Anticholinergic symptoms of dry mouth, constipation, urinary retention and blurred vision.
Extrapyramidal side effects. This may include muscle stiffness (drug-induced Parkinsonism) which may have a marked impact on mobility after brain injury which can lead to an increased risk of falls. These symptoms are alleviated following withdrawal of the drug.
Akathisia : a highly unpleasant subjective sensation of motor restlessness. Akathisia is dose-related and can cause or contribute to agitation and insomnia but is often under-reported even in patients without cognitive or communication difficulties.
Tardive Dyskinesia: ‘a rhythmic involuntary movement of tongue, face and jaw which usually develops on long term therapy or with high dosage. However, it may develop on short term treatment with low doses’ (BNF). Withdrawal of antipsychotics may exacerbate Tardive Dyskinesia in those who have been on this type of medication for some time.
Dystonias i.e. involuntary, painful muscle contractions, abnormal postures and/or tremor.
Difficulties eating, drinking and swallowing (Dysphagia). This increases the risk of malnutrition, confusion and chest infections (risk of aspiration).
Hypersalivation: this can be socially distressing and may increase risk of aspiration and chest infection if the patient is dysphagic.
Increased risk of weight gain, type II diabetes and hypercholesterolemia.
Increased cardiovascular risk, particularly at high doses, including hypotension, tachycardia, prolonged QTc interval and other arrhythmias. ECG monitoring is essential.
On rare occasions the patient may develop Neuroleptic Malignant Syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, autonomic dysfunction, tachycardia and sweating). The development of this syndrome is potentially fatal and emergency treatment is required.
