Antipsychotic poisoning
Receptor-based prediction of toxicity, agent-by-agent risk (quetiapine, olanzapine, amisulpride, clozapine, chlorpromazine, haloperidol), the 2025 CTRC recommendations on QT monitoring, airway and hypotension management, dystonia, and how to tell NMS from serotonin and anticholinergic toxicity.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Antipsychotic overdoses are common because the drugs are widely prescribed for psychosis, mood disorders, agitation and insomnia (off-label quetiapine).
- Most cause sedation and hypotension. Death is uncommon with modern atypicals alone, and usually follows airway loss, aspiration or a co-ingestant.
- QT and torsades risk depends on the drug. The 2025 Clinical Toxicology Recommendations Collaborative (CTRC) review found real risk with amisulpride, thioridazine and ziprasidone, and concluded the risk is overstated for quetiapine, olanzapine and risperidone.
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Sources
- Berling I, Yates C, Hoffman RS et al. QT interval prolongation in acute antipsychotic poisoning: systematic review and recommendations. Clin Toxicol 2025;63:810-37Clinical Toxicology (Clinical Toxicology Recommendations Collaborative), 2025
- Therapeutic Guidelines: Toxicology and Toxinology (December 2024 update)AU/NZTherapeutic Guidelines Limited, 2024
- Poisons Information Centre (13 11 26)AU/NZNSW Poisons Information Centre, Sydney Children's Hospitals Network
- Isbister GK, Balit CR, Macleod D, Duffull SB. Amisulpride overdose is frequently associated with QT prolongation and torsades de pointes. J Clin Psychopharmacol 2010;30:391-5AU/NZJournal of Clinical Psychopharmacology, 2010
- Balit CR, Isbister GK, Hackett LP, Whyte IM. Quetiapine poisoning: a case series. Ann Emerg Med 2003;42:751-8AU/NZAnnals of Emergency Medicine, 2003
- Berling I, Isbister GK. Chlorpromazine overdose: a case series. Clin Toxicol 2024;62:372-7AU/NZClinical Toxicology, 2024
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy