* Neuroleptic have as main action to block central dopaminergic receptors

* Atypical antipsychotics have a lower risk of neurological side effects in individuals and can be used as first-line (riserpéridone, olanzapine; sulpiride)


– Action psycholeptic (=> psychomotor indifference) without hypnotic action

– Reduction of the agitation and aggression

– Reducing action on acute and chronic psychoses

– Are the original production of neurological and autonomic side effects

– Have a dominant subcortical Action

* Act in mesocortical regions and mesolimbic and nigrostriatal (extrapyramidal side effects) and at the tuberoinfundibular system (hyper-prolactin levels, elevated GH).

* They can block other receptors and muscarinic cholinergic; adrenergic (α1); histamine (H1 above).

* Butyrophenones (Haldol) shows the most effective anti-hallucinatory effect and fastest

1- Classification:

A- NL (Neuroleptic) sedative:

* Levomepromazine (Nozinan®)

* Chlorpromazine (Largactil®)

* Sulpiride (Dogmatil®) high dose

B- NL déshinibiteur:

Sulpiride (Dogmatil®) Low dose

C- polyvalent NL:

Haloperidol (Haldol)

2- secondary effects:

Action strong autonomic => Orthostatic hypotension:

Phenothiazines -> Chlorpromazine (Largactil®) / Levomepromazine (Nozinan®)

Hyperkinetic syndrome:

Butyrophenones -> Haloperidol (Haldol)

Akineto-hypertonic syndrome:

Benzamides -> Sulpiride (Dogmatil®)

3- Other side effects:

* Extrapyramidal syndrome (early or late)

* Anticholinergic (atropine): constipation, dry mouth, retrograde ejaculation, confusion, glaucoma, urinary retention …

* Epilepsy (lower the seizure threshold)

* Cardiovascular: orthostatic hypotension (α-adrenergic blocking agent); sinus tachycardia; QT prolongation

* Endocrine effects: generated by hyperprolactinemia (frigidity, impotence, gynecomastia, galactorrhea, dysmenorrhea); obesity

* Skin manifestations: purple color of the face; photosensitivity;

* Blood Accidents

* Blood Accidents: benign leukopenia with relative lymphocytosis; agranulocytosis

* Digestive complications: cholestatic or cytolytic hepatitis; paralytic ileus

Malignant syndrome:

Hyperthermia with profuse sweating, paleness, very important extrapyramidal stiffness, stupor, dehydration with hypotension and tachycardia; elevated muscle enzymes; leukocytosis with polymorphonuclear.

Psychic signs:

Indifference psychomotor (passivity); depressive syndrome (25%); drowsiness; Access anxiety and delusional reactivation (low dose); confusional access (anticholinergic share)

+ Indications: manic (neuroleptic sedatives); acute delirium (neuroleptic sedatives); chronic psychoses; delirious melancholy; intractable insomnia

+ Accessories Indications: psychosomatic disorders (especially gastrointestinal); anomalous movements (Huntington’s disease, Tourette’s syndrome, tics, dystonia); nausea and severe vomiting during treatment with antimitotic. Emesis gravidarum (metoclopramide)

+ Contraindications: Parkinson’s disease; multiple thrust plate; any degenerative disease of CNS; porphyria (chlorpromazine may be used); lobe epilepsy unbalanced; risk of closure glaucoma; history of malignant syndrome;pregnancy (teratogenic risk) Largactil except in case of need