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Phenothiazine


Presentation

  • We present 4 patients seen in the last 5 years who had taken thioridazine (Mellaril) prior to development of priapism.[ncbi.nlm.nih.gov]
Fever
  • Signs and symptoms of NMS include severe muscle stiffness, fever, fast heartbeat, difficult breathing, increased sweating, and loss of bladder control.[mayoclinic.org]
  • […] coordination Needing to move, restlessness SKIN Rapid sunburn if exposed to the sun Bluish skin (changing to purplish) STOMACH AND INTESTINAL TRACT Constipation Loss of appetite Nausea OTHER Changes in menstrual pattern in women, from long-term use Fever[medlineplus.gov]
  • Phenothiazine antipsychotics can also cause neuroleptic malignant syndrome (NMS), which include symptoms of: fever, muscle rigidity, altered mental status, irregular blood pressure, and irregular heart rate and rhythm.[medicinenet.com]
  • […] stay warm Mouth ulcers that may affect the throat Dryness in the mouth, or drooling Ringing in the ears Yellow-colored eyes, bluish-colored skin Prone to easy sunburns on sun-exposure Vision abnormalities including blurred vision, brown-tinged vision Fever[dovemed.com]
Falling
  • Medications, particularly benzodiazepines, phenothiazines and anti-depressants, have been implicated as a risk factor for falls in patients with dementia [1, 3, 4, 11, 12], via the proposed mechanisms of central sedation, orthostatic hypotension and extra-pyramidal[medical-dictionary.thefreedictionary.com]
  • LECKAGE Verschüttetes Material in Behältern sammeln; falls erforderlich durch Anfeuchten Staubentwicklung verhindern. Reste sorgfältig sammeln. An sicheren Ort bringen.[chemicalbook.com]
Fatigue
  • Immune Deficiency Syndrome (CFIDS) Chronic Fatigue Syndrome Chronic Hepatitis Chronic Obstructive Pulmonary Disease Chronic Pancreatitis Chronic Pelvic Pain Syndrome (in men) Chronic Prostatitis Cigarette Addiction Cigarette Smokers, Nutrition Cirrhosis[therapy.epnet.com]
Nausea
  • Nausea and Vomiting (Causes, Natural Remedies, Diet, Medication) Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms...[medicinenet.com]
  • Phenothiazines are medicines used to treat serious mental and emotional disorders, and to reduce nausea. This article discusses an overdose of phenothiazines.[medlineplus.gov]
  • Some phenothiazines (such as prochlorperazine and chlorpromazine) are also effective at relieving other symptoms unrelated to psychosis, such as nausea , vomiting , prolonged hiccups , tetanus symptoms and hyper-excitable behavior in children.[drugs.com]
  • During this time, check with your doctor if you notice dizziness, nausea and vomiting, stomach pain, trembling of the fingers and hands, or any of the following signs of tardive dyskinesia or tardive dystonia: Although not all of the side effects listed[mayoclinic.org]
Abdominal Pain
  • They emphasize the difficulty of recognizing this syndrome in the psychotic patient; careful evaluation is indicated in the constipated patient who exhibits vomiting, abdominal pain, distension, or tenderness.[ncbi.nlm.nih.gov]
Tachycardia
  • Phenothiazine-induced ventricular tachycardia, when it occurs in the overdose situation, may be refractory to conventional antiarrhythmic drugs. We present a case in which the usual therapy was unsuccessful.[ncbi.nlm.nih.gov]
  • Incompatibilities & Reactivities Exposure Routes inhalation, skin absorption, ingestion, skin and/or eye contact Symptoms Itching, irritation, reddening skin; hepatitis, hemolytic anemia, abdominal cramps, tachycardia; kidney damage; skin photophobia[cdc.gov]
  • Tachycardia and orthostatic Hypotension Mild to moderate anticholinergic syndrome Urinary retention is common Seizures and extrapyramidal effects are rare. Kloss and Bruce. Toxicology in a Box. McGraw-Hill Education 2014.[lifeinthefastlane.com]
  • Oral doses of 1 or more grams per day may cause toxic hepatitis, hemolytic anemia, abdominal cramps, tachycardia, gastrointestinal and skin irritation, skin photosensitization, kidney damage, and pruritus.[osha.gov]
Hypotension
  • Resuscitation: Reduced GCS: Prompt intubation and ventilation Hypotension: Give 10 – 20 ml/kg of IV crystalloid, if response is not adequate start noradrenaline ( adrenaline is contraindicated due to paradoxical hypotension from beta 2 mediated vasodilatation[lifeinthefastlane.com]
  • Metoclopramide appears to result in roughly the same incidence of acute dystonic reactions, akathisia, or hypotension as the phenothiazines.[medical-dictionary.thefreedictionary.com]
  • The signs and symptoms of Phenothiazine Overdose may include: Urinary difficulties Unable to breathe or rapid breathing Nausea, vomiting Increased heart-rate Hypertension or hypotension (high or low blood pressure respectively) Lethargy and weakness Restlessness[dovemed.com]
  • Psychiatry, 2008 Edition Adverse Effects Profile Drug Sedating effects Anticholinergic effects Extrapyramidal side effects Hypotensive effects Chlorpromazine High High Low IM-High PO-Moderate Fluphenazine Low Low Very high Low Haloperidol Very low Very[psychopharmacologyinstitute.com]
Orthostatic Hypotension
  • If you think how you use these drugs in an aggressive patient you will understand their effects in overdose for a spectrum of CNS depression, orthostatic hypotension, anticholinergic effects and rarely dystonia.[lifeinthefastlane.com]
  • Medications, particularly benzodiazepines, phenothiazines and anti-depressants, have been implicated as a risk factor for falls in patients with dementia [1, 3, 4, 11, 12], via the proposed mechanisms of central sedation, orthostatic hypotension and extra-pyramidal[medical-dictionary.thefreedictionary.com]
Torticollis
  • Extrapyramidal symptoms such as torticollis, oculogyric crisis and blepharospasm are typical manifestations of phenothiazine-induced drug reactions. Widespread use of such drugs, especially in children make these symptoms relatively commonplace.[ncbi.nlm.nih.gov]
Torticollis
  • Extrapyramidal symptoms such as torticollis, oculogyric crisis and blepharospasm are typical manifestations of phenothiazine-induced drug reactions. Widespread use of such drugs, especially in children make these symptoms relatively commonplace.[ncbi.nlm.nih.gov]
Erythema
  • A case report is presented which offers evidence that administration of a phenothiazine drug resulted in erythema multiforme of the oral cavity in a psychotic patient. The condition remissed after discontinuation of the medication.[ncbi.nlm.nih.gov]
  • Includes fluphenazine, perphenazine, prochlorperazine and trifluoperazine The phenothiazines, in particular, chlorpromazine, may cause photosensitivity characterised by burning, erythema, swelling and later, frank eczematous changes.[gpnotebook.co.uk]
Pruritus
  • Oral doses of 1 or more grams per day may cause toxic hepatitis, hemolytic anemia, abdominal cramps, tachycardia, gastrointestinal and skin irritation, skin photosensitization, kidney damage, and pruritus.[osha.gov]
Agitation
  • Noradrenaline dose: 0.15mg/kg in 50ml D5W at 1-10ml/hr (0.05 – 0.5 mcg/kg/min) Seizures (rare)/agitation: IV benzodiazepines incrementally dosed every 5 minutes to effect.[lifeinthefastlane.com]
  • Some are used also to control agitation in certain patients, severe nausea and vomiting, severe hiccups, and moderate to severe pain in some hospitalized patients.[mayoclinic.org]
  • […] antidepressants (Winstead, 1976); higher doses of phenothiazines may be prescribed due to the clinician's failure to recognize caffeine's ability to increase catecholamine output (Greden, Fontaine, Lubetsky, & Chamberline, 1978) and observable initial agitation[medical-dictionary.thefreedictionary.com]
  • […] throat Vision color changes (things look brownish) Yellow eyes HEART AND BLOOD High or very low blood pressure Irregular heartbeat Rapid heartbeat MUSCLES AND JOINTS Muscle spasms, particularly of the neck, face, and back Muscle stiffness NERVOUS SYSTEM Agitation[medlineplus.gov]
Confusion
  • Stop taking this medicine and get emergency help immediately if any of the following effects occur: Rare Confusion (severe) or coma difficult or fast breathing drooling fast heartbeat high or low (irregular) blood pressure increased sweating loss of bladder[mayoclinic.org]
  • Fundus changes in the late stages may be confused with choroideremia or Bietti crystalline corneoretinal dystrophy; the symptoms include visual field loss and night blindness.[aao.org]
  • […] things look brownish) Yellow eyes HEART AND BLOOD High or very low blood pressure Irregular heartbeat Rapid heartbeat MUSCLES AND JOINTS Muscle spasms, particularly of the neck, face, and back Muscle stiffness NERVOUS SYSTEM Agitation, irritability, confusion[medlineplus.gov]
  • If you become confused, feel restless/agitated, or have difficulty urinating, let your doctor know right away.[webmd.com]
Seizure
  • Seizures are uncommon. Children: Ingestion of one tablet requires hospital assessment. Delayed extrapyramidal effects can occur in children days later.[lifeinthefastlane.com]
  • People who overdose on these drugs may have severe problems such as seizures, difficulty breathing, and tremors, and need to seek emergency medical treatment.[addiction.com]
  • […] or low blood pressure respectively) Lethargy and weakness Restlessness and irritability, appetite loss Stiff muscles, muscular spasms affecting the head and neck area Confusion and awkwardness; lack of proper muscle coordination Shaking or tremors; seizures[dovemed.com]
  • Side effects of these drugs include dystonic reactions, tardive dyskinesia, seizures, and sedation.[medical-dictionary.thefreedictionary.com]
  • […] skin rash sunburn (severe) Rare Abdominal or stomach pains aching muscles and joints agitation, bizarre dreams, excitement, or trouble in sleeping bleeding or bruising (unusual chest pain clumsiness confusion (mild) constipation (severe) convulsions (seizures[mayoclinic.org]
Dystonia
  • Patients with dystonias had more extensive neurologic testing than patients without dystonias, suggesting that physicians may not recognize dystonias as a clinical finding characteristic of phenothiazine or butyrophenone exposure.[ncbi.nlm.nih.gov]
  • Tardive dyskinesia or tardive dystonia (muscle movement disorders) may occur and may not go away after you stop using the medicine.[mayoclinic.org]
  • Typical antipsychotics (also called first-generation antipsychotics) are commonly associated with extrapyramidal side effects (these are drug-induced movement disorders and include dystonia , Parkinson's-like symptoms, restlessness, rigidity, tardive[drugs.com]
  • Links: chlorpromazine promazine piperazine compounds piperadine compounds treatment of acute dystonia due to phenothiazines[gpnotebook.co.uk]
Extrapyramidal Symptoms
  • Extrapyramidal symptoms such as torticollis, oculogyric crisis and blepharospasm are typical manifestations of phenothiazine-induced drug reactions. Widespread use of such drugs, especially in children make these symptoms relatively commonplace.[ncbi.nlm.nih.gov]
  • These drugs have antipsychotic and, often, antiemetic properties, although they may also cause severe side effects such as extrapyramidal symptoms (including akathisia and tardive dyskinesia), hyperprolactinaemia, and the rare but potentially fatal neuroleptic[en.wikipedia.org]
  • Nigrostriatal pathway: Extrapyramidal Symptoms Antagonism of D2 receptors in the nigrostriatal pathway is associated with increased risk of extrapyramidal symptoms.[psychopharmacologyinstitute.com]

Workup

Torsades De Pointes
  • A patient with schizophrenia developed torsade de pointes, a life-threatening cardiac arrhythmia, due to administration of phenothiazines. An intravenous infusion of isoproterenol improved the symptoms.[ncbi.nlm.nih.gov]
  • Minor QT prolongation but no Torsades de pointes has been reported since thiorodiazine was taken off the market. Isbister GK. Risk assessment of drug-induced QT prolongation. Australian Prescriber 2015.[lifeinthefastlane.com]

Treatment

  • It may be a useful medication if depressive symptoms in psychotic patients require antidepressant treatment or if other antipsychotics cannot be administered.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis of Phenothiazine Overdose is dependent on the amount of drug consumed, time between overdose and treatment, severity of the symptoms, as well as general health status of the patient If the individual can recover from the symptoms within[dovemed.com]
  • Prognosis [ 15 ] The severity of the problem varies considerably and prognosis is therefore very variable. It can cause catastrophic and potentially lethal problems like massive pulmonary embolism, stroke and myocardial infarction.[patient.info]
  • Colorectal cancer expression of peroxisome proliferator-activated receptor gamma (PPARG, PPARgamma) is associated with good prognosis. Gastroenterology, 2009, 136: 1242–1250 PubMed PubMedCentral CrossRef Google Scholar 20. Girnun G.[link.springer.com]

Etiology

Epidemiology

  • OBJECTIVE: To describe the presentation, epidemiology, management, and outcome of phenothiazine and butyrophenone ingestions in children requiring hospitalization. METHOD: Retrospective case series in two pediatric hospitals.[ncbi.nlm.nih.gov]
  • Epidemiology In systemic lupus erythematosus (SLE) 30% have aPL antibodies. [ 1 ] They are also found in 1-5% of the healthy population. In the elderly, aCL antibodies occur more frequently. There is a higher prevalence in black people.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Certain pathophysiologic mechanisms of death, rarely encountered in routine forensic science practice, may be important in determining the cause of death in psychiatric patients, especially in cases where the autopsy is unrevealing.[ncbi.nlm.nih.gov]
  • Mesolimbic pathway: Antipsychotic effects As explained earlier, overactivity of this pathway is thought to be involved in the pathophysiology of positive symptoms of schizophrenia.[psychopharmacologyinstitute.com]

Prevention

  • It is suggested that the traditional treatment with antipsychotic should reformed, and that drugs of degrading lipid and coagulation should be used to prevent and reduce the risk factors causing the onset of cardiovascular and cerebrovascular diseases[ncbi.nlm.nih.gov]

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