Presentation
A recommended protocol is presented. [ncbi.nlm.nih.gov]
Cardiovascular
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Orthostatic Hypotension
Orthostatic hypotension could lead to falls with the potential for fractures and other injuries. [pdr.net]
It is also known to possess a relatively high liability for causing orthostatic hypotension compared to other antipsychotics. Similarly to other first-generation antipsychotics it has a relatively high liability for causing prolactin elevation. [en.wikipedia.org]
Adverse Effect : Pseudoparkinsonism, tardive dyskinesia, dystonia, orthostatic hypotension, cholestatic jaundice, leukopenia, photosensitivity. Interaction : Anticholinergics: Potentiates adverse effects of anticholinergics. [pediatriconcall.com]
hypotension, hyperpyrexia, paradoxical reaction. [empr.com]
Musculoskeletal
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Motor Restlessness
Reactions may include dyskinesias such as repetitive, involuntary, and purposeless body or facial movements, Parkinsonism (cogwheel muscle rigidity, pill-rolling tremor and reduced or slowed movements), akathisia (motor restlessness, especially in the [library.neura.edu.au]
Other signs of the condition include fidgety movements, leg swinging while sitting, rocking from foot to foot or pacing and motor restlessness. [worstpills.org]
restlessness, hyperreflexia, and convulsions. 6) Hypothermia. 7) Cardiac abnormalities, including arrhythmia, tachycardia. [rxmed.com]
These disorders include akathisia (motor restlessness), dystonia (abnormal muscle tone), and tardive dyskinesia (involuntary and repetitive movements). [ncbi.nlm.nih.gov]
Extrapyramidal Symptoms: Akathisia, agitation, motor restlessness, dystonic reactions, trismus, torticollis, opisthotonus, oculogyric crises, tremor, muscular rigidity, akinesia. [rxlist.com]
Eyes
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Retinal Pigmentation
Atrophy and disorganization of the photoreceptor outer segments appeared to be the initial degenerative event, followed by loss of the retinal pigment epithelium and choriocapillaris. [ncbi.nlm.nih.gov]
Nevertheless, nine cases of retinal pigmentation following its use have been reported. 1-8 The clinical picture is distinctive and closely resembles that seen following the use of another phenothiazine tranquilizer, NP-207. [jamanetwork.com]
Psychiatrical
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Stereotyped Behavior
Thioridazine and visual screening procedures are effective in reducing the stereotypic behaviors of individuals with mental retardation. [ncbi.nlm.nih.gov]
Neurologic
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Seizure
delirium, seizures, encephalopathy and grossly abnormal EEG's. All patients had been on lithium without thioridazine prior to and after the neurotoxic episode with no complications or EEG changes. [ncbi.nlm.nih.gov]
Stop taking and see physician NOW: Seizures, chest pain or breathlessness. [psyweb.com]
Seizures : High doses should be avoided in patients with a history of seizures. [healthyplace.com]
[…] approved for the treatment of patients with dementia-related psychosis Contraindications Documented hypersensitivity to phenothiazines Coma, severe hypotension, severe CNS depression, concurrency with large amounts of CNS depressants, poorly controlled seizure [reference.medscape.com]
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Agitation
Neuroleptics have been used to help control agitation, restlessness, and hostility in patients with traumatic brain injury. [ncbi.nlm.nih.gov]
Report of Case A 19-year-old male college student developed symptoms of agitation and was admitted for treatment with a diagnosis of schizophrenia. He was first given chlorpromazine, but this was discontinued after one week when a rash developed. [jamanetwork.com]
Because of its strong sedative effect it is well suited for violent and agitated patients. But it can also have a beneficial effect in subjects in whom depressive symptoms are the main problem. [infomed.ch]
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Akathisia
Behavioral deterioration following neuroleptic taper can represent (a) relapse of a mental illness, (b) and anticholinergic rebound reaction, (c) tardive akathisia, and (d) possibly a supersensitivity psychosis. [ncbi.nlm.nih.gov]
‘In some cases, patients who experience unacceptable rigidity, akathisia, or dystonia with high potency agents may benefit from a lower potency neuroleptic such as thiothixene or thioridazine.’ [oxforddictionaries.com]
Drug-Induced Acute Akathisia (Restlessness) [ hide all summaries ] (April 2011) The article lists 27 drugs that can cause akathisia, a condition characterized by muscular quivering and the inability to sit still. [worstpills.org]
There were no differences between remoxipride and thioridazine on dystonia, hypokinesia, dyskinesia, rigidity and akathisia. The results indicate that remoxipride has similar antipsychotic efficacy to thioridazine but causes fewer side effects. [doi.org]
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Stupor
14140009 Neuroleptic malignant syndrome contraindication 15244003 DOID:14464 Senile dementia contraindication 15662003 Orthostatic hypotension contraindication 28651003 Hypokalemia contraindication 43339004 Epilepsy contraindication 84757009 DOID:1826 Stupor [drugcentral.org]
Tobacco smoking: If people taking thioridazine continue to smoke tobacco it may result in lessening stupor caused by this medication. [herbs2000.com]
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Choreoathetoid Movements
The syndrome is characterized by involuntary choreoathetoid movements which variously involve the tongue, face, mouth, lips, or jaw (e.g., protrusion of the tongue, puffing of cheeks, puckering of the mouth, chewing movements), trunk, and extremities. [rxlist.com]
Workup
QT, RR, ST Intervals
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Prolonged QT Interval
Abstract In December 2000, the Committee for Safety of Medicines (CSM) advised that thioridazine may prolong QT intervals risking arrhythmias. [ncbi.nlm.nih.gov]
Over the Edge NUEDEXTA is contraindicated in patients receiving drugs that both prolong QT interval and are metabolized by CYP2D6 e.g., thioridazine and pimozide and should not be used concomitantly with other drugs containing quinidine, quinine, or mefloquine [wordnik.com]
QT interval contraindication 111975006 Disease of blood AND/OR blood-forming organ contraindication 191124002 DOID:74 Coma contraindication 371632003 Breastfeeding (mother) contraindication 413712001 Congenital long QT syndrome contraindication 442917000 [drugcentral.org]
If you are taking any drugs that can cause a certain type of heartbeat that is not normal (prolonged QT interval). There are many drugs that can do this. Ask your doctor or pharmacist if you are not sure. [drugs.com]
Blocks
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First-Degree Atrioventricular Block
The following occurred in the thioridazine group: sinus bradycardia, premature atrial contractions, first degree atrioventricular block & nonspecific T‐wave abnormality, prlongation of QT interval Figures and Tables - Table 3. [dx.doi.org]
Rhythm
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Torsades De Pointes
ADR Inferred Reduced CYP2D6 activity associated with Torsades de pointes and/or sudden death. [drugbank.ca]
There are several published case reports of Torsades de pointes and sudden death associated with thioridazine treatment. [dailymed.nlm.nih.gov]
Thioridazine has an established risk of QT prolongation and torsades de pointes (TdP). [pdr.net]
Other ECG Findings
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Electrocardiogram Change
Electrocardiogram changes were significantly more frequent in the thioridazine group (n 254, 2 RCTs, RR 2.38, CI 1.6 to 3.6, NNH 4 CI 3 to 10). Six RCTs (total n 344) randomised thioridazine against atypical antipsychotics. [ncbi.nlm.nih.gov]
Electrocardiogram changes were significantly higher in the thioridazine group, which fits with the guidelines of monitoring patients for cardiovascular abnormalities. [dx.doi.org]
Treatment
[…] problems for which specific treatments are available. [dailymed.nlm.nih.gov]
Thioridazine (Mellaril or Melleril) is a piperidine typical antipsychotic drug belonging to the phenothiazine drug group and was previously widely used in the treatment of schizophrenia and psychosis. [en.wikipedia.org]
RESULTS Combined treatment with thioridazine and irradiation significantly reduced viability of ESCC cells compared with thioridazine or irradiation treatment alone. [ncbi.nlm.nih.gov]
Prognosis
Although thioridazine does produce some serious side-effects, the poor prognosis associated with an XDRTB infection of a patient that presents with AIDS merits that the use of thioridazine for therapy of XDRTB is seriously considered. [ncbi.nlm.nih.gov]
New Results doi: Abstract Glioblastoma multiforme is a form of cancer with poor survival prognosis and few treatment options. [biorxiv.org]
The prognosis of Thioridazine 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 a [dovemed.com]
Etiology
This poster describes the neurobiology of Schizophrenia, as well as highlighting the genetic and environmental factors that play a fundamental role in the etiology of the disease. The current and emerging drug targets are also discussed. [tocris.com]
The etiology of schizophrenia is unknown, but it is thought to result from a combination of complex genetic and environmental factors. [ncbi.nlm.nih.gov]
Epidemiology
Increased Mortality in Schizophrenia Due to Cardiovascular Disease â “ A Non-Systematic Review of Epidemiology, Possible Causes, and Interventions. [cambridge.org]
Neither clinical studies nor epidemiologic studies conducted to date, however, have shown an association between chronic administration of these drugs and mammary tumorigenesis; the available evidence is considered too limited to be conclusive at this [rxlist.com]
David MZ, Daum RS (2010) Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev 23: 616–687 23/3/616 [pii]; 10.1128/CMR.00081-09 [doi]. [doi.org]
Pathophysiology
Controlling the data in this way will have important implications for understanding the pathophysiology of psychosis and for evaluating more accurately the effects of so called “atypical” neuroleptics. [ebmh.bmj.com]
Gulbins E, Li PL (2006) Physiological and pathophysiological aspects of ceramide. Am J Physiol Regul Integr Comp Physiol 290: R11–R26. View Article Google Scholar 34. [doi.org]
Prevention
The possible risk of combining lithium and neuroleptics (thioridazine) is discussed and repeated EEGs are recommended as a preventive measure. [ncbi.nlm.nih.gov]
• health professionals to switch patients from thioridazine to an alternative therapy at the earliest medically feasible point, individualize the switching strategy for each patient, and gradually reduce the thioridazine dosage over several weeks to prevent [apps.who.int]