Zotepine

Zotepine (Nipolept, Losizopilon, Lodopin, Setous) is an atypical antipsychotic indicated for acute and chronic schizophrenia. It has been used in Germany since 1990 and Japan since 1982.

Pharmacology
The antipsychotic effect of zotepine is thought to be mediated through antagonist activity at dopamine and serotonin receptors. Zotepine has a high affinity for the D1 and D2 receptors. It also affects the 5-HT2A, 5-HT2C, 5-HT6, and 5-HT7 receptors. In addition, it acts as a norepinephrine reuptake inhibitor, likely contributing to its efficacy against the negative symptoms of schizophrenia.

Dosing
The most common dosage used is 150 mg daily. It is suggested that zotepine therapy starts at 75 mg to 150 mg divided into three daily doses. Some people may need to have their dosage increased to 300 mg.

Side effects
The most common side effect of zotepine is weight gain. This weight gain side effect compares badly to the older typical antipsychotics. Somnolence is the second most common side effect. Constipation, asthenia, dry mouth, and akathisia are also reported. As with all antipsychotics, there is a risk of tardive dyskinesia, a potentially incurable neurologic disorder, with prolonged use of zotepine.

The likelihood of side effects are as follows:


 * Weight gain: Medium to high
 * Hyperprolactinemia: High
 * Sexual problems: High
 * Sedation: High
 * Extrapyramindal: Low
 * Hypotension: Medium
 * Hyperglycemia: Low