Phenothiazine Antipsychotics

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

What are the side effects of phenothiazine antipsychotics?

There are many side effects of phenothiazine antipsychotics. Common side effects include:

Phenothiazine antipsychotics may cause extra-pyramidal symptoms such:

  • as abnormal muscle contractions,
  • difficulty breathing and swallowing,
  • neck spasms, and
  • movement abnormalities on face, arms, and legs.

Constipation also is common.

Phenothiazine antipsychotics can also cause neuroleptic malignant syndrome (NMS), which include symptoms of:

All phenothiazine antipsychotics carry a boxed warning of increased deaths in elderly patients when used for dementia-related psychosis.

What drugs interact with phenothiazine antipsychotics?

Phenothiazine antipsychotics should not be combined with other antipsychotics or medications that cause extra-pyramidal side effects and neuroleptic malignant syndrome due to an increased likelihood of these side effects.

Phenothiazine antipsychotics should be used with caution with medications (for example, fluoxetine [Prozac, Sarafem, Prozac Weekly]) that reduce the activity of liver enzymes that eliminate phenothiazines because levels of phenothiazines can increase and lead to more side effects.

Phenothiazines affect heart rhythm and the risk of abnormal heart rhythms, especially when they are combined with other drugs that also affect heart rhythm. Examples include:

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