Handouts · Medications
First-Generation (Typical) Antipsychotics
Includes haloperidol, fluphenazine, perphenazine, and chlorpromazine. Effective older antipsychotics; main trade-off is a higher chance of movement side effects.
What This Group Is
These older antipsychotics block dopamine strongly and are very effective for psychosis and severe agitation.
They cause less weight gain than newer ones, but are more likely to cause muscle and movement side effects.
How to Take It
Take as prescribed, by mouth or as a long-acting injection. Take with or without food.
Do not stop suddenly. Tell us early about any stiffness, tremor, or restlessness — these are often treatable.
Black Box Warning
Not approved for dementia-related psychosis in older adults — it raises the risk of death in that group.
Common (Usually Mild) Side Effects
- Stiffness, tremor, or slowed movement (like Parkinson’s) — often eased with another medicine.
- Restlessness (akathisia).
- Drowsiness, dizziness on standing.
- Higher prolactin: breast changes, milk production, cycle changes, low libido.
Serious — Call Us or Seek Care
- Dystonia: sudden muscle spasms of the neck, jaw, or eyes — seek care promptly.
- Tardive dyskinesia: lasting involuntary movements — risk is higher than with newer agents.
- NMS: high fever, severe stiffness, confusion — an emergency.
- Fainting or irregular heartbeat.
Alcohol
Avoid or limit alcohol — it worsens drowsiness and dizziness.
Recommended Monitoring
• Movement screening (AIMS) for tardive dyskinesia
• EKG — especially with haloperidol or IV dosing (rhythm/QT)
• Weight, glucose, and lipids per general antipsychotic guidelines
• Blood pressure and heart rate