Psychopharmacology Tips

• Constipation: encourage high-fiber diet, adequate fluid intake, use of aperients if persistent
• Fever: Symptomatic relief, check full blood count and look for sources of infection
• Hypersalivation: Consider use of hyoscine hydrobromide (upto 300 mcg tds), pirenzepine (upto 50 mg tds)
• Hypertension: Monitor closely, slow rate or halt dose increase, if persistent consider use of hypotensive agent (e.g., atenolol)
• Hypotension: advise caution when getting up quickly, monitor closely, slow or halt dose increase.
• Nausea: Consider use of antiemetic (avoid metoclopramide and prochlorperazine if previous problems with extrapyramidal side effects).
• Neutropenia/agranulocytosis: Stop Clozapine, if outpatient admit to hospital
• Nocturnal enuresis: avoid fluids in the evening, alter dose scheduling, if severe consider use of desmopressin
• Sedation: reschedule dosing to give smaller morning or total dose
• Seizures: Withhold clozapine for 24 hours, recommence at lower dose, consider prophylactic anticonvulsant
• Weight gain: Dietary and exercise counseling

Ref: - Semple, D., Smyth, R., Burns, J., Darjee, R. & McIntosh, A. (2005) Oxford Handbook of Psychiatry, New York: Oxford University Press.