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Pharmacokinetics of common first generation antipsychotic medications

Pharmacokinetics of common first generation antipsychotic medications
  Time to peak plasma level (hours) Half-life (hours), therapeutic Protein binding (%) Volume of distribution (L/kg) Metabolism Active metabolite(s)
Chlorpromazine 2 to 4

23 to 37 (chlorpromazine)

10 to >40 (active metabolites)

92 to 97

8.4 (steady state)

15.7 (single dose)

CYP1A2

CYP2D6

CYP3A4

UGT glucuronidation

Nor1-chlorpromazine

7-OH-chlorpromazine

Fluphenazine 2.8 14 to 16 NR NR CYP2D6 NR
Haloperidol 2 to 6 14 to 37 92 52.6 (+/– 14.5)

CYP2D6

CYP3A4

UGT glucuronidation

Pyridinium derivative (potential neurotoxin)
Loxapine 1 to 2

6 to 8 (loxapine)

12 to 19 (active metabolites)

97 NR

CYP1A2

CYP2D6

CYP3A4

UGT glucuronidation

7-hydroxyloxapine

8-hydroxyloxapine

Perphenazine 1 to 4

9 to 12 (perphenazine)

10 to 19 (active metabolite)

NR NR

CYP2D6*

CYP3A4

Other CYPs

7-hydroxyperphenazine
Pimozide 6 to 8

55

150 (poor metabolizers)

99 NR

CYP2D6*

CYP3A4

None
Thioridazine 1 to 4

4 to 10 (thioridazine)

21 to 25 (active metabolites)

99 1.8 to 6.7

CYP2C19

CYP2D6*

Mesoridazine

Sulforidazine

Thiothixene 1 to 2 34 90 NR CYP1A2 NR
Trifluoperazine 1.5 to 6

3 to 12 (trifluoperazine)

22 (active metabolites)

NR (highly protein bound) NR

CYP1A2

UGT glucuronidation

N-desmethyltrifluoperazine 7-hydroxyrifluoperazine
This table is intended for use in conjunction with UpToDate content on first generation (typical) antipsychotic medication poisoning. Pharmacokinetic data are derived from plasma sampling in adults following oral administration of immediate-release preparation(s) dosed within the therapeutic range.

NR: not reported

* Metabolism subject to genetic polymorphism; prolonged half-life and higher plasma concentrations have been observed compared with normal or extensive metabolizers.

Data from: UpToDate Lexidrug. More information available at https://online.lexi.com/.
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