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First generation antipsychotics, also known as typical antipsychotics, have been used for decades to manage psychotic disorders. They primarily target dopamine receptors in the brain to reduce symptoms such as hallucinations and delusions. These medications are still relevant today, especially in resource-limited settings, due to their effectiveness and affordability.
Common First Generation Antipsychotics
- Chlorpromazine
- Haloperidol
- Fluphenazine
- Perphenazine
- Loxapine
Clinical Uses of First Generation Antipsychotics
These medications are primarily used to treat:
- Schizophrenia and other psychotic disorders
- Bipolar disorder during manic episodes
- Severe agitation and delirium
- Intractable hiccups (off-label use)
Mechanism of Action and Side Effects
First generation antipsychotics work mainly by blocking dopamine D2 receptors in the brain. While effective, they are associated with notable side effects, including:
- Extrapyramidal symptoms (EPS) such as tremors, rigidity, and tardive dyskinesia
- Sedation and drowsiness
- Anticholinergic effects like dry mouth and blurred vision
- Orthostatic hypotension
- Weight gain and metabolic changes (less common)
Monitoring and Considerations
Patients on first generation antipsychotics require regular monitoring for side effects, especially movement disorders. Clinicians must balance therapeutic benefits with potential risks and consider patient history when choosing appropriate medication.