Drugs with the fastest onsets include haloperidol, risperidone, and olanzapine, with onsets appearing in 2 6 days.
Among typical antipsychotics, haloperidol is the drug of choice in the rapid tranquilization setting. Another option is zuclopenthixol acetate, another high potency typical agent. Compared to haloperidol, it has a longer duration of action (48-72 hours) and a longer and less predictable onset.
Ziprasidone. Ziprasidone primarily acts as a dopamine/ serotonin antagonist. It has low potential for causing extrapyramidal symptoms and was the first atypical antipsychotic made available in rapid-acting intramuscular formulation, with an onset of action of 30–45 minutes ( Battaglia 2005).
Apart from clozapine, the following two drugs—aripiprazole and paliperidone—have been shown to be most effective, whereas quetiapine, ziprasidone and haloperidol displayed a relatively short time to discontinuation.
Antipsychotic medications can help to calm and clear confusion in a person with acute psychosis within hours or days, but they can take up to four or six weeks to reach their full effect. These medications can help to control symptoms, but they do not cure the underlying condition.
Risperidone is a medication taken by mouth, widely used for treating people manage the symptoms of psychosis. As well as being an antipsychotic (preventing psychosis), it also could calm people down or help them to sleep.
In general, the high-milligram, low-potency antipsychotics, such as chlorpromazine and mesoridazine, produce more sedation than the low-milligram, high-potency antipsychotics such as haloperidol and fluphenazine (Table 1). This principle tends to hold true for the atypical antipsychotics as well.
Quetiapine abuse is relatively common, and is abused far more often than any other second-generation antipsychotic.
Fluphenazine (Prolixin): This drug treats schizophrenia and psychotic symptoms such as hallucinations, delusions, and hostility. Haloperidol (Haldol): Doctors prescribe this drug to treat psychotic disorders, tics associated with Tourette's syndrome, and severe behavioral problems in children.
In that study, amisulpride was found more effective than quetiapine in general and olanzapin was found superior to risperidone and haloperidol in the treatment of negative symptoms. It is recommended, therefore, to consider side effects as one of the priorities when selecting an antipsychotic.
There are now 9 available FDA-approved second-generation long-acting injectable antipsychotics including aripiprazole (3), olanzapine (1), paliperidone (3), and risperidone (2). These high-cost medications are commonly used with the goal of improving adherence and patient outcomes.
The review of available evidence found that combinations of antipsychotics may be more effective in treating symptoms of schizophrenia compared with taking one antipsychotic. In particular, combination treatments that included clozapine and typical antipsychotic in both groups were found to be effective.
Conventional antipsychotics (termed typical or first-generation antipsychotics [FGAs] (i.e., haloperidol, chlorpromazine)), act on the dopaminergic system by blocking the dopamine type 2 (D2) receptors.
Benzodiazepines most commonly used to treat anxiety disorders are clonazepam (Rivotril)*, alprazolam (Xanax) and lorazepam (Ativan). Also used are bromazepam (Lectopam), oxazepam (Serax), chlordiazepoxide (once marketed as Librium), clorazepate (Tranxene) and diazepam (Valium).
antidepressants – used to treat depression, anxiety and some types of personality disorders. antipsychotics – used to treat schizophrenia and sometimes bipolar disorder and to help restore your brain's chemical balance. mood stabilisers – often used to treat people with bipolar disorder.
Clozapine is the most effective antipsychotic in terms of managing treatment-resistant schizophrenia. This drug is approximately 30% effective in controlling schizophrenic episodes in treatment-resistant patients, compared with a 4% efficacy rate with the combination of chlorpromazine and benztropine.
Several studies even indicate that Seroquel is the most commonly abused atypical antipsychotic. Abuse can lead to addiction that requires treatment and therapy in a rehab facility.
Midazolam is the fastest acting of its class because of its lipophilic abilities, and it is superior to lorazepam and diazepam in its amnestic effects, making it the ideal benzodiazepine for use in short ED procedures.
A benzodiazepine (lorazepam) is the drug of choice to achieve rapid tranquilisation. Benzodiazepines are best avoided if delirium is diagnosed or suspected.
Antipsychotics. There is currently only one antipsychotic, trifluoperazine, a first-generation antipsychotic (FGA), which is FDA-approved for the treatment of anxiety.
For people with schizophrenia it may be important to know that aripiprazole may not be as good or effective as olanzapine but that it has less side effects. Aripiprazole is similar in effectiveness to risperidone and somewhat better than ziprasidone.
The U.S. Food and Drug Administration (FDA) approved Rykindo as an extended-release injectable version of risperidone on January 15, 2023, according to a press release from Luye Pharma, the company that developed the drug.