Drug acting on Central Nervous

system

• What is the central nervous system (CNS)?

The central nervous system (CNS) is the part of the nervous system consisting
primarily of the brain and spinal cord.

• What are the different types of drugs that work on the CNS?
There are many different types of drugs that work on the CNS, including anaesthetics,
anticonvulsants, antiemetics, antiparkinsonian agents, CNS stimulants, muscle
relaxants, narcotic analgesics (pain relievers), nonnarcotic analgesics (such as
acetaminophen and NSAIDs), and sedatives.
• How do medications affect neurotransmitters?
Medications are used to either stimulate or depress the effect of the neurotransmitter.
For example, CNS depressants alter the brain by decreasing excitability of
neurotransmitters, blocking their receptor site, or increasing the inhibitory
neurotransmitter.
 • What are central nervous system agents?
Central nervous system agents are medicines that affect the central nervous
system (CNS). The CNS is responsible for processing and controlling most of our
bodily functions, and consists of the nerves in the brain and spinal cord.
Neurotransmitters
Neurotransmitters are biological substances that transmit
signals from a presynaptic neuron to a target receptor on
the postsynaptic neuron.
Neurotransmitters are endogenous chemicals that allow neurons to communicate with each
other throughout the body.
Types of neurotransmitters in the CNS:
1.Acetylcholine (Ach).
2.Catecholamines that composed of Norepinephrine (NE),
Epinephrine (Epi) and Dopamine (DA).
3.Serotonin (5-hydroxy tryptamine) (5-HT).
4.Aminoacids that divided into:
A. Inhibitory (GABA and Glycine)
B. Excitatory (Aspartate and Glutamate).

Drug acting on the central nervous system - Definition, classification,

pharmacological actions, dose, indications and contraindications:
1. General anaesthetics
2. Sedatives and Hypnotics
3. Anticonvulsant drugs
4. Anti-anxiety drugs
5. Anti-depressant drugs
6. Anti- psychotics
7. Nootropic agents
8. Centrally acting muscle relaxants
9. Opioid analgesics
Anaesthetic:
An anesthetic (American English) or anaesthetic (British English)
- is a drug used to induce anesthesia ⁠— ⁠in other words, to result in a temporary
loss of sensation or awareness or consciousness.
They may be divided into two broad classes:
General anesthetics, which result in a reversible loss of consciousness,
Local anesthetics, which cause a reversible loss of sensation for a limited
region of the body without necessarily affecting consciousness.
General anesthetics
General anaesthetics, are drugs (volatile agents), which produced reversible loss
of all sensation and consciousness.
The cardinal features of general anaesthesia are-
-Loss of all sensation especially pain
-Sleep(unconsciousness) and amnesia
-Immobility and muscle relaxation
-Abolition of somatic and autonomic reflexes
Stages of GA-
1. Stage 1 - Analgesia or Disorientation: Patient is conscious and rational
with decreased perception of pain
2. Stage 2 - Excitement or Delirium: Patient is unconscious , body respond
reflexively, irregular breathing pattern with breath holding
3. Stage 3 – Surgical Anesthesia: Increasing degrees of muscle relaxation
4. Stage 4 - Overdose: There is depression of cardiovascular and respiratory
centers
General anaesthetics divided into –
1. Inhalational
2. Intravenous
Inhaled agents
Inhalational anaesthetic
• Desflurane (common)
 • Enflurane (largely discontinued)
• Halothane (inexpensive, discontinued)
• Isoflurane (common)
• Methoxyflurane
• Nitrous oxide
• Sevoflurane (common)
• Xenon (rarely used)

Intravenous agents (non-opioid)/ anaesthetics

While there are many drugs that can be used intravenously to produce
anesthesia or sedation, the most common are:
• Barbiturates
• Amobarbital (trade name: Amytal)
• Methohexital (trade name: Brevital)
• Thiamylal (trade name: Surital)
• Thiopental (trade name: Penthothal, referred to as thiopentone in
the UK)
• Benzodiazepines
• Diazepam
• Lorazepam
• Midazolam
• Etomidate
• Ketamine
• Propofol

Local anesthetics-
Local anesthetic agents prevent the transmission of nerve impulses without
causing unconsciousness. They act by reversibly binding to fast sodium
channels from within nerve fibres, thereby preventing sodium from entering the
fibres, stabilising the cell membrane and preventing action
potential propagation.
Ester-based
• Benzocaine
• Cocaine (historical)
• Procaine
• Tetracaine (sometimes called Amethocaine)
Amide-Based
• Bupivacaine
• Cinchocaine(INN/BAN)/Dibucaine(USAN)
• Etidocaine
• Levobupivacaine
• Lidocaine
• Mepivacaine
• Prilocaine
• Ropivacaine

Local anesthetics can be either ester- or amide-based.

Ester local anesthetics are generally unstable in solution and fast-acting, are
rapidly metabolised by cholinesterases in the blood plasma and liver, and more
commonly induce allergic reactions. Some esters, such
as benzocaine and tetracaine, are found in topical formulations to be absorbed
through the skin.
Amide local anesthetics are generally heat-stable, with a long shelf life (around
two years). Amides have a slower onset and longer half-life than ester
anesthetics. Amides are generally used within regional and epidural or spinal
techniques, due to their longer duration of action, which provides adequate
analgesia for surgery, labour, and symptomatic relief.
 Sedatives and Hypnotics:

What is the difference between sedatives and hypnotics?

The term sedative describes drugs that serve to calm or relieve anxiety, whereas
the term hypnotic describes drugs whose main purpose is to initiate, sustain, or
lengthen sleep.
Sedatives:
A sedative is a substance that reduces irritability or excitement by affecting the
central nervous system. (without sleep)
Sedatives have numerous clinical uses. For example, they can induce sedation
before surgical procedures, and this can range from mild sedation to general
anesthesia.
Doctors also give sedatives and analgesics to individuals to reduce anxiety and
provide pain relief before and after procedures.
Obstetric anaesthesiologists may also give sedatives to people experiencing
distress or restlessness during labour.
Because of their ability to relieve physical stress and anxiety and promote
relaxation, doctors may also prescribe sedatives to people with insomnia,
anxiety disorders, and muscle spasms.
People with bipolar disorder, post-traumatic stress disorder, and seizures may
also benefit from prescription sedatives.
sedatives to treat conditions such as:
• anxiety disorders
• sleep disorders
• seizures
• tension
• panic disorders
• alcohol withdrawal syndrome
List of sedatives
The following is a list of sedatives that people commonly use.
Barbiturates
Barbiturates help relieve anxiety and treat seizures.
Examples of barbiturates include:
• phenobarbital (Luminal)
• amobarbital (Amytal Sodium)
• butalbital (Fiorinal)
• pentobarbital (Nembutal)
Benzodiazepines
Benzodiazepines treat various conditions, including:
• panic attacks
• insomnia
• seizures
• depression
• painful muscle spasms
Examples of benzodiazepines include:
• diazepam (Valium) (commonly used)
• alprazolam (Xanax)
• clonazepam (Klonopin)
• lorazepam (Ativan)

Hypnotics
Hypnotics are a class of drugs that induce and sustain sleep, often used to
treat insomnia or other sleep disorders.

Also known as nonbenzodiazepine sleep medications or Z-drugs,

hypnotics are similar to benzodiazepines but cause fewer side
effects. Doctors typically use hypnotics to treat sleep disorders.
Hypnotics can be further classified into different categories based on their
chemical structure and mechanism of action. The primary goal of hypnotic
medications is to produce sedation and calmness, leading to the initiation
and maintenance of a natural sleep cycle. It’s important to note that the use
of hypnotics should be under the guidance of a healthcare professional, as
their prescription and administration require careful consideration of
individual health conditions, potential side effects, and the risk of
dependency.

Classification of Hypnotics

1. Benzodiazepines:

Examples: Temazepam, Triazolam, Flurazepam.

Mechanism: Enhance the inhibitory effects of GABA (gamma-aminobutyric

acid) in the brain.

2. Non-Benzodiazepine Receptor Agonists (Z-drugs):

Examples: Zolpidem, Eszopiclone, Zaleplon.

Mechanism: Act on the same GABA-A receptor as benzodiazepines but

with a more selective action.

3. Melatonin Receptor Agonists:

Example: Ramelteon.

Mechanism: Acts on melatonin receptors to regulate the sleep-wake cycle.

4. Barbiturates (Historically Used, Rarely Prescribed):

Example: Phenobarbital.
Mechanism: Enhance GABAergic activity but have a higher risk of adverse
effects and dependence.

Examples of hypnotics include:

• zolpidem (Ambien)
• eszopiclone (Lunesta)
• zaleplon (Sonata)
Some antihistamines have sedating properties and are useful in treating mild
sleep problems.
Antihistamines are available over the counter and include:
• diphenhydramine (Benadryl)
• dimenhydrinate (Dramamine)
• brompheniramine (Dimetapp)
Others
Other medications slow brain activity and have sedating effects using different
mechanisms than those that sedatives utilize. These include:
• opioids
• alcohol
• general anesthetics
• muscle relaxants
• antidepressants
• antipsychotics
Some examples of these prescription medications include:
• oxycodone (OxyContin)
• morphine (Roxanol)
• baclofen (Lioresal)
• gamma-hydroxybutyrate (Xyrem)
Pharmacological Actions of Hypnotics:

1. Central Nervous System Depression:

Hypnotics exert a depressant effect on the central nervous system, promoting

relaxation and reducing arousal.

2. Enhancement of GABA Activity:

Many hypnotics, especially benzodiazepines and Z-drugs, enhance the activity

of the neurotransmitter GABA, leading to inhibitory effects on neuronal
activity.

3. Sedation and Induction of Sleep:

The primary action of hypnotics is to induce and maintain sleep, helping

individuals initiate the sleep cycle.

Dose, Indications, and Contraindications:

1. Dose:

The specific dosage depends on the hypnotic, the patient’s age, overall health,
and the severity of sleep disturbances.

2. Indications:

Insomnia: Hypnotics are prescribed for the short-term management of

insomnia.

Sleep Onset Difficulty: This is especially beneficial for those with trouble
falling asleep.

Shift Work Sleep Disorder: This is for individuals with irregular work
schedules affecting their sleep patterns.

3. Contraindications:

Pregnancy and Lactation: Generally avoided during pregnancy and

breastfeeding due to potential risks to the fetus or infant.
Respiratory Conditions: Contraindicated in individuals with severe respiratory
conditions, as they can further depress respiratory function.

History of Substance Abuse: Caution is exercised in individuals with a history

of substance abuse or dependence.

Myasthenia Gravis: Some hypnotics are contraindicated in individuals with

this neuromuscular disorder.

Anticonvulsant drugs (Anti- epileptic

drugs):
Anticonvulsants (also known as antiepileptic drugs, antiseizure drugs, or anti-
seizure medications (ASM) are a diverse group of pharmacological agents used
in the treatment of epileptic seizures. Anticonvulsants are also increasingly
being used in the treatment of bipolar disorder and borderline personality
disorder, since many seem to act as mood stabilizers, and for the treatment
of neuropathic pain. Anticonvulsants suppress the excessive rapid firing
of neurons during seizures. Anticonvulsants also prevent the spread of the
seizure within the brain.
By blocking sodium or calcium channels, antiepileptic drugs reduce the
release of excitatory glutamate, whose release is considered to be elevated in
epilepsy, but also that of GABA.
Anticonvulsants are more accurately called antiepileptic drugs (AEDs) because
not every epileptic seizure involves convulsion, and vice versa, not every
convulsion is caused by an epileptic seizure. They are also often referred to as
antiseizure drugs because they provide symptomatic treatment only and have
not been demonstrated to alter the course of epilepsy.
Some AEDs act on the sodium channels by either blocking their repetitive
activation or by enhancing their slow inactivation.
Drugs:
Barbiturates
Barbiturates are drugs that act as central nervous
system (CNS) depressants, and by virtue of this they produce a wide
spectrum of effects, from mild sedation to anesthesia. The following
are classified as anticonvulsants:
 • Phenobarbital (1912). See also the related drug primidone.
• Methylphenobarbital (1935). Known as mephobarbital in the US. No
longer marketed in the UK.
• Barbexaclone (1982). Only available in some European countries.
Benzodiazepines
The benzodiazepines are a class of drugs with hypnotic, anxiolytic,
anticonvulsive, amnestic and muscle relaxant properties. Benzodiazepines
act as a central nervous system depressant. The relative strength of each of
these properties in any given benzodiazepine varies greatly and influences
the indications for which it is prescribed. Long-term use can be
problematic due to the development of tolerance to the anticonvulsant
effects and dependency. Of many drugs in this class, only a few are used to
treat epilepsy:
• Clobazam (1979). Notably, used on a short-term basis around
menstruation in women with catamenial epilepsy.
• Clonazepam (1974).
• Clorazepate (1972).
The following benzodiazepines are used to treat status epilepticus:
• Diazepam (1963). Can be given rectally by trained care-givers.
• Midazolam (N/A). Increasingly being used as an alternative to
diazepam. This water-soluble drug is squirted into the side of the
mouth but not swallowed. It is rapidly absorbed by the buccal
mucosa.
• Lorazepam (1972). Given by injection in hospital.
Nitrazepam, temazepam, and especially nimetazepam are powerful
anticonvulsant agents, however their use is rare due to an increased
incidence of side effects and strong sedative and motor-impairing
properties.
Bromides
• Potassium bromide (1857). The earliest effective treatment for
epilepsy. There would not be a better drug until phenobarbital in
1912. It is still used as an anticonvulsant for dogs and cats but is no
longer used in humans.
Carbamates
• Felbamate (1993). This effective anticonvulsant has had its usage
severely restricted due to rare but life-threatening side effects.[35][36][37]
• Cenobamate (2019).
Carboxamides
The following are carboxamides:
• Carbamazepine (1963). A popular anticonvulsant that is available in
generic formulations.
• Oxcarbazepine (1990). A derivative of carbamazepine that has
similar efficacy and is better tolerated and is also available
generically.
• Eslicarbazepine acetate (2009).
• Photo switchable analogues of carbamazepine (2024) are research
compounds developed to control its pharmacological activity locally
and on demand using light, with the purpose to reduce adverse
systemic effects.[38] One of these compounds (carbadiazocine, based
on a bridged azobenzene) has been shown to produce analgesia with
non-invasive illumination in a rat model of neuropathic pain.
Fatty acids
The following are fatty-acids:
• The valproates — valproic acid, sodium valproate, and divalproex
sodium (1967).
• Vigabatrin (1989).
• Progabide (1987).
• Tiagabine (1996).
Vigabatrin and progabide are also analogs of GABA.
Fructose derivatives
• Topiramate (1995).
Gabapentinoids
GABA analogues
Voltage-gated calcium channel
Gabapentinoids are used in epilepsy, neuropathic
pain, fibromyalgia, restless leg syndrome, opioid
withdrawal and generalized anxiety disorder (GAD). Gabapentinoids
block voltage-gated calcium channels, mainly the N-Type, and P/Q-type
calcium channels. The following are gabapentinoids:
• Pregabalin (2004)
• Mirogabalin (2019) (Japan only)
• Gabapentin (1993)
• Gabapentin enacarbil (Horizant) (2011)
• Gabapentin extended release (Gralise) (1996)
Gabapentinoids are analogs of GABA, but they do not act on GABA
receptors. They have analgesic, anticonvulsant, and anxiolytic effects.
Hydantoins
The following are hydantoins:
• Ethotoin (1957).
• Phenytoin (1938).
• Mephenytoin.
• Fosphenytoin (1996).
Oxazolidinediones
The following are oxazolidinediones:
• Paramethadione.
• Trimethadione (1946).
• Ethadione.
Propionates
• Beclamide.
Pyrimidinediones
• Primidone (1952).
Pyrrolidines
 • Brivaracetam (2016).
• Etiracetam.
• Levetiracetam (1999).
• Seletracetam.
Succinimides
The following are succinimides:
• Ethosuximide (1955).
• Phensuximide.
• Mesuximide.
Sulfonamides
• Acetazolamide (1953).
• Sultiame.
• Methazolamide.
• Zonisamide (2000).
Triazines
• Lamotrigine (1990).
Ureas
• Pheneturide.
• Phenacemide.
Valproylamides
• Valpromide.
• Valnoctamide.
Other
• Perampanel.
• Stiripentol.[28]
• Pyridoxine (1939).
Non-pharmaceutical anticonvulsants
The ketogenic diet and vagus nerve stimulation are alternative treatments for
epilepsy without the involvement of pharmaceuticals. The ketogenic diet consists of
a high-fat, low-carbohydrate diet, and has shown good results in patients whose
epilepsy has not responded to medications and who cannot receive surgery. The
vagus nerve stimulator is a device that can be implanted into patients with epilepsy,
especially that which originates from a specific part of the brain. However, both of
these treatment options can cause severe adverse effects. Additionally, while
seizure frequency typically decreases, they often do not stop entirely.

Indications:
Epilepsy, Convulsions, seizures, anxiety, migraine, and nerve pain.
Contraindication:
Pregnancy, hepatic failure, certain blood diseases, narrow-
angle glaucoma, and familial short QT syndrome (genetic cardiac disease)

Anti-anxiety drugs
Anxiety-
It is a emotional state, unpleasant in nature discomfort and concern or fear about
some define or undefined feature threat.

Sometimes symptoms like anorexia, breathlessness, palpitation, etc.

Some degree of anxiety, is a part of normal life.
Antianxiety-
These are an ill-defined group of drug, mostly mild CNS depressant which are
aimed to control the symptoms of anxiety, produce a restful state of mind,
without interfering normal mental or physical functions.
How do I know if I need anxiety medication?
A person may require anxiety medication if they frequently experience
symptoms of anxiety, such as restlessness, feeling on edge, racing thoughts, and
difficulty concentrating. Before medication, A doctor may recommend other
treatments, such as CBT or breathing exercises.
Antianxiety drugs-
Types of anxiety medications include selective serotonin reuptake inhibitors
(SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic
antidepressants (TCAs), benzodiazepines, beta-blockers, and more.
Serotonin reuptake inhibitors (SSRIs)
Although SSRIs are a type of antidepressant, doctors can prescribe them to
people with anxiety and obsessive-compulsive disorder (OCD).
According to a 2022 article, doctors consider SSRIs to be the first-line drug
treatment for general anxiety disorder.
SSRIs work by stopping nerve cells in the brain from reabsorbing serotonin,
which is a chemical that plays a vital role in mood regulation.
Examples of SSRIs for anxiety include:
• citalopram (Celexa)
• escitalopram (Lexapro)
• fluoxetine (Prozac)
• fluvoxamine (Luvox)
• paroxetine (Paxil, Pexeva)
• sertraline (Zoloft)
These medications typically begin to take effect within 2–6 weeksTrusted
Source, but they may not work for everyone. People usually take SSRIs for 6–
12 months to treat anxiety and then gradually reduce the dosage.
These drugs are not habit-forming, meaning that they do not usually lead to
dependence.
People should consult a doctor or physician before they start reducing or
stopping their medication.
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
SNRIs are another class of antidepressants that can treat depression and anxiety.
Doctors may also prescribe them to treat some chronic pain conditions.
The ADAA notes that medical professionals also consider SNRIs to be the first-
line treatment for anxiety. However, they are not as effective in treating OCD.
These medications work by reducing the brain’s reabsorption of the chemicals
serotonin and norepinephrine.
Examples of SNRIs for anxiety are:
• duloxetine (Cymbalta)
• venlafaxine (Effexor XR)
As with SSRIs, SNRIs can take several weeks to have an effect.
Learn more about SNRIs.
Tricyclic antidepressants (TCAs)
TCAs are an older class of antidepressant. Although they may be effective for
the treatment of depression and anxiety, doctors often prescribe SSRIs instead
as they cause fewerTrusted Source adverse side effects.
However, TCAs may be useful for some people, especially if other medications
do not provide relief.
These medications work by blocking the reabsorption of serotonin and
norepinephrine. This increases the levels of these neurotransmitters in the brain.
Examples of TCAs for anxiety include:
• amitriptyline (Elavil)
• imipramine (Tofranil)
• nortriptyline (Pamelor)
Learn more about TCAs.
Benzodiazepines
Boxed warnings: Increased risk of death in certain older adults
Fanapt has a boxed warning about an increased risk of death in certain older
adults. A boxed warning is the most serious warning from the Food and Drug
Administration (FDA). It alerts doctors and patients about drug effects that may
be dangerous.
Older adults with dementia-related psychosis who take atypical antipsychotic
drugs have an increased risk of death. For this reason, Fanapt is not approved
for psychosis that’s related to dementia in adults ages 65 years and older.
For more information, see “Dosage adjustments” in the “Factors that can affect
your dosage” section below.
Benzodiazepines are a type of sedative that reduces the physical symptoms of
anxiety, such as tense muscles. These drugs also encourage relaxation, and their
effects take place quickly.
Peak levels in the blood occur 1–2 hours after a person takes their dose. People
may feel the effects sooner than this.
Benzodiazepines include:
• alprazolam (Xanax)
• chlordiazepoxide (Librium)
• diazepam (Valium)
• lorazepam (Ativan)
Although they can be highly effective for short-term issues, doctors rarely
prescribe benzodiazepines because they become less effective over time and can
be addictive.
Due to these risks, experts suggest that doctors do not prescribe the continuous
use of benzodiazepines for more than 6 monthsTrusted Source.
Some people may take benzodiazepines to manage short-term anxiety. For
example, people with a fear of flying may take them before a flight.
At times, people can take a benzodiazepine alongside an SSRI for 2–4
weeks until the SSRI takes effect.
Learn more about the benefits and risks of benzodiazepines.
Other medications for anxiety
Many other medications may help treat anxiety, although doctors usually only
prescribe them if SSRIs or similar drugs do not work.
Beta-blockers
Beta-blockers are a common medication for people with high blood
pressure and heart conditions. However, doctors may prescribe themTrusted
Source off-label for anxiety in certain situations.
Beta-blockers reduce the effects of norepinephrine, meaning that they can
relieve some of the physical symptoms of anxiety. Examples of beta-blockers
include atenolol (Tenormin) and propranolol (Inderal).
Buspirone
This anti-anxiety medication may treatTrusted Source short- or long-term
anxiety symptoms.
Buspirone (BuSpar) works much more slowly than benzodiazepines and may
not treat all types of anxiety disorders, but it causes fewer side effects and has a
lower risk of dependency.
Monoamine oxidase inhibitors (MAOIs)
MAOIs are one of the earliest types of antidepressant. Doctors may prescribe
them off-label to treat some types of anxiety, though they can potentially
cause serious side effects, so doctors rarely prescribe them.
Types of MAOI include:
• isocarboxazid (Marplan)
• phenelzine (Nardil)
• selegiline (Emsam)
• tranylcypromine (Parnate)
Learn more about MAOIs.
Side effects
Antidepressants and other drugs for anxiety have the potential to cause side
effects in some people.
These often resolve after a few weeks, but it is crucial to contact a doctor if they
are severe or do not subside.
Some doctors may recommend taking anxiety medications with food to
minimize side effects or taking them before bed if the drug does not interfere
with sleep.
The side effects a person experiences may vary depending on the type of
medication.
SSRIs
The side effects of SSRIs can include:
• nausea
• diarrhea
• constipation
 • loss of appetite
• blurry vision
• dizziness
• drowsiness or fatigue
• dry mouth
• feeling agitated or restless
• headaches
• sexual difficulties or erectile dysfunction
• sleep problems
SNRIs
The side effects of SNRIs are similar to those of SSRIs, and can include:
• constipation
• dizziness
• drowsiness or fatigue
• dry mouth
• headaches
• increased blood pressure
• loss of appetite
• nausea
• sexual problems or erectile dysfunction
• sleep problems
• sweating more than usual
• stomach aches
TCAs
Side effects vary among TCAs as they work in different ways. Possible side
effects include:
• blurry vision
• constipation
 • difficulty urinating
• dry mouth
• drowsiness
• increase in appetite
• lightheadedness
• low blood pressure after standing up
• sexual problems or erectile dysfunction
• sweating more than usual
• tremors
• weight gain
Benzodiazepines
Benzodiazepines can cause several side effects, such as:
• blurry vision
• confusion
• dizziness
• drowsiness or fatigue
• headaches
• loss of memory or concentration
• issues with balance, coordination, or speech
• an upset stomach
Benzodiazepines also carry certain risks. For example, they can cause physical
dependence, even after a short period of use. Withdrawal from
benzodiazepines may lead toTrusted Source:
• anxiety and restlessness
• depression
• sleep problems
• sweating
• seizures
More severe risks of benzodiazepines may includeTrusted Source:
• addiction
• cognitive decline
• fractures
• motor vehicle accidents as benzodiazepines can affectTrusted Source a
person’s ability to drive
• overdose, especially in combination with opioid drugs or alcohol
Beta-blockers
Possible side effects of beta-blockers include:
• cold hands and feet
• depression
• tiredness
• low blood pressure
• shortness of breath
• sleep issues
• sexual problems
People with asthma should avoid beta-blockers. Individuals
with diabetes should take them with caution and speak with a doctor about the
possible risks.
Buspirone
The side effects of buspirone may include:
• blurry vision
• diarrhea
• dizziness
• drowsiness
• dry mouth
• fatigue
• headaches
 • muscle pains
• nausea
• confusion
• restlessness or nervousness
• sleep problems
• sweating
• weakness
MAOIs
Some common side effectsTrusted Source of MAOIs include:
• nausea
• diarrhoea
• constipation
• dry mouth
• dizziness
• drowsiness
• light-headedness
• insomnia
These medications also interact with several other drugs, as well as some foods
and drinks. Anyone taking MAOIs should ask their doctor for a complete list of
the medications, foods, and drinks they need to avoid.
Suicidal tendency may develop in patient which is taking antianxiety drugs.

Anti-depressant drugs
These are drugs which can elevate in depressive illness.
Antidepressants are a class of medications used to treat major depressive
disorder, anxiety disorders, chronic pain, and addiction.
Antidepressants work by increasing neurotransmitters in the brain. Experts
believe these brain chemicals are responsible for changes in mood and behavior.
Examples of antidepressants:
SSRIs, SNRIs, TCAs, and NaSSAs. MAOIs may also be an option, though
doctors prescribe these less often due to the risk of adverse side effects.
Antidepressants cannot cure depression, but they can help reduce anxiety, low
mood, and suicidal thoughts. They work by changing how the brain uses
chemicals to balance mood or deal with stress.
It can take several weeks for antidepressants to start working. People may
experience side effects.

Anti- psychotics-
Antipsychotics, previously known as neuroleptics and major tranquilizers, are a
class of psychotropic medication primarily used to manage psychosis,
principally in schizophrenia but also in a range of other psychotic disorders.
Are there different types of antipsychotics?
There are two main types of antipsychotic medications:
• First-generation antipsychotics. Also known as “typical
antipsychotics,” these drugs were the first types of medications developed
for treating psychosis. Most aren’t commonly used for treating psychosis
now.
• Second-generation antipsychotics. Also known as “atypical
antipsychotics,” these are now the main drugs for treating psychosis.
That’s mostly because they have fewer side effects.
First-generation (typical) antipsychotics
• Chlorpromazine. The brand name of this medication (Thorazine) is no
longer available in the U.S., but generic versions still are.
• Fluphenazine. The brand names of this medication (Prolixin, Permitil) are
no longer available in the U.S., but generic versions still are.
• Haloperidol (Haldol®).
 • Loxapine (Adusuve®). One of the brand names of this medication
(Loxitane) is no longer available in the U.S., but generic versions still are.
• Molindone. The brand name of this medication (Moban) is no longer
available in the U.S., but generic versions still are.
• Perphenazine. The brand name of this medication (Trilafon) is no longer
available in the U.S., but generic versions still are.
• Pimozide (Orap*).
• Prochlorperazine (Compro®). One of the brand names of this medication
(Compazine) is no longer available in the U.S., but generic versions still
are.
• Thiothixene. The brand name of this medication (Navane) is no longer
available in the U.S., but generic versions still are.
• Thoridazine. The brand name of this medication (Mellaril) is no longer
available in the U.S., but generic versions still are.
• Trifluoperazine. The brand name of this medication (Stelazine) is no
longer available in the U.S., but generic versions still are.
Second-generation (atypical) antipsychotics
• Aripiprazole (Abilify®, Aristada®).
• Asenapine (Secuado®, Saphris®).
• Brexpiprazole (Rexulti®).
• Cariprazine (Vraylar®).
• Clozapine (Clozaril®, Versacloz®). One of the brand names of this
medication (Fazaclo) is no longer available in the U.S., but generic
versions still are.
• Iloperidone (Fanapt®).
• Lumateperone (Caplyta®).
• Lurasidone (Latuda®).
• Olanzapine (Zyprexa®, Lybalvi®, Symbyax®).
• Quetiapine (Seroquel®).
• Paliperidone (Invega®).
• Pimavanserin (Nuplazid®).
• Risperidone (Perseris®, Risperdal®).
• Ziprasidone (Geodon®).
• ContentsOverviewRisks / BenefitsRecovery and OutlookWhen To Call
the DoctorAdditional Common Questions
• ContentsOverviewRisks / BenefitsRecovery and OutlookWhen To Call
the DoctorAdditional Common Questions
• Overview
• What are antipsychotics?
• Antipsychotic medications are drugs that mainly treat psychosis-related
conditions and symptoms. But taking an antipsychotic drug doesn’t
always mean you have a symptom or condition related to psychosis.
That’s because these drugs are very important for treating other
conditions, too.
• What is psychosis?
• Psychosis isn’t a medical condition. It’s a collection of symptoms that
indicate your brain isn’t processing certain kinds of information as it
should. The symptoms all involve a disconnection from reality. The main
symptoms are hallucinations and delusions. It can also involve
disorganized thoughts and actions, or dampen how you show emotions.
• Are there different types of antipsychotics?
• There are two main types of antipsychotic medications:
• First-generation antipsychotics. Also known as “typical
antipsychotics,” these drugs were the first types of medications developed
for treating psychosis. Most aren’t commonly used for treating psychosis
now.
• Second-generation antipsychotics. Also known as “atypical
antipsychotics,” these are now the main drugs for treating psychosis.
That’s mostly because they have fewer side effects.
• First-generation (typical) antipsychotics
• Chlorpromazine. The brand name of this medication (Thorazine) is no
longer available in the U.S., but generic versions still are.
• Fluphenazine. The brand names of this medication (Prolixin, Permitil) are
no longer available in the U.S., but generic versions still are.
• Haloperidol (Haldol®).
• Loxapine (Adusuve®). One of the brand names of this medication
(Loxitane) is no longer available in the U.S., but generic versions still are.
• Molindone. The brand name of this medication (Moban) is no longer
available in the U.S., but generic versions still are.
• Perphenazine. The brand name of this medication (Trilafon) is no longer
available in the U.S., but generic versions still are.
• Pimozide (Orap*).
• Prochlorperazine (Compro®). One of the brand names of this medication
(Compazine) is no longer available in the U.S., but generic versions still
are.
• Thiothixene. The brand name of this medication (Navane) is no longer
available in the U.S., but generic versions still are.
• Thoridazine. The brand name of this medication (Mellaril) is no longer
available in the U.S., but generic versions still are.
• Trifluoperazine. The brand name of this medication (Stelazine) is no
longer available in the U.S., but generic versions still are.
• Second-generation (atypical) antipsychotics
• Aripiprazole (Abilify®, Aristada®).
• Asenapine (Secuado®, Saphris®).
• Brexpiprazole (Rexulti®).
• Cariprazine (Vraylar®).
• Clozapine (Clozaril®, Versacloz®). One of the brand names of this
medication (Fazaclo) is no longer available in the U.S., but generic
versions still are.
• Iloperidone (Fanapt®).
• Lumateperone (Caplyta®).
• Lurasidone (Latuda®).
• Olanzapine (Zyprexa®, Lybalvi®, Symbyax®).
• Quetiapine (Seroquel®).
• Paliperidone (Invega®).
 • Pimavanserin (Nuplazid®).
• Risperidone (Perseris®, Risperdal®).
• Ziprasidone (Geodon®).

• How do antipsychotics work?

• First-generation antipsychotics: These block the way your brain uses
several neurotransmitters, especially dopamine. They also
block acetylcholine (pronounced “Uh-SEE-till-CO-lean”), histamine
and norepinephrine from latching onto various receptors.
• Second-generation antipsychotics: These block certain dopamine and
serotonin receptors. But unlike first-generation antipsychotics, these
medications don’t just block receptors. They also activate certain other
dopamine and serotonin receptors. Blocking some receptors and
activating others is why these medications work differently.
What conditions do antipsychotics treat?
Antipsychotics treat conditions that cause or involve psychosis. Those include:
• Schizophrenia (and its related spectrum of disorders,
including schizoaffective disorder and schizophreniform disorder).
• Bipolar disorder.
• Mania.
• Major depressive disorder with psychotic features.
• Delusional disorder.
• Severe agitation.
• Borderline personality disorder.
• Dementia.
• Delirium.
• Substance-induced psychotic disorder.
Providers may treat other conditions with antipsychotics, but those drugs aren’t
their main treatment. These conditions include:
• Tourette syndrome.
 • Huntington’s disease.
• Parkinson’s disease.
• Lesch-Nyhan syndrome.
• Obsessive-compulsive disorder.

What are the possible disadvantages, side effects and complications of

antipsychotics?
Antipsychotics are useful, but there are possible drawbacks. Antipsychotic
medications can have various side effects and complications, including:
• Drug-induced movement disorders. First-generation and second-
generation antipsychotics can cause an inability to hold still
(akathisia) or uncontrolled face muscle movements (tardive dyskinesia).
Other symptoms include tremors or parkinsonism-like symptoms. They
can also cause neuroleptic malignant syndrome, a possibly deadly
complication. Scientists developed second-generation antipsychotics to
avoid that side effect.
• Heart and circulatory problems. Antipsychotic drugs may alter your
heart rhythm. They can also cause orthostatic hypotension, which is a
blood pressure drop when you stand or sit up quickly that can make you
fall or pass out.
• Interactions. Antipsychotic medications can interact with several other
types of medications. Be sure to tell your healthcare provider about every
medication, supplement, vitamin or herbal remedy you take. That can
help them determine if there’s a risk of interactions with an antipsychotic
medication they prescribe for you.
• Metabolism effects. Antipsychotic drugs can cause high cholesterol
(hyperlipidemia) and high blood sugar (hyperglycemia). They can also
increase your risk of developing Type 2 diabetes.
• Dizziness and sedation. All antipsychotics can have a sedative effect,
meaning they make you tired. They can also cause dizziness, increasing
your risk of falls and injuries.
• High prolactin levels (hyperprolactinemia). Antipsychotics can affect
your levels of the hormone prolactin. This can affect fertility and
cause missed periods (amenorrhea) and leaky discharge from your breasts
 when you aren’t breastfeeding/chestfeeding (galactorrhea) in women
and people assigned female at birth. It can cause infertility and sexual
dysfunction in men and people assigned male at birth.
• Immune disruption. Some antipsychotics can cause agranulocytosis, a
dangerous condition that involves a weakening of your immune system.
• Jaundice. This is when your skin and the whites of your eyes (sclera)
turn yellow because of a problem in your liver.
Other less serious side effects can include:
• Weight gain.
• Dry mouth.
• Constipation.
• Urinary retention.

Nootropic agents
Nootropics are compounds that claim to improve cognitive functions, such
as memory or attention.
Nootropics—commonly known as "smart drugs"—are a diverse group of
medications and supplements that boost your cognition (thinking) and
overall brain health. This class of drugs affects the nervous system—but
each type of medication or supplement can have slightly different effects on
your brain.
What Do Nootropics Do?
Nootropics work in lots of different ways and may offer one or more of the
following effects:1
• Improving the brain’s supply of blood, glucose (sugar), and oxygen
• Protecting the brain from ongoing damage
• Stimulating the production of certain proteins found in the brain
• Positively affecting your body’s stress response system
• Increasing available amounts of certain neurotransmitters, such as
acetylcholine or dopamine
 Examples of Nootropic:
• Adderall (amphetamine/dextroamphetamine salts) -
• Ritalin (methylphenidate)
• Provigil (modafinil)
These drugs increase the availability of neurotransmitters such as
dopamine and norepinephrine, both of which help improve attention
and academic performance.
• Artocoron (Naftidrofuryl) and Hydergine (ergoloid mesylates)
• Deanol (DMAE) and Lucidril (meclofenoxate)- can increase the
amount of acetylcholine in the brain.
• lecithin( which is often found in foods like egg yolks. This
supplement helps produce acetylcholine in the brain and improves
memory.)
• CDP-choline (citicoline)
Herbal and Plant-Based Supplements
Herbal supplements promote sharper thinking, improved memory, better
concentration, and increased energy. Others may help improve symptoms
of insomnia, depression, anxiety, and sexual dysfunction. These supplements are
known as adaptogens, which affect cortisol levels (your stress hormones) to
promote overall physical resilience.
Ashwagandha
Holy basil
Gotu kola
Amino Acids, Vitamins, and Food Supplements
Some people classify products that you might get from foods as possible
nootropics. For example, some health companies market individual amino
acids (the chemical components of protein) as nootropics. These amino acids
may increase the amount of certain neurotransmitters in your brain, like
acetylcholine.
Examples of amino acid nootropics include:
• L-theanine
 • L-tyrosine
• L-taurine
• Creatine
• Some experts consider certain vitamins to fall under the category of
nootropics. These vitamins may improve thinking and decrease anxious
thoughts. Some examples include vitamin B6 and pyritinol.10

Certain products derived from foods are also sometimes promoted as

nootropics. For example, omega-3 fatty acids, which are found in certain
kinds of fish, are important for overall brain health and preventing
cognitive decline.

• Additionally, resveratrol (found in grapes) and carnitine (derived from

some animals) may help improve cognition and benefit people with
Alzheimer's disease.

Caffeine and Nicotine

While you may not think of caffeine and nicotine as nootropics, some experts
categorize these substances as nootropics. Caffeine can enhance attention and
promote sharper thinking, at least for a limited time period. Nicotine, however,
affects acetylcholine levels, which in some cases may enhance memory and
mental sharpness.

Indications :

Dementia

Alzheimer’s disease

ADHD(Attention Deficit/Hyperactivity Disorder)

Insomnia

Potential Side Effects

• Restlessness
• Insomnia
• An upset stomach
• Headache
 • Reduced appetite
• Increased anxiety
• Higher blood pressure
• Risk of developing an irregular heartbeat

Keep in mind: if you stop taking nootropics suddenly, you may also
experience symptoms of withdrawal.