| Table 4 Prescribing Information for Thioridazine (Mellaril ®) | ||
| Optimum Dosage1-3 mg/kg/day
20-200 mg/day Not recommended under 2 years of age Starting dose 10-25 mg b.i.d. |
Drug InteractionsCNS depressants
Antacids decrease absorption Anticholinergics Anticonvulsants increase risk of seizures Epinephrine increases hypotension Guanethidine |
|
| Minor Side-EffectsaAnticholinergic 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-indicationsHypersensitivity to other phenothiazines
History of blood dyscrasias Do not use in “pure” attention deficit disorders, because of decrease in learning curve |
|
| Drug Withdrawal EffectsTardive 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-EffectsParkinsonism (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 andAlternatives
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. |
||
Leave a Reply