Side Effects (SE)

• Acute Dystonia
  • Patient taking a 1st gen antipsychotic given a CYP2D6 inhibitor and metabolized (paroxetine/fluoxetine, Beta-Blockers)
  • Treatment
    • Anticholinergics
    • Benadryl
• Akathisia
  • Typical ≥ Atypicals
  • Pacing, restolessness
  • Treatment
    • 1) Decrease Dose of Antipsychotic
      • If it is managing symptoms well
    • 2) Switch to lower EPS drug
    • 3) Add low dose BB, Benzodiazepine, or Benztropine, Clonidine
• Aplastic Anemia
  • Carbamazepine, methimazole, NSAIDs, benzene, chloramphenicol, cytostatic drugs, PTU
• Depression
  • Corticosteroids, interferon, lidocaine, procainamide, beta blockers, reserpine, chloroquine, mefloquine
• Drug Associated Autoimmune Vasculitis
  • Hydralazine
• Drug-Induced Diabetes
  • Steroids, Calcineurin Inhibitors, Protease Inhibitors, NRTIs, Niacin, Statins, BBs, Thiazides, Vasopressors, Oral Contraceptives, Progetin Megestrol, GH, Atypical Antipsychotics, Moxifloxacin
• Elevated LFTs (DILI)
  • Allopurinol, amiodarone, amoxicillin clavulanate, anabolic steroids, atorvastatin, azathioprine, carbamazepine, chlorpromazine, dantrolene, diclofenac, disulfiram, erythromycin, hydralazine, ibuprofen, infliximab, interferon beta, isoniazid, ketoconazole, methotrexate, methyldopa, nitrofurantoin, phenytoin, PTU, rifampin, simvastatin, TCAs (0.1%), TMP SMX, sulfasalazine, sulfonamides, valproate
  • Azithromycin, heparin, imatinib, levofloxacin, oxacillin, phenobarbital, tamoxifen, terbinafine
  • Macrolides, tetracyclines, metoclopramide, chlorpromazine, Augmentin
• Erectile disorder
  • Antihypertensives (Propranolol): Decreased NE - B
  • Antihypertensives (Methyldopa): Increased central NE - a
  • Antidepressants (fluoxetine): Increased serotonin
  • Antipsychotics (Thioridazine): Decreased Dopamine
• Inhibited ejaculation
  • Antidepressants (Fluoxetine): Increased Serotonin
  • Antipsychotics (Thioridazine): Decreased Dopamine
• Inhibited orgasm
  • Antidepressants (Fluoxetine): Increased Serotonin
• Libido
  • Reduced
    • Antidepressants (Fluoxetine): Increased serotonin
    • Antihypertensives (Propranolol): Decreased NE - B
    • Antihypertensives (Methyldopa): Increased central NE - a
  • Increased
    • Antiparkinsonian (Levodopa): Increased Dopamine
• Mania/Psychosis
  • Cocaine, pcp, synthetic cannabinoids, corticosteroids, levothyroxine, dopaminergic anti-parkinsonian drugs (levodopa)
• Pancytopenia
  • Mycophenolate Mofetil
• Parkinsonism
  • Treatment
    • 1) Decreased Dose of Antipsychotic
    • 2) Switch to lower EPS drug
    • 3) Add Benztropine ≥ Amantadine

• Priapism

  • Persistent, painful erection that develops without sexual stimulation and has a long duration
  • Antidepressants (Trazodone, SSRIs): Increased Serotonin
  • Phosphodiesterase Inhibitors (Sildenafil)
  • Stimulants (Methylphenidate, Cocaine)
  • Medical: Leukemia, Sickle Cell disease
  • Surgical: Perineal or genital trauma
  • Neurogenic: Cauda Equina Syndrome
• Pseudo-parkinsonism
  • Women 2x more likely
  • Symptoms
    • Bradykinesia
  • Treatment
    • Anticholinergics
    • Benadryl
    • Amantadine
• SJS/TEN
  • Lamotrigine, carbamazepine, phenytoin, phenobarbitone
  • Allopurinol if ≥100mg/day
  • Cotrimoxazole, sulfasalazine
  • Penicillin’s, cephalosporins, quinolones, minocycline
  • Tylenol, Nevirapine, NSAIDs, Contrast
• Thrombocytopenia
  • Linezolid
• Vaginal dryness
  • Antihistamine (Diphenhydramine): Decreased Histamine
  • Anticholinergic (Atropine): Decreased Acetylcholine