What is it?

Feeling sleepy, lazy or lacking energy

What to do about it

Take the medication at night, develop a good routine for sleep and avoid napping during the day.  Try to increase physical activity during the day and get outside for some sunlight and fresh air. Drowsiness is more common when the dose is increased quickly. Reducing the dose and then increasing it more slowly can minimise this side effect. Drowsiness usually improves with time as people become ‘tolerant’ to the sedating effects. It’s important not to drive until drowsiness has resolved.

Antipsychotics can be used in higher doses when people are agitated or distressed. High doses can make some people feel quite sleepy or 'drugged up', which is why high doses should usually only be used for a short time until the person starts feeling better.

What is it?

Eating more and putting on weight

What to do about it

Weight gain seems to be related to increased appetite rather than directly slowing down metabolism. Weight gain can lead to health problems such as an increased risk of diabetes, heart attacks and strokes.

Stick to a healthy diet including lots of fruits and vegetables. Try to exercise regularly.  It can be difficult trying to fit exercise in but it can be as simple as doing more walking. Try to avoid fatty and sugary foods like chips, pies, lollies and chocolate. Drink plenty of fluid and keep sugary drinks like fizzy drinks and fruit juices to special occasions. Water is best and it’s free! Ask a member of your care team to see a dietician if you need help with food choices.

What is it?

• Feeling shaky, having a tremor or a ‘tick’ that people feel they can’t control
• Slowed down movements
• Stiff muscles
• Sudden muscle cramps
• A person’s neck may twist back
• A person’s eyes and tongue may move on their own

What to do about it

These are not usually dangerous but if they are severe or worrying the person they should discuss it with their care team. Reducing the dose or changing to another antipsychotic can help. Medication is also available to treat this side effect, such as benztropine and procyclidine.

What is it?

Feeling uncomfortable and restless. Some people feel like they can’t keep still

What to do about it

This can improve with time but some people find it very unpleasant. If this is the case it should be discussed with the care team. Reducing the dose or changing to another antipsychotic can help. Medication can also be added to reduce the feeling of restlessness.

What is it?

Things look fuzzy or it is difficult to focus the eyes properly

What to do about it

This usually improves with time and doesn’t mean the person will need glasses. It should be discussed with the doctor or care team. It’s important not to drive until vision has gone back to normal.

What is it?

A person’s mouth may feel dry and they may not produce much saliva (spit)

What to do about it

Drink plenty of water. Try carrying a drink bottle and having small sips often. Chewing sugarfree gum or sucking ice cubes in summer can help. Sprays, gels and mouthwashes for dry mouth are available from pharmacies. If nothing seems to help then a change in medication or dose might be needed.

What is it?

• Having difficulty passing a stool (poo), or going less often than usual
• Feeling ‘bunged up’.
• Sometimes there is loss of appetite, stomach pain, bloating or feeling sick.
• Diarrhoea can also be a sign of constipation. If a hard mass of stool is blocking the bowel then small amounts of liquid stool may be passed.

What to do about it

Eat a high fibre diet including lots of fruits, vegetables and wholegrains. Drink at least 6-8 glasses of water a day. Doing more exercise such as walking can help to keep the bowels moving regularly.  If nothing seems to help or if the constipation is severe, then laxatives (medicines used to relieve and/or prevent constipation) may be needed. They can be bought from the pharmacy or supermarket, but it is often better to go through your doctor as they are cheaper on a prescription.

For people taking the antipsychotic clozapine, constipation can be serious and needs to be treated quickly. People taking clozapine should have a plan for managing constipation agreed in advance. If constipation has gone on longer than 2 days they should contact their care team urgently.

What is it?

Feeling dizzy, woozy, faint, or like the room is spinning

What to do about it

Dizziness is more common when starting a medicine or after a dose increase and can improve with time. Increasing the dose more slowly can minimise this side effect. It’s important not to drive until dizziness has resolved. A change in medication or dose might be needed if dizziness is severe or doesn’t seem to be getting better.

What are they?

Side effects that are caused by high prolactin levels. Prolactin is a hormone that is normally present in the body in both men and women but at a lower level. Prolactin levels increase during pregnancy and breastfeeding in women because this helps with breast milk production. Antipsychotics can increase prolactin above the usual level when it is not needed. 

The number and type of side effects a person gets from having high prolactin levels depends on a number of things. These include how high the prolactin level is, whether they are male or female and how sensitive the individual person is to having high prolactin. Common side effects can happen when prolactin is only slightly higher than the usual range. Less common and rare side effects usually only happen when the prolactin is much higher than the usual range.

Common

Sexual dysfunction - this can include losing interest in sex (low libido), difficulty getting or maintaining erection for men or difficulty having an orgasm

Less common

Changes in the menstrual cycle for women - periods can become irregular or stop altogether

Increased growth of body hair in women (hirsutism)

Swollen breast tissue, breast tenderness or breast growth - This can happen to both men and women

Rare

Milk production - people may notice milk coming out of their breasts (this can happen to both men and women)

What to do about it

These side effects can seem concerning but they are fully reversible and will go away with a change in treatment. People who have any of the side effects associated with high prolactin levels should talk to their care team – they can do a simple blood test to check the prolactin level. Medication may need to be changed or the dose reduced. Sometimes another medicine can be added to manage this side effect.

What is it?

Cholesterol and triglycerides are types of fat (lipid) in the blood. High blood sugar is also known as increased blood glucose. These will show up in blood test results. Over time, these side effects can put people at an increased risk of developing heart disease and diabetes.

What to do about it

Preventing these side effects with a healthy lifestyle is the best way to manage them. This includes eating a healthy diet and exercising regularly.

It is also important to see the care team or family doctor (GP) for a physical health check-up. They will monitor any changes in a person’s weight, blood pressure, cholesterol and blood sugar. This should happen at least once per year but might be more often after starting or changing medication, or when blood results show high cholesterol or blood sugar.

What is it?

Difficulty in passing urine (peeing) or not much urine passed

What to do about it

Contact the doctor immediately

What is it?

A fast or irregular heartbeat 

What to do about it

Contact the doctor or care team. This is not usually dangerous but the team might want to look into it further.

What is it?

Signs and symptoms of NMS include confusion, a high body temperature (fever), sweating, very stiff or rigid muscles, and a fast heartbeat. The risk of NMS is increased in some situations such as taking high doses of antipsychotics, more than one antipsychotic or after a big dose increase. Having certain medical conditions can also increase the risk.

What to do about it

Contact a doctor immediately. A doctor will be able to tell whether the symptoms are likely to be NMS. An admission to hospital might be needed until the person recovers.

What is it?

Blotches or marks seen anywhere on the skin 

What to do about it

Contact your doctor immediately