Presentation
A recommended protocol is presented. [ncbi.nlm.nih.gov]
Cardiovascular
- Orthostatic Hypotension
Low potency phenothiazines such as thioridazine can cause orthostatic hypotension due to their potent alpha-1 receptor blocking effects. [pdr.net]
hypotension, hyperpyrexia, paradoxical reaction. [empr.com]
Musculoskeletal
- Muscle Spasm
Other dystonias and dyskinesias (dystonic muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs). [fadavispt.mhmedical.com]
Tardive dyskinesia Tardive dyskinesia involves random and uncontrollable muscle spasms. The person may exhibit twitches in the face and other parts of the body, grimacing, tongue smacking, and other unusual movements. [schizophrenic.com]
AND BONES Muscle spasms Muscle stiffness Neck or face stiffness NERVOUS SYSTEM Drowsiness, coma Difficulty walking Dizziness Fever Hypothermia (body temperature is lower than normal) Seizures Tremor Weakness, lack of coordination OTHER Menstrual changes [ufhealth.org]
Possible Side Effects While Using This Medicine Call your doctor right away if you notice any of these side effects: Dizziness, fainting Fever, severe muscle stiffness, excessive sweating Irregular or fast heartbeat Muscle spasms of the neck, face, or [umms.org]
- 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]
- Torticollis
Extrapyramidal reactions (including Parkinsonism with motor retardation, rigidity, mask-like facies, tremor, salivation), dystonic reactions (including facial grimacing, tics, trismus, torticollis, opisthotonos, oculogyric crises), tremor, muscular rigidity [rxmed.com]
Extrapyramidal Symptoms: Akathisia, agitation, motor restlessness, dystonic reactions, trismus, torticollis, opisthotonus, oculogyric crises, tremor, muscular rigidity, akinesia. [rxlist.com]
- Muscle Cramp
Call your doctor right away if you have any fever, muscle cramps or stiffness, dizziness, very bad headache, confusion, change in thinking, fast heartbeat, heartbeat that does not feel normal, or are sweating a lot. [drugs.com]
Eyes
- 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]
- Central Scotoma
Best-corrected visual acuity was 20/60 OD and 20/100 OS with markedly constricted visual fields and central scotomas in both eyes. [jamanetwork.com]
- Retinal Damage
The range of drug-induced eye diseases includes diseases of the eyelids, glaucoma, cataracts, retinal damage and optic nerve damage. [worstpills.org]
Skin
- Skin Rash
See physician NOW: Low white blood cell count, skin rash or reduced urinary output. Stop taking and see physician NOW: Seizures, chest pain or breathlessness. [psyweb.com]
[…] or eyes Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome): difficulty passing urine difficulty sleeping headache sexual dysfunction skin rash, or itching [mychart.geisinger.org]
SHOW MORE SHOW LESS Side effects Major & minor side effects for Thioridazine Drowsiness Dry mouth Constipation Agitation Weight gain Skin rash Muscle spasm Headache Irregular heartbeat Tremors SEVERE Contact your doctor immediately if any of these symptoms [practo.com]
Side effects that you should report to your doctor or health care professional as soon as possible: allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue low blood counts - this medicine may decrease the number of [fairview.org]
Psychiatrical
- Delusion
Related Disease Conditions Schizophrenia is a disabling brain disorder that may cause hallucinations and delusions and affect a person's ability to communicate and pay attention. [medicinenet.com]
They are used primarily to treat positive symptoms including the experiences of perceptual abnormalities (hallucinations) and fixed, false, irrational beliefs (delusions). [library.neura.edu.au]
Also used to help treat false perceptions ( e.g. hallucinations or delusions ). THIS DRUG MAY CAUSE RETINITIS PIGMENTOSA OR NEUROLEPTIC MALIGNANT SYNDROME. [psyweb.com]
Unfortunately, it does not cure schizophrenia, but is often effective in keeping many of the symptoms, such as hallucinations and delusions, under control. How it’s administered Thioridazine comes in tablet form, and is typically taken orally. [schizophrenic.com]
Neurologic
- Seizure
Four cases on a combination of lithium and thioridazine developed severe neurotoxic symptoms, e.g., delirium, seizures, encephalopathy and grossly abnormal EEG's. [ncbi.nlm.nih.gov]
Stop taking and see physician NOW: Seizures, chest pain or breathlessness. [psyweb.com]
Intracranial mass, seizure disorder, seizures Phenothiazines may lower the seizure threshold. Patients who have a history of seizure disorder, epilepsy, or EEG abnormalities should be carefully monitored during therapy with thioridazine. [pdr.net]
[…] 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]
Seizures : High doses should be avoided in patients with a history of seizures. [healthyplace.com]
- Agitation
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]
[…] of an organic brain syndrome; during alcohol withdrawal for the relief of symptoms such as anxiety, agitation, hostility, or hallucinations; as an adjuvant treatment in agitated depression; in children with severe behavioral disorders such as emotional [rxmed.com]
- Akathisia
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. [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]
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]
- 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]
- 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]
Workup
QT, RR, ST Intervals
- 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]
Panobinostat is known to significantly prolong QT interval. [reference.medscape.com]
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]
Rhythm
- Torsades De Pointes
CYP2D6 activity associated with Torsades de pointes and/or sudden death.Details [go.drugbank.com]
ADR Inferred Reduced CYP2D6 activity associated with Torsades de pointes and/or sudden death. [drugbank.ca]
Thioridazine has an established risk of QT prolongation and torsades de pointes (TdP). [pdr.net]
There are several published case reports of Torsades de pointes and sudden death associated with thioridazine treatment. [dailymed.nlm.nih.gov]
Visual Field Test
- Central Scotoma
Best-corrected visual acuity was 20/60 OD and 20/100 OS with markedly constricted visual fields and central scotomas in both eyes. [jamanetwork.com]
Other ECG Findings
- 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 more frequent in the thioridazine (NNH 4) group, confirming its recognised potential to affect heart rhythm ( Psychotropics 2006 ), although we do not know whether these changes were torsades de pointe or other changes. [dx.doi.org]
Treatment
[…] problems for which specific treatments are available. [dailymed.nlm.nih.gov]
Combined treatment with carboplatin and thioridazine markedly induced caspase-mediated apoptosis in head and neck squamous cell carcinoma (AMC-HN4) cells. [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]
My ophthalmologist said it is so rare there is not much to tell me regarding prognosis. Posted by: Nancy B. at August 27, 2006 05:12 PM [schizophrenia.com]
New Results doi: https://doi.org/10.1101/532788 Abstract Glioblastoma multiforme is a form of cancer with poor survival prognosis and few treatment options. [biorxiv.org]
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 – A Non-Systematic Review of Epidemiology, Possible Causes, and Interventions. [bjp.rcpsych.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]
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]
More research is needed to determine if people taking thioridazine might prevent heart problems by supplementing with potassium. The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence. [umcvc.org]
• 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]