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TABLE 2

Antipsychotic Adverse Symptoms

NeurotransmitterSymptomsAntipsychotics Commonly Associated With Symptom
Dopamine   
 Nigrostriatal tract Extrapyramidal symptoms (eg, dystonia, dyskinesia, akathisia, Parkinsonism) High-potency “typical” antipsychotics (haloperidol) 
 Tuberoinfundibular tract Hyperprolactinemia All “typical” antipsychotics, risperidone 
 Preoptic tract Hypothermia Rare, possibly more common with atypical antipsychotics 
Acetylcholine (muscarinic) Sinus tachycardia, dry mucous membranes, mydriasis, urinary retention Low-potency “typical” antipsychotics (chlorpromazine) 
α-Adrenergic Orthostatic hypotension, reflex tachycardia Atypical antipsychotics 
Histamine Sedation “Typical” antipsychotics 
Mechanism unknown   
 Potential etiology: Pancreatic versus CNS adrenergic α1, α2, dopamine D2, muscarinic, histamine H1, serotonin1, serotonin2, or serotonin6 Wt gain, obesity, hyperlipidemia, metabolic syndrome, impaired glucose tolerance, hyperglycemia, type 2 diabetes Atypical antipsychotics 
Highest risk: clozapine, olanzapine 
Lower risk: quetiapine, risperidone 
Lowest risk: ziprasidone, aripiprazole 
NeurotransmitterSymptomsAntipsychotics Commonly Associated With Symptom
Dopamine   
 Nigrostriatal tract Extrapyramidal symptoms (eg, dystonia, dyskinesia, akathisia, Parkinsonism) High-potency “typical” antipsychotics (haloperidol) 
 Tuberoinfundibular tract Hyperprolactinemia All “typical” antipsychotics, risperidone 
 Preoptic tract Hypothermia Rare, possibly more common with atypical antipsychotics 
Acetylcholine (muscarinic) Sinus tachycardia, dry mucous membranes, mydriasis, urinary retention Low-potency “typical” antipsychotics (chlorpromazine) 
α-Adrenergic Orthostatic hypotension, reflex tachycardia Atypical antipsychotics 
Histamine Sedation “Typical” antipsychotics 
Mechanism unknown   
 Potential etiology: Pancreatic versus CNS adrenergic α1, α2, dopamine D2, muscarinic, histamine H1, serotonin1, serotonin2, or serotonin6 Wt gain, obesity, hyperlipidemia, metabolic syndrome, impaired glucose tolerance, hyperglycemia, type 2 diabetes Atypical antipsychotics 
Highest risk: clozapine, olanzapine 
Lower risk: quetiapine, risperidone 
Lowest risk: ziprasidone, aripiprazole 
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