Type of Drug:

Typical (conventional) antipsychotic

How the Drug Works:

The exact mechanism of action of antipsychotic agents is not fully understood. It is believed antipsychotic agents reduce nerve sensitivity in different areas of the brain. They are not used to treat anxiety but can improve concentration and self control in severely mentally ill (psychotic or schizophrenic) patients.

Uses:

All phenothiazine derivatives: To reduce symptoms of psychosis (mental illness).

Unlabeled Uses: Occasionally doctors may prescribe antipsychotic agents to treat migraine headaches (chlorpromazine, prochlorperazine), severe vascular or tension headaches (prochlorperazine), hemiballismus (perphenazine), Huntington chorea (chlorpromazine, fluphenazine), hiccups (perphenazine), or PCP psychosis (chlorpromazine).

Precautions:

Tardive dyskinesia: Involuntary and uncontrollable movements may develop in patients treated with antipsychotic drugs. Occurrence is highest in the elderly, especially Women. However, it is impossible to predict which patients are likely to develop the syndrome. The risk of developing these involuntary movements and the likelihood they will become permanent are increased with long term use and with high doses. However, it is possible to develop these symptoms after short­term treatment at low doses. The syndrome is characterized by rhythmical, involuntary movements of tongue, face, mouth, or jaw (eg, protrusion of tongue, puffing of cheeks, puckering of mouth, chewing movements), sometimes accompanied by involuntary movements of the arms and legs. Fine wormlike movement of the tongue may be an early sign of the syndrome. If the medication is stopped at this time, the syndrome may not develop further. There is no known treatment for established cases of tardive dyskinesia, although the syndrome may stop, partially or completely, if the drug is withdrawn. Antipsychotic treatment, however, may suppress or partially suppress the signs and symptoms of the syndrome and thereby may possibly mask the underlying disease process. The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown.

Neuroleptic Malignant Syndrome (NMS) Is a potentially fatal syndrome associated with antipsychotic drugs. Symptoms include fever, mUScle rigidity, altered mental abilities, irregular PUlse and blood pressure, increased heart rate, sweating, and irregular heart rhythm.

Abrupt withdrawal: These drugs are not known to cause dependance and do not produce tolerance or addiction. However, following abrupt with draw al of high dose therapy, symptoms such as nausea, vomiting, dizziness, tremors, headache, upset stomach, and increased heart rate have been reported. Symptoms occurred in 1 to 4 days and subsided in 1 to 2 weeks. These symptoms can be reduced by a gradual decrease in dos ­age or by continuing anti parkinson agents for several weeks after the antipsychotic agent is withdrawn.

Skin discoloration: Rare instances of skin pigmentation have occurred, primarily in females on long-term, high dose therapy. These changes, restricted to exposed areas of the skin, range from a very slight darkening to a slate gray color, sometimes with a violet hue. Pigmentation may fade following drug discontinuation. Use caution against exposure to ultraviolet light (eg, tanning booths) or undue exposure to sunlight. These effects occur most commonly with chlorpromazine.

Eye changes: Ocular changes have occasionally occurred in patients receiving long-term, high dose therapy. Eye changes are characterized by deposits of fine particular matter in the lens and cornea. Eye lesions may regress after drug discontinuation. Exposure to light, along with dos ­age and duration of therapy, seem to be the most significant factor in this reaction.

PKU tests: These drugs may produce false-positive phenylketonuria (PKU) test results.

Pregnancy: Safety for use during pregnancy is not established. Some newborns of women using these medicines have experienced prolonged jaundice and abnormal movements and reflexes. Use only when clearly needed and the potential benefits outweigh the possible hazards to the fetus.

Breastfeeding: Chlorpromazine appears in breast milk. Consult your doctor about this and other antipsychotic agents before you begin breast­feeding.

Children: In general, these products are not recommended for children younger than 12 years of age. Phenothiazine use in children younger than 1 year of age may be a factor in sudden infant death syndrome (SIDS). Children with acute illnesses (eg, chickenpox, measles) or dehydration appear much more susceptible to neuromuscular reactions than adults. Symptoms can occur and may be confused with the signs of an undiagnosed primary disease responsible for the vomiting (eg, Reyes syndrome). Avoid antipsychotic agents in children and adolescents whose symptoms (eg, vomiting, hyperactivity, confusion) suggest Reye syndrome.

Mesoridazine – Safety and effectiveness is not established in children.

Prochlorperazine – Contraindicated in children under 20 pounds or younger than 2 years of age. Do not use in pediatric surgery. Children seem more prone to develop Parkinson-like reactions. Use the low ­est effective dose. Occasionally, the patient may react to the drug with restlessness and excitement. If this occurs, do not administer additionill doses. Use with caution in children with acute illnesses or dehydration. Not for use in conditions for which children’s dosages are not established.

Trifluoperazine – This drug is for children, aged 6 to 12 years, who are hospitalized or under close Supervision. Dosage must be adjusted to the weight of the child and severity of symptoms.

Elderly: Low doses are usually sufficient for elderly patients. These patients are more susceptible to lowered blood pressure and other side effects. Doses should be increased gradually.

Lab Tests: Lab tests may be required during therapy. Tests include eye exams, blood counts, and kidney and liver function tests.

Sulfites: Some of these products may contain sulfite preservatives that can cause allergic reactions in certain individuals. Check package label when available or consult your doctor or pharmacist.

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary sUpplements while taking these drugs. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The fOllowing drugs and drug classes may interact with these drugs:

* ACE inhibitors (eg, captopril)

* Alcohol aluminum-containing antacids (eg, Rolaids)

* Beta-blockers (eg, propranolol)

* Clonidine (eg, Catapres)

* Cimetidine (eg, Tagamet)

* Diazoxide (eg, Proglycem)

* Dopamine (eg, lntropin)

* Metrizamide (Amipaque)

* SUccinylcholine (eg, Anectine)

Side Effects:

Every drug is capable of producing side effects. Many patients Experience no, or minor, side effects. The frequency and severity of side affects depend on many, factors including dose, duration of IndividuAl susceptibility. Possible side effects Include:

Hormones: Appearance of milk and breast engorgement in women; breast enlargement in men; menstrual irregularities; loss of menstruation; changes in sex drive or ability; changes in blood sugar levels; false­positive pregnancy tests; dry vagina.

Muscular System: Muscle spasms or aches; aching and numbness of legs and arms; lockjaw; protrusion, discoloration, aching, and rounding of the tongue; tightness in throat; weakness; inability to sit still; exaggeration of reflexes; joint pain or stiffness; difficulty moving.

Digestive Tract: Appetite changes; nausea; vomiting; constipation; diarrhea; stomach pain or upset; fecal impaction; dry mouth; excess salivation; reduced salivation; swallowing difficulty; tongue protrusion; swollen tongue; excessive thirst; reduced thirst; sore mouth or gums; excessive eating.

Circulatory System: Changes in blood pressure; orthostatic hypotension (dizziness or light-headedness when rising quickly from a sitting or lying position); fainting; changes in heart rate; heart attack; blood cholesterol level changes; abnormal blood counts; anemia.

Psychiatric: Hallucinations; catatonia; restlessness; hyperactivity; confusion; depression; agitation; increased dream activity; bizarre dreams; exaggerated sense of well being (euphoria); excitement; lethargy; paranoid reactions; aggressiveness; sedation.

Nervous System: Headache; drowsiness (about 1 to 2 weeks); increased sleep duration; dizziness; light-headedness; nervousness; tremors; jitteriness; clumsiness; sleeplessness; anxiety; feeling of whirling motion (vertigo); slurred speech; seizures; fatigue; twitching; tension; numb­ness

Respiratory System: Spasms of larynx and bronchial tubes (breathing pas­sages); nasal congestion; increased depth of breathing; painful or difficult breathing; asthma; sore throat; cough; sinus problems; upper respiratory infections.

Skin: Hives; rash; oily skin; redness; itching; sensitivity to light; hair loss; pallor; flushing; sweating; discoloration; lesions; swelling; dry skin; yellowing of skin.

Eyes or Ocular: Glaucoma; sensitivity to light; blurred vision; changes in pupil size; cataracts; problems with cornea, lens, and retina; abnormal vision; drooping eyelid; brownish coloring of vision, abnormal eye movements; impairment of night vision (thioridazine only); yellowing of eyes.

Urinary and Reproductive Tract: Urinary retention; increased urination; glucose in urine; lack of bladder control; persistent or painful erections; frequent urination; painful or difficult urination; bed wetting.

Other: Toothache; swelling in hands or feet; weight gain; heatstroke; fever; chills; problems with body temperature regulation; back or chest pain; swollen glands; Parkinson-like symptoms; tardive dyskinesia; Neurolep­tic Malignant Syndrome.

Guidelines for Use:

* Dosage is individualized. Use exactly as prescribed.

* Do not stop taking or change the dose, unless instructed by your doctor.

* If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless instructed by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, con­tact your doctor or pharmacist.

* Oral agents may be ineffective if expelled after vomiting has already begun. Consider use of injection or suppositories under such circumstances.

* Take these drugs routinely as directed. They control illness symptoms. They are not addicting.

* Improvement may not be seen for several weeks.

* May cause dizziness, drowsiness, or blurred vision. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.

* Avoid alcohol or other drugs that cause drowsiness while taking this medicine.

* May cause sensitivity to sunlight. Avoid prolonged exposure to the sun and other sources of ultraviolet (UV) light (eg, tanning beds). Use sun­screens and wear protective clothing until tolerance is determined.

* If dizziness or fainting occurs (more common after first injection), avoid sudden changes in posture.

* May increase susceptibility to heatstroke. Use caution in hot weather.

* Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.

* Contact your doctor if you experience involuntary muscle twitching, involuntary movements of the tongue, stomach cramping, sore throat, fever, lethargy, decreased sensation of thirst, irregular pulse, excessive sweating, soreness of mouth, gums, or throat, symptoms of upper respiratory infection, unusual bleeding or bruising, weakness, impaired vision, pale stools, skin rash, tremors, or yellowing of skin or eyes.

* Liquid concentrates – Liquid concentrates are light sensitive. Keep in amber or opaque bottles and protect from light. These solutions are most conveniently used when diluted in fruit juices or other liquids. Use these solutions immediately after dilution. Avoid contact with skin (contact dermatitis may occur). Shake well before using.

* Chlorpromazine concentrate- Add desired dose to 2 oz or more of liquid just prior to use. Suggested liquids are tomato or fruit juice, milk, simple syrup, orange syrup, carbonated beverages, coffee, tea, or water, Semisolid foods (eg, soups, puddings) may also be used.

* Mesoridazine – Use the calibrated dropper enclosed with the package to measure the dose. Concentrate may be diluted just prior to use with distilled water or orange or grape juice. Do not prepare and store in bulk.

* Thioridazine – Add dose to 2 oz or more just prior to use. Liquids suggested are tomato or fruit juices, milk, simple syrup, carbonated beverages, coffee, tea, or water. Semisolid (HIP, puddings) may also bo used.

* Trifluoperazine _ Concentrate is for institutional use only. Use in severe neuropsychiatric conditions when oral medication is preferred and other oral forms are impractical. Add concentrate dose to 2 oz or more just prior to use. Liquids suggested are tomato or fruit juices, milk, simple syrup, orange syrup, carbonated beverages, coffee, tea or water. Semisolid foods (eg, soup,puddings) may also be used.

* Store as directed by package labeling.