First-Generation Antipsychotics: A Practical Overview

When working with first‑generation antipsychotics, the older class of drugs that block dopamine D2 receptors to calm psychotic symptoms. Also known as typical antipsychotics, they have shaped modern psychiatry for decades. These medicines rely on dopamine D2 receptor antagonism to reduce hallucinations and delusions, but that same mechanism can trigger extrapyramidal side effects like stiffness and tremor. Chlorpromazine, the first drug in this group, illustrates the sedating profile that many clinicians still encounter.

The first‑generation antipsychotics you’ll read about today are prized for their potency and low cost, yet they demand careful monitoring. Because they block dopamine in the nigrostriatal pathway, patients often develop motor symptoms that resemble Parkinson’s disease—resting tremor, rigidity, and slowed movements. To manage these risks, doctors may add anticholinergic agents such as benztropine or switch to a lower‑potency drug like thioridazine when the side‑effects become disruptive. Classic examples include haloperidol, a high‑potency agent that’s still used in emergency settings for rapid calm, and fluphenazine, a depot formulation that helps maintain steady blood levels over weeks. When choosing a medication, clinicians weigh therapeutic benefit against the likelihood of extrapyramidal side effects, metabolic changes, and cardiac concerns such as QT prolongation. Blood work, movement exams, and patient education are essential parts of the prescribing process. Many patients also experience sedation, dry mouth, or orthostatic hypotension, especially with low‑potency drugs that hit antihistamine and alpha‑adrenergic receptors.

Below you’ll find a curated collection of articles that dive deeper into each of these points. We cover dosage strategies for chlorpromazine and haloperidol, side‑effect monitoring checklists, and real‑world comparisons with newer atypical agents. Whether you’re a caregiver, a student, or a clinician looking for a refresher, the posts ahead give clear, actionable guidance on how to use first‑generation antipsychotics safely and effectively. Explore the detailed breakdowns, safety tips, and patient stories to help you make informed decisions about treatment options.