Based on lysotracker red imaging in cultured hippocampal neurons, antipsychotic drugs (APDs) were proposed to accumulate in synaptic vesicles by acidic trapping and to be released in response to action potentials. Because many APDs are dopamine (DA) D2 receptor (D2R) antagonists, such a mechanism would be particularly interesting if it operated in midbrain DA neurons. Here, the APD cyamemazine (CYAM) is visualized directly by two-photon microscopy in substantia nigra and striatum brain slices. CYAM accumulated slowly into puncta based on vacuolar H + -ATPase activity and dispersed rapidly upon dissipating organelle pH gradients. Thus, CYAM is subject to acidic trapping and released upon deprotonation. In the striatum, Ca 2+ -dependent reduction of the CYAM punctate signal was induced by depolarization or action potentials. Striatal CYAM overlapped with the dopamine transporter (DAT). Furthermore, parachloroamphetamine (pCA), acting via vesicular monoamine transporter (VMAT), and a charged VMAT, substrate 1-methyl-4-phenylpyridinium (MPP + ), reduced striatal CYAM. In vivo CYAM administration and in vitro experiments confirmed that clinically relevant CYAM concentrations result in vesicular accumulation and pCA-dependent release. These results show that some CYAM is in DA neuron VMAT vesicles and suggests a new drug interaction in which amphetamine induces CYAM deprotonation and release as a consequence of the H + countertransport by VMAT that accompanies vesicular uptake, but not by inducing exchange or acting as a weak base. Therefore, in the striatum, APDs are released with DA in response to action potentials and an amphetamine. This synaptic corelease is expected to enhance APD antagonism of D2Rs where and when dopaminergic transmission occurs.M ost antipsychotic drugs (APDs) are competitive dopamine (DA) D2 receptor (D2R) antagonists (1, 2). The standard view is that APDs, by being weak bases that are in equilibrium with an uncharged form, cross the blood-brain barrier to access extracellular receptor binding sites from the circulation. However, because APDs are weak bases, they have been proposed to accumulate also in acidic intracellular organelles by acidic trapping (i.e., the less abundant uncharged basic hydrophobic form enters organelles passively and then is protonated to become membrane-impermeant). This hypothesis was first explored by examining a D2 antagonist with a covalently added fluorophore and APD displacement of acridine orange (3). More recently, APDs were found to be released from brain tissue by depolarization, which is expected for any positively charged drug. However, follow-up experiments in hippocampal neuron cultures showed that APDs displace the acidophilic dye lysotracker red, implying there is overlap in intracellular distribution between APDs and lysotracker red. Furthermore, lysotracker red was found to accumulate in hippocampal neuron synaptic vesicles by acidic trapping without displacing native neurotransmitter and to be released in response to electrical stimulation. Thus, b...