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Psychotropic Drugs in Children: Thioridazine (Mellaril)


Table 4 Prescribing Information for Thioridazine (Mellaril ®)
Optimum Dosage1-3 mg/kg/day

20-200 mg/day

Not recommended under 2 years of


Starting dose 10-25 mg b.i.d.

Drug InteractionsCNS depressants

Antacids decrease absorption


Anticonvulsants increase risk of seizures

Epinephrine increases hypotension


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


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.


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