Involuntary contractions of muscles due to some antipsychotics. Can include torticollis (twisting neck), opisthotonos (arching spine or neck), oculogyric crisis (eyes rolling back), and trismus (jaw clenching). Rare but serious is tongue swelling, which can block the airway or cause choking when eating. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Equetro is the only FDA-approved formulation of carbamazepine for bipolar disorder, but use of other formulations would result in the same effects at a lower price. Generally, carbamazepine is not considered a first-line treatment for bipolar disorder due to its side effect profile and high likelihood of significant drug interactions. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

NAC is a glutamate modulator and is derived from the amino acid cysteine. It has been tested for many psychiatric conditions, but is most likely effective as an add-on treatment to SSRIs in OCD, trichotillomania, nail biting, and skin picking. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Dextroamphetamine is the dextro-isomer of racemic amphetamine. It has a long history of safe use in children, and is available in short- and long-acting formulations as generics. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Iloperidone is not recommended as a first-choice agent due to twice-daily dosing, need for titration, QT prolongation (comparable to ziprasidone), dizziness, moderate weight gain, and increases in blood sugar; and because it appears less efficacious than other antipsychotics. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

An uncomfortable sensation of dryness due to diminished saliva; can lead to dental caries, because saliva has an antibacterial effect. Can also cause decreased taste and inflammation of gums. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Alprazolam is fast acting and effective for generalized anxiety disorder (GAD) and panic disorder, but its short duration of action may contribute to breakthrough symptoms between doses and make withdrawal more difficult. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

A sense of restlessness, causing the patient to appear fidgety, to have difficulty sitting still, and to rock from one leg to the other while standing. It can present as an inner sense of restlessness without obvious movement. Can lead to agitation and even suicidal ideation. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Antihistamines can be very effective sleep aids for many patients, although some patients may experience too much grogginess (“hangover”) in the morning. They are good first-line agents due to a low risk of drug tolerance, dependence, or abuse, but exercise caution in the elderly, who are more sensitive to cognitive and peripheral effects. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Excessive sweating, which tends to be more prominent in the face, neck, and chest, and less prominent in the armpits and palms. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).