayo_Adetokunbo)\ **Post date:** [January 24, 2005, 7:05pm UTC](https://talk.edrugplus.org/t/e-drug-anti-psychotics-extra-pyrimidal-reactions/21472/1 "2005-01-24T19:05:20Z")
E-DRUG: Anti-psychotics & extra-pyrimidal reactions --------------------------------------------------- Dear fellow e-druggers, My intimate hospital experience (spanning over two decades) has demonstrated quite vividly that it is relatively easy to predict the likelihood of a patient developing some extra-pyramidal reactions to a specific anti-psychotic on the basis of chemical classification and dosage,(for instance, it is commoner to find higher incidences of such reactions associated with high doses of butyrophenones such as haloperidol, including its depot preps, the piperazine phenothiazines such as trifluoperazine, fluphenazine and its depot preps,and the dimethylaminopropyl phenothiazines such as chlorpromazine than with the piperidine phenothiazines such as thioridazine in equi-effective doses. But my concern arises out of the fact that many prescribers are unable to anticipate the occurrence of such reactions on the basis of patient-specific factors such as age group, gender,(race) etc.; and the sight of a patient experiencing anti-psychotic-induced EPS can be quite pathetic and bewildering to the uninitiated carer, care-giver or by-stander, even though recovery can be rather dramatic in many cases if the right doses of a suitable anti-muscarinic agent (and a benzodiazepine) are promptly administered via an appropriate route. Sometimes, experienced psychiatrists prepare the minds of their patients, considered vulnerable, for such possibility by prescribing a few doses of oral benzhexol (a.k.a. trihexylphenidyl in the U.S.) to be used if and whenever such reactions occur. (In the past, benztropine mesylate was available in this hospital but not popular. Most other non-specialist prescribers don't. Prophylactically co-administering anti-muscarinics with anti-psychotics is fraught with its own hazards which may include symptoms of atropine-like over-dosage such as mouth/throat dryness, blurred vision, mental confusion, staggering, constipation, skin flushing, urinary retention, restlessness/excitement, etc.; and thus cannot be a clinically appropriate solution. (Anti-muscarinic abuse is also possible due to their mood-altering properties). Does anyone have any experience worth sharing or evidence-based and technically logical principles that can serve as a reasonable guide in coping with such challenges? Please, take note of our peculiarly resource-poor setting. I also wish someone kindly assist me retrieve the detailed reports on the type and incidence of extra-pyramidal reactions stated to be contained in MARTINDALE-The Extra Pharmacopoeia 26th Edition, p.1814 Thank you. Best regards. Sincerely, Olutayo Adetokunbo Moronkeji, Pharmacist OAUTH Wesley Guild Hospital, Ilesa, NIGERIA. oamoronkeji@yahoo.com