Which type of phenothiazine is known to produce more extrapyramidal symptoms (EPS)?

Piperazine-type phenothiazines are more likely to produce extrapyramidal symptoms (EPS) due to their potent antagonistic effects on the D2 dopamine receptors in the central nervous system. These medications have a higher affinity for these receptors compared to others in the phenothiazine class, which leads to a greater risk of disrupting the dopaminergic pathways involved in motor control. As a result, when these medications are used, patients may experience various movement disorders such as tremors, rigidity, and akathisia, which are characteristic of EPS.

Other types of phenothiazines, such as aliphatic and piperidine, tend to have a lower risk of inducing EPS due to their different receptor binding profiles. Aliphatic phenothiazines, for instance, may have a stronger sedative effect and a lesser propensity to cause movement disorders. Similarly, piperidine derivatives also exhibit a lower incidence of EPS. Thioxanthenes, while structurally related, are considered a separate class and may also produce EPS, but not to the extent seen with piperazine.

This understanding of the pharmacological profiles of different phenothiazines helps clinicians manage antipsychotic therapy effectively, balancing the therapeutic benefits with the potential