Phencyclidine (PCP)-Related Psychiatric Disorders Medication

  • Author: Alan D Schmetzer, MD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK)   more...
 
Updated: Aug 23, 2011
 

Medication Summary

Benzodiazepines are the medication of choice when treating acute PCP intoxication.

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Benzodiazepines

Class Summary

Treat symptoms of aggressivity and may decrease the likelihood of seizures and psychotic complications in PCP intoxication.

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Lorazepam (Ativan)

 

DOC; may be used IV and is well-absorbed after IM injection. Onset of action occurs within minutes of an injection and effects peak 15-20 minutes after injection. Duration of action is 6-8 h. No active metabolites exist.

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Diazepam (Valium, Diastat)

 

Historically, this medication has been the most helpful benzodiazepine in treating acute PCP intoxication. Even the psychotic symptoms respond sometimes. Diazepam is not absorbed reliably IM, but it can be administered both PO and IV. If IV administration is contemplated, decrease dose and be prepared to treat possible respiratory depression. If IM route is used, consider lorazepam as alternative, with dosage range of 1-2 mg.

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Antipsychotic agents

Class Summary

These agents are useful when PCP-induced psychotic symptoms do not respond adequately to benzodiazepines or when benzodiazepines are contraindicated. Avoid using highly anticholinergic antipsychotics because PCP is fairly anticholinergic.

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Risperidone (Risperdal)

 

Atypical antipsychotic medication. Has lower incidence of extrapyramidal adverse effects than traditional neuroleptics, such as haloperidol. Binds to dopamine D2 receptor with 20 times lower affinity than for 5-HT2 receptor. Improves negative symptoms of psychoses and reduces incidence of extrapyramidal adverse effects. Similarly, other newer atypical antipsychotics, such as olanzapine or quetiapine, may also be effective. Risperidone has a quick-dissolving oral formulation, Risperdal M-Tab.

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Ziprasidone (Geodon)

 

Available in tab and a parenteral form.

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Contributor Information and Disclosures
Author

Alan D Schmetzer, MD  Professor Emeritus, Interim Chairman, Vice-Chair for Education, Associate Residency Training Director in General Psychiatry, Fellowship Training Director in Addiction Psychiatry, Department of Psychiatry, Indiana University School of Medicine; Addiction Psychiatrist, Midtown Mental Health Cener at Wishard Health Services

Alan D Schmetzer, MD is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Clinical Psychiatrists, American Academy of Psychiatry and the Law, American College of Physician Executives, American Medical Association, American Neuropsychiatric Association, American Psychiatric Association, and Association for Convulsive Therapy

Disclosure: Eli Lilly & Co. Grant/research funds Other

Coauthor(s)

Roland McGrath, MD  Chairman, Professor, Department of Emergency Medicine, Indiana University School of Medicine

Roland McGrath, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

David R Diaz, MD  Assistant Professor of Clinical Psychiatry, Indiana University School of Medicine; Attending Psychiatrist, Adult Service, Larue D Carter Memorial Hospital; Attending Psychiatrist, Indiana University Hospital Adult Outpatient Clinic, Indianapolis, Indiana

David R Diaz, MD is a member of the following medical societies: American Psychiatric Association, Indiana Psychiatric Society, Indiana State Medical Association, and Indianapolis Medical Society

Disclosure: Eli Lilly and Company Honoraria Speaking and teaching

Specialty Editor Board

Barry I Liskow, MD  Professor of Psychiatry, Vice Chairman, Psychiatry Department, Director, Psychiatric Residency Program, University of Kansas School of Medicine; Director, Psychiatric Outpatient Clinic, The University of Kansas Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych (UK)  Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

Acknowledgments

The authors would like to acknowledge Indiana University School of Medicine, William Niles Wishard Memorial Hospital, and Larue D. Carter Memorial Hospital for their support of the faculty involved in the preparation of this eMedicine article.

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