Antipsychotics

Antipsychotic is also known as major tranquilizersor or nerve blockers. It refers to a group of drugs used for the treatment of schizophrenia and other kinds of severe mental illness. It contains various types with commonly used including phenothiazine type and butyrophenone type such as chlorpromazine, thioridazine, perphenazine, trifluoperazine and haloperidol. Long-term use, mistakenly administration or attempted suicide causes swallowing of large doses of antipsychotic drugs, further resulting in Antipsychotics poisoning and producing a variety of neuropsychiatric disorders.

Pathogenesis
Antipsychotic drugs (especially phenothiazine-class drug) mainly take effect on the network structure. The ascending activation system in the network structure is related to the maintenance of the excitability and awareness states of the cerebral cortex while the descending system is related to the movement and behavior.

Therefore, upon overdose of antipsychotic causes inhibition of the cerebral cortex and subcortical center, further triggering disturbance of consciousness with sometimes inducing seizures. Antipsychotic drugs can inhibit the striatal dopamine but stimulate the acetylcholine. Administration of high doses can cause extrapyramidal symptoms. This group of drugs can inhibit the vasomotor center and block the α-adrenergic receptor, leading to vasodilation and reduced peripheral resistance. Therefore, large-dose administration can cause low blood pressure.

Clinical manifestations
Single time swallowing a large dose of antipsychotics (750 ~ 1000mg rear) cam cause acute poisoning, in addition to produce symptoms such as lower blood pressure and altered heart function, those major neuropsychiatric symptoms are:
First, psychiatric symptoms: acute poisoning victims mainly exhibit disturbance of consciousness. Upon light or moderate poisoning, it can be occurred of lethargy, apathy, weakness, irritability, excitement, anxiety as well as being restless. Patients of severe poisoning are characterized by disturbance of consciousness, drowsiness and coma.
Second, the neurological symptoms and signs: patients of mild poisoning may have ataxia, tremors and increased muscle tension, often accompanied by acute extrapyramidal symptoms, such as akathisia, eye crisis, spasmodic torticollis, opisthotonos, torsion spasms, myoclonus, etc. Patients of severe poisoning can exhibit seizures, miosis, hypotonia and disappearance of tendon reflexes and so on.

Diagnosis
First, for people of history of taking antipsychotic, they should be asked of medication time, dose and species, whether it is single-drug poisoning or mixed drugs poisoning. This is of great important for establishing the diagnosis, determining the disease condition as well as estimation of prognosis.
Second, the laboratory inspection: it will be good for diagnosis and prognosis to conduct qualitative or quantitative examination of urine or blood toxicant.
It should be noted to distinguish this from the poisoning of other kinds of drugs as well as disturbance of consciousness caused by organic brain disease. It can be distinguished mainly based medication history, the severity of extrapyramidal symptoms and toxicology analysis of urine and blood.

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Structure Chemical Name CAS MF
Ziprasidone hydrochloride monohydrate Ziprasidone hydrochloride monohydrate 138982-67-9 C21H24Cl2N4O2S
ILOPERIDONE ILOPERIDONE 133454-47-4 C24H27FN2O4
Duloxetine Duloxetine 116539-59-4 C18H19NOS
Risperidone Risperidone 106266-06-2 C23H27FN4O2
Quetiapine fumarate Quetiapine fumarate 111974-72-2 C25H29N3O6S
Ziprasidone Ziprasidone 146939-27-7 C21H21ClN4OS
Quetiapine Quetiapine 111974-69-7 C21H25N3O2S
lurasidone lurasidone 367514-87-2 C28H36N4O2S
10,11-Dihydro-11-oxodibenzo[b,f][1,4]thiazepine 10,11-Dihydro-11-oxodibenzo[b,f][1,4]thiazepine 3159-07-7 C13H9NOS
Lurasidone hydrochloride Lurasidone hydrochloride 367514-88-3 C28H37ClN4O2S
(R)-Duloxetine (R)-Duloxetine 116539-60-7 C18H19NOS
Tandospirone Tandospirone 87760-53-0 C21H29N5O2
Amisulpride Amisulpride 71675-85-9 C17H27N3O4S
Haloperidol Haloperidol 52-86-8 C21H23ClFNO2
Clozapine Clozapine 5786-21-0 C18H19ClN4
Diclofensine Diclofensine 67165-56-4 C17H17Cl2NO
Troparil Troparil 74163-84-1 C16H21NO2
SERTINDOLE SERTINDOLE 106516-24-9 C24H26ClFN4O
FLUSPIRILENE FLUSPIRILENE 1841-19-6 C29H31F2N3O
EQUILIN EQUILIN 474-86-2 C18H20O2
Trifluoperazine dihydrochloride Trifluoperazine dihydrochloride 440-17-5 C21H26Cl2F3N3S
Azaperone Azaperone 1649-18-9 C19H22FN3O
BROMPERIDOL BROMPERIDOL 10457-90-6 C21H23BrFNO2
Fupentixol dihydrochloride Fupentixol dihydrochloride 2413-38-9 C23H25F3N2OS.2ClH
Chlorpromazine hydrochloride Chlorpromazine hydrochloride 69-09-0 C17H20Cl2N2S
Zuclopenthixol Zuclopenthixol 53772-83-1 C22H25ClN2OS
PROCHLORPERAZINE MALEATE PROCHLORPERAZINE MALEATE 84-02-6 C28H32ClN3O8S
Chlorprothixene hydrochloride Chlorprothixene hydrochloride 6469-93-8 C18H19Cl2NS
Sulpiride Sulpiride 15676-16-1 C15H23N3O4S
FLUPHENAZINE HYDROCHLORIDE FLUPHENAZINE HYDROCHLORIDE 146-56-5 C22H28Cl2F3N3OS
Thioridazine hydrochloride Thioridazine hydrochloride 130-61-0 C21H27ClN2S2
ACEPROMAZINE MALEATE ACEPROMAZINE MALEATE 3598-37-6 C23H26N2O5S
Chlorpromazine Chlorpromazine 50-53-3 C17H19ClN2S
trimetozine trimetozine 635-41-6 C14H19NO5
Chlorprothixene Chlorprothixene 113-59-7 C18H18ClNS
PERPHENAZINE PERPHENAZINE 58-39-9 C21H26ClN3OS
Thioridazine Thioridazine 50-52-2 C21H26N2S2
clopenthixol clopenthixol 982-24-1 C22H25ClN2OS
Pimozide Pimozide 2062-78-4 C28H29F2N3O
Prochlorperazine Prochlorperazine 58-38-8 C20H24ClN3S
Promazine hydrochloride Promazine hydrochloride 53-60-1 C17H21ClN2S
Fluanisone Fluanisone 1480-19-9 C21H25FN2O2
Flupentixol decanoate Flupentixol decanoate 30909-51-4 C33H43F3N2O2S
Sultopride hydrochloride Sultopride hydrochloride 23694-17-9 C17H27ClN2O4S
Penfluridol Penfluridol 26864-56-2 C28H27ClF5NO
Aripiprazole Aripiprazole 129722-12-9 C23H27Cl2N3O2
(RS)-N-Methyl-gama-(1-naphthalenyloxy)-2-thiophenepropanamine hydrochloride (RS)-N-Methyl-gama-(1-naphthalenyloxy)-2-thiophenepropanamine hydrochloride 116817-11-9 C19H21NOS
MOSAPRAMINE MOSAPRAMINE 89419-40-9 C28H35ClN4O
acepromazine acepromazine 61-00-7 C19H22N2OS
DROPERIDOL DROPERIDOL 548-73-2 C22H22FN3O2
Trifluoperazine Trifluoperazine 117-89-5 C21H24F3N3S
triflupromazine triflupromazine 146-54-3 C18H19F3N2S
Pipotiazine Pipotiazine 39860-99-6 C24H33N3O3S2
Nemonapride Nemonapride 93664-94-9 C21H26ClN3O2
Tiapride Tiapride 51012-32-9 C15H24N2O4S
Tiapride hydrochloride Tiapride hydrochloride 51012-33-0 C15H25ClN2O4S
FLUPENTIXOL IMPURITY D FLUPENTIXOL IMPURITY D 791521-96-5 C25H29F3N2O2S
FLUPENTIXOL IMPURITY F FLUPENTIXOL IMPURITY F 756419-50-8 C23H25F3N2OS
TRIFLUPROMAZINE HYDROCHLORIDE TRIFLUPROMAZINE HYDROCHLORIDE 1098-60-8 C18H20ClF3N2S
loxapine loxapine 1977-10-2 C18H18ClN3O
trifluperidol trifluperidol 749-13-3 C22H23F4NO2
CIS-THIOTHIXENE CIS-THIOTHIXENE 3313-26-6 C23H29N3O2S2
CONCANAMYCIN A CONCANAMYCIN A 98932-70-8 C46H75NO14
Fluspiperone Fluspiperone 54965-22-9 C23H25F2N3O2
Acephenazine Acephenazine
Alseroxvlon Alseroxvlon
Levomepromazine maleate Levomepromazine maleate 7104-38-3 C23H28N2O5S
(-)-10-(3-[DIMETHYLAMINO]-2-METHYLPROPYL)-2-METHOXY-PHENOTHIAZINE MALEATE SALT (-)-10-(3-[DIMETHYLAMINO]-2-METHYLPROPYL)-2-METHOXY-PHENOTHIAZINE MALEATE SALT 60-99-1 C19H24N2OS
Promazine Promazine 58-40-2 C17H20N2S
7-HYDROXY RISPERIDONE 7-HYDROXY RISPERIDONE 147663-04-5 C23H27FN4O3
CLOTHIAPINE CLOTHIAPINE 2058-52-8 C18H18ClN3S
cis-Flupentixol hydrochloride cis-Flupentixol hydrochloride 51529-01-2 C23H26ClF3N2OS
FLUPHENAZINE FLUPHENAZINE 69-23-8 C22H26F3N3OS
HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE
PIPERACETAZINE (250 MG) PIPERACETAZINE (250 MG) 3819-00-9 C24H30N2O2S
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