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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Klavot on February 9, 2007, at 12:04:36
What exactly is the distinction between typical and atypical antipsychotics?
Klavot
Posted by Phillipa on February 9, 2007, at 12:48:22
In reply to Difference between typical / atypical APs?, posted by Klavot on February 9, 2007, at 12:04:36
Old vs new where the old had more tydive dyskenesia and dystonia and the other neuroleptic side effects. And I think they were stronger and more dangerous not sure though. Love Phillipa
Posted by med_empowered on February 9, 2007, at 12:51:22
In reply to Difference between typical / atypical APs?, posted by Klavot on February 9, 2007, at 12:04:36
OK...here's the thing: there are actually alot of differences amongst all the "typical" APs. For instance: Mellaril is slightly atypical and causes less EPS than a lot of other meds. Haldol is super-high potency and causes lots of problems; Loxapine and Moban are both somewhat atypical, and some drugs that aren't usually considered neuroleptics (surmontil, asendin) can be used in some cases of psychosis. Its all very confusing.
Generally speaking, atypical antipsychotics: have significant serotonin antagonism, don't cause marked EPS as effective dosages, carry a lower risk of TD than older meds, and may be somewhat more effective on mood and/or anxiety symptoms than older meds. But...like I said..there's a lot of variation; low-to-mid dose perphenazine, for instance, performed about as well as Zyprexa in the CATIE study. Haldol+benztropine did about as well as zyprexa in another study. One common characteristic seems to be less D2 blockade at common dosage and a lot of them only block D2 for a while, whereas older drugs tend to stick around in the receptor 24/7. Abilify is an exception; at the higher end of the dosages, it can block 90% or more D2 receptors without the EPS you'd expect, b/c of its partial agonism. But then again, Abilify also causes marked akathisia, so time will tell just how tolerable and wonderful it turns out to be.
It could just be that the serotonin activity plus built-in anticholinergic action that some have (zyprexa, seroquel) dampens down EPS, in the same sense that adding BuSpar and benztropine to, say, a low-dose of Haldol might also make it more tolerable.
Posted by munificentexegete on February 9, 2007, at 21:01:44
In reply to Difference between typical / atypical APs?, posted by Klavot on February 9, 2007, at 12:04:36
> What exactly is the distinction between typical and atypical antipsychotics?
>
> Klavottechnically it is where a greater number of receptors are targeted. where as typicals went after dopamine, atypicals such as the first and achetypal clozapine also go after serotonin, achetocholine, adrenaline and histamines. the dose of atypicals prescribed usually results in less than 80% d2 occupancy and therefore less instantaneous eps, but this is more a dose related phenomenon rather than any special characteristic of the atypicals.
This is the end of the thread.
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