| Table 4 Prescribing Information for Thioridazine (Mellaril ®) | ||
| Optimum Dosage 1-3 mg/kg/day 20-200 mg/day Not recommended under 2 years of age Starting dose 10-25 mg b.i.d. | Drug Interactions CNS depressants Antacids decrease absorption Anticholinergics Anticonvulsants increase risk of seizures Epinephrine increases hypotension Guanethidine | |
| Minor Side-Effectsa Anticholinergic effects (>30%) Orthostatic hypotension (10%-30%) Drowsiness, sedation, lethargy (10%-30%) Amenorrhea and inhibition of ejaculation (10%-30%) Tachycardia (2%-10%) Photosensitivity and skin pigmentation (2%-10%) Weight gain (10%-30%) Gastrointestinal distressc Nasal stuffinessc Breast enlargement and galactorrheac Peripheral edemac Parotid swellingc | Contra-indications Hypersensitivity to other phenothiazines History of blood dyscrasias Do not use in “pure” attention deficit disorders, because of decrease in learning curve | |
| Drug Withdrawal Effects Tardive and withdrawal dyskinesia following long-term usage (>3-6 months) particularly in non-responders to treatment Rebound behavioural phenomenon Gastrointestinal distress Insomnia, restlessness, irritability Chills and cold sweats Common practice to decrease over 1 month to minimize above phenomena | ||
| Major Side-Effects Parkinsonism (2%-10%)b Akathisia(2%-10%)b Dystonic reactions (<2%)b Cardiac arrhythmias (10%-30%)b ECG abnormalities without cardiac injury (>30%) Pigmentary retinopathy (10%-30%) after chronic therapy Obstructive jaundice (<2%) Blood dyscrasia (2%-10%) within 1-3 months Dulling of intellectual performance0 Epileptic seizures (<2%)b | ||
| Concurrent Treatment and Alternatives When used as a non-specific tranquilizer, the medication should be used in conjunction with one or more of the following: Behaviour therapy Family or caretaker therapy Residential treatment Remedial education Other psychotherapies | ||
| a. Frequencies from Bezchilibnyk-Butler and Jeffries.b. Dose related. c. Rare. | ||