create serious risk of oculogyric crisis and although these dystonic reactions are reversible, they irritate the patient substantially.
The first generation antipsychotic medications (FGAs), also commonly referred to as "neuroleptics," which include phenothiazines, butyrophenones
, and thiothixenes, treat many of the symptoms of psychosis but have undesirable side effects such as akathisia, tardive dyskinesia, dystonia, and parkinsonism, collectively referred to as "extrapyramidal side effects" (EPS).
High-potency typical antipsychotic medications, such as phenothiazines, butyrophenones
, and thioxanthenes are associated with hyperprolactinemia, whereas atypical antipsychotics, such as molindone, clozapine, olanzapine, quetiapine, ziprasidone, and aripiprazole are thought to have little if any effect.
In both groups, participants with the following conditions were excluded from the study: pregnancy or lactation, menstrual abnormalities, consumption of medications that affected serum PRL levels (i.e., antidepressants, antipsychotics, butyrophenones
, estrogens, H2 blockers, methyldopa, metoclopramide, phenothiazines, reserpine, verapamil, etc.), any condition that affected the evaluated hormones levels (including head trauma, prolactinoma, hypothalamus diseases, hypo/hyperthyroidism, and adrenal and renal diseases), and any malignancy or physical and psychiatric condition that could impair participation in the study.
Dopamine receptors are located in the chemoreceptor trigger zone and dopamine receptor antagonists primarily affect this area; however, high doses of dopamine receptor blockades result in extrapyramidal reactions, disorientation, and sedation, which limit the clinical use of such agents, including phenothiazines and butyrophenones
(droperidol and haloperidol) (8).
The most common drug classes for single-drug incidents were phenothiazines 84, tricyclic antidepressants 83, butyrophenones
74, paraaminophenols 62, benzodiazepines 46, carbamazepines 36, iron compounds 35, methoxybenzamides 27 and xanthines 27.
Anti-emetics The phenothiazines, butyrophenones
(such as droperidol) and metoclopramide, have all been known to cause drug induced PD, and can aggravate and intensify the patient's symptoms (Burton et al 2004).
Moreover, he was editor of important books of clinical psychopharmacology such as the Clinical handbook of psychopharmacology (Science House, New York, 1970) and Butyrophenones
in psychiatry (Raven Press, New York, 1972).
Haloperidol, a prototype of butyrophenones
, is a high-affinity [D.sub.2] postsynaptic receptor blocker.
Two major groups of neuroleptics are the phenothiazines and the butyrophenones
. (The phenothiazines are discussed in more detail in the earlier section on "Antihistamines.")
TABLE Physiologic, pharmacologic, and pathologic causes of an elevated serum prolactin level (1) PHYSIOLOGIC Pregnancy Ectopic pregnancy Lactation Nipple stimulation Stress Sleep disorder PHARMACOLGIC Dopamine receptor antagonists: phenothiazines, butyrophenones
, thioxanthene, risperidone, metoclopramide, sulpiride, pimozide Dopamine-depleting agents: [alpha]-methyldopa, reserpine Hormones: estrogens, antiandrogens Others: danazol, isoniazid, verapamil, cyproheptadine, opiates, H2-blockers (cimetidine), cocaine and marijuana, tricyclic antidepressants PATHOLOGIC Acromegaly Alcoholic cirrhosis Chest wall trauma or tumor Herpes zoster Hypothalamic and pituitary stalk disease Hypothyroidism Pituitary tumors: prolactinomas, adenomas Polycystic ovarian syndrome Renal failure Sarcoidosis
, which also work on the dopamine receptors, cause sedation as well as restlessness.