Zotepine

What is zotepine?

Second generation antipsychotics (sometimes referred to as ‘atypical’ antipsychotics) such as zotepine are a newer class of antipsychotic medication than first generation ‘typical’ antipsychotics. Second generation antipsychotics are effective for the positive symptoms of schizophrenia. It is sometimes claimed that they are more effective than first generation antipsychotics in treating the negative symptoms of schizophrenia. Negative symptoms include a lack of ordinary mental activities such as emotional expression, social engagement, thinking and motivation, whereas positive symptoms include the experiences of perceptual abnormalities (hallucinations) and fixed, false, irrational beliefs (delusions).

Second generation antipsychotics may also cause less extra-pyramidal side effects. These include dyskinesias such as repetitive, involuntary, and purposeless body or facial movements, Parkinsonism (cogwheel muscle rigidity, pill-rolling tremor and reduced or slowed movements), akathisia (motor restlessness, especially in the legs, and resembling agitation) and dystonias such as muscle contractions causing unusual twisting of parts of the body, most often in the neck. These effects are caused by the dopamine receptor antagonist action of these drugs.

What is the evidence for zotepine?

High quality evidence suggests zotepine results in greater study retention than placebo. Moderate to low quality evidence suggests a greater clinical response with zotepine than placebo, although zotepine may result in more sleep problems.

Compared to first generation antipsychotics in general, high quality evidence suggests zotepine is associated with greater clinical response, with improved global and mental state Zotepine causes less akathisia than first generation antipsychotics, and may also cause less akathisia and dystonia.

Low quality evidence is unable to determine any differences in mental state between zotepine and clozapine, risperidone or remoxipride. Moderate to low quality evidence suggests zotepine may result in higher levels of extrapyramidal symptoms than clozapine. Low quality evidence is unable to determine any differences in adverse effects between zotepine and risperidone or remoxipride.

March 2019

Last updated at: 11:06 pm, 22nd March 2019
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