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Atypical Antipsychotics and Borderline Personality Disorder

Antipsychotic medicines that might be used to treat symptoms of borderline personality disorder include olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal).

These medicines help stabilize certain brain chemicals called neurotransmitters, which control emotions and behavior. Balancing these brain chemicals may help you avoid impulsive and reckless behaviors. Antipsychotic medicines also help treat symptoms of psychosis in people who have borderline personality disorder.

Side effects

Olanzapine. The most common side effects of olanzapine are dry mouth, constipation, weight gain, drowsiness, and shakiness. This medicine can sometimes cause slurred speech or low blood pressure that makes you feel dizzy when you stand up. Less common side effects include headaches or a skin rash caused by an allergic reaction.

Quetiapine. This medicine can cause side effects such as tiredness, headaches, dizziness, rash, fever, weight gain, dry mouth, and other flu-like symptoms.

Risperidone. This medicine may cause sleepiness, weight gain, and breast tenderness. Unusual side effects include headaches, constipation, decreased sexual desire and function, an irregular heartbeat, and an allergic reaction that causes a skin rash. Risperidone may also be linked to an increased risk of stroke in older adults.

What to think about

Olanzapine, quetiapine, and risperidone may be associated with an increased risk of adult-onset diabetes and high cholesterol. Your doctor may watch your blood sugar and cholesterol levels if you are taking any of these medicines. All of these medicines carry a small risk of a movement disorder called tardive dyskinesia.

The makers of Risperdal (risperidone) have issued a warning stating that older adults who are taking this medicine may have an increased risk of stroke. Talk with your doctor about this risk before you take Risperdal.

Before you take olanzapine, quetiapine, or risperidone, be sure to tell your doctor whether you have other medical problems. This may not be the right type of medicine for you. These medicines typically are not recommended if you are pregnant or have had a condition called neuroleptic malignant syndrome.

Antipsychotics should be started at a low dosage. To avoid negative drug interactions, talk with your doctor about all other medicines you are taking. If you are taking an antipsychotic medicine, your doctor may need to test your blood now and then to check how well your liver is working. Your blood pressure should also be checked.

Avoid herbal stimulants (such as ma huang, ginseng, or kola) while taking an antipsychotic medicine.

Talk to your doctor or pharmacist about drinking grapefruit juice while you are taking an antipsychotic medicine. Grapefruit juice can increase the level of these medicines in your blood. Having too much medicine in your blood increases your chances of having serious side effects.

By Healthwise Staff
Sarah Marshall, MD - Family Medicine
Lisa S. Weinstock, MD - Psychiatry
Last Revised March 8, 2013

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