Non-psychotic uses for anti-psychotics

Journal of Drugs in Dermatology, March-April, 2004 by Aparche Yang, John Y. Koo

Table 1. Anti-psychotics: classes and FDA-approved indications

With the exception of five anti-psychotics (bolded). the official
FDA-approved indication for anti-psychotics is schizophrenia.

ANTI-PSYCHOTICS       FDA-approved Indication(s) (3,4,6,7)
                      ADULTS            CHILDREN

TYPICAL
HIGH-POTENCY
Fluphenazine          Resistant         Not approved
(Prolixin, Permitil,  Schizophrenics
Modecate, Moditen)
Haloperidol           Schizophrenia     Psychotic disorders
(Haldol)                                ages: 3-12
Perphenazine          1. Schizophrenia  Not approved in
(Trilafon)            2. Nausea and     children < 12
                      emesis            years old
Pimozide              Resistant         Tourette's > 12
(Orap)                motor and         years old
                      phonic ties in
                      patients with
                      Tourette's
                      Syndrome
Thiothixene           Schizophrenia     1. Adolescents:
(Navane)                                adult dosing
                                        2. Not approved
                                        in children
                                        < 12 years old
Trifluoperazine       1. Schizophrenia  Psychotic disorders
(Stelazine)           2. Non-psychotic  6-12 years old
                      generalized
                      anxiety
                      disorders
MID-POTENCY
Loxapine              Schizophrenia     Not approved in
(Loxitane)                              children
Molindone             Schizophrenia     Adolescents:
(Moban)                                 adult dosing
LOW-POTENCY
Chlorpromazine        1. Schizophrenia  1. Severe
(Thorazine)           2. Nausea,        behavioral problems
                      emesis            2. Psychotic
                      3. Restlessness,  disorders 6 months-
                      apprehension      12 years
                      prior to
                      surgery
                      4. Acute
                      intermittent
                      porphyria
                      5. Adjunct
                      treatment of
                      tetanus
                      6. Manic
                      depressive-like
                      illnesses
                      7. Intractable
                      hiccups
Mesoridazine          Refractory        Not approved
(Serentil)            Schizophrenia
Thioridazine          Refractory        Behavioral disorders
(Mellaril)            Schizophrenia     2-12 years

ATYPICAL
Clozapine             Refractory        Not approved
(Clozaril)            schizophrenia
Risperidone           Schizophrenia     Not approved
(Risperdal)
Olanzapine            1. Schizophrenia  Not approved
(Zyprexa, Zyprexa     2. Bipolar
Zydis)                mania (only
                      atypical
                      approved)
Quetiapine            Schizophrenia     Not approved
(Seroquel)
Ziprasidone           Schizophrenia     Not approved
(Geodon)

ANTI-PSYCHOTICS       Off-label, Non-Psychotic Indications

TYPICAL
HIGH-POTENCY          1. Cognitive disorder
                      associated with agitation (16)
                      2. Autism (8)
                      3. Impulse control (8)
                      4. Huntington's chorea (8)
                      5. Ballismus (8)
Fluphenazine          1. Conduct disorder (8)
(Prolixin. Permitil,  2. Huntington's chorea (8)
Modecate, Moditen)
Haloperidol           1. Non-psychotic, combative
(Haldol)              behavior in adults (6)
                      2. Borderline personality
                      disorder (8)
                      3. Conduct disorder (8)
                      4. Huntington's chorea (8)
Perphenazine
(Trilafon)
Pimozide              1. Delusions of parasitosis (1)
(Orap)                2. Huntington's chorea (8)
Thiothixene           Borderline personality
(Navane)              disorder (8)
Trifluoperazine
(Stelazine)
MID-POTENCY
Loxapine
(Loxitane)
Molindone
(Moban)
LOW-POTENCY           Mental Retardation with
                      severe agitation and
                      combativeness (8)
Chlorpromazine
(Thorazine)
Mesoridazine
(Serentil)
Thioridazine          Nausea and emesis (8)
(Mellaril)

ATYPICAL
Clozapine             Nausea and emesis (8)
(Clozaril)
Risperidone           Unusually aggressive, non-
(Risperdal)           psvchotic children (7)
Olanzapine
(Zyprexa, Zyprexa
Zydis)
Quetiapine
(Seroquel)
Ziprasidone
(Geodon)

Table 2. Off-label indications for antipsychotics

Non-psychotic Indication(s)  Comprehensive Textbook of  New Oxford Text
                             Psychiatry                 of Psychiatry
                             Kaplan and Sadock 1995     Gelder, Lopex-
                                                        Ibor and
                                                        Andreasen 2000

PSYCHIATRIC
MOOD DISORDERS                
(Manic excitement)           All anti-psychotics
BORDERLINE PERSONALITY                                   
D/O                          Low-dose: thiothixene,
                             haloperidol
COGNITIVE D/O ASSOCIATED                                 
AGITATION                    Low dose, high potency
(Alzheimer's dementia,
Wernicke's and
Korsakoff's syndromes)
MENTAL RETARDATION            
(Severe agitation,
combativeness)
AUTISM                                                   
(severe withdrawal,          High potency
hyperactivity, aggressive
and stereotyped behaviors)
ATTENTION-DEFICIT/                                       
HYPERACTIVITY DISORDER       If stimulants not
                             effective
CONDUCT DISORDERS             
                             fluphenazine, haloperidol
IMPULSE CONTROL               
(w/propensity for violence   Controversial, last
& agitation)                 resort Low dose, high
                             potency
SELF-INJURIOUS BEHAVIOR                                  

NON-PSYCHIATRIC
ANESTHESIA & ANALGESIA         increase the effects of
                             analgesics, hypnotics and
                             anesthetics; droperidol
                             b/c short 1/2 life
TIC DISORDERS                  high-potency              
(Tourette's, treatment-
resistant OCD, intractable
hiccups)
Trichotillomania                                         
HUNTINGTON'S DISEASE          
(early--chorea; later--      High potency
psychological symptoms       Fluphenazine,
including: irritability,     Haloperidol, pimozide
paranoia, hallucinations,
violent tendencies, bizarre
behaviors)
BALLISMUS                     
(hemiballism, confusion,     Low dose, high potency
disorientation, dementia)
ESSENTIAL TREMOR                                         
WATER INTOXICATION                                       
SYNDROME
In Schizophrenic Patients
NAUSEA, EMESIS                                           
                             All anti-psychotics,
                             especially chlorpromazine
                             prochlorperazine,
                             thioridazine, clozapine
PORPHYRIAS                                               
PURITIS                                                  
                             Trimeprazine (Temaril)
GERD (Gastro-Esophageal       
Reflux Disease), DELAYED     Metoclopramide (Reglan)
GASTRIC EMPTYING

  = Described in reference book.