Class: First Generation Antipsychotic/Dihydroindolone FDA Indications: Schizophrenia Off-Label Use: Impulsive Aggression In ADHD
Forms: 5, 10, 25, 50mg tablet Dose Range: 50-225 mg/day Starting: The usual starting dosage is 50-75 mg/day. Increase to 100 mg/day in 3 or 4 days. Based on severity of symptomatology, dosage may be titrated up or down depending on individual patient response. An increase to 225 mg/day may be required in patients with severe symptomatology. Stopping: Taper 6-8 weeks, rapid d/c can lead to rebound psychosis Monitoring:
Contraindications: Contraindicated in severe central nervous system depression (alcohol, barbiturates, narcotics, etc.) or comatose states Serious Side Effects:
Neuroleptic Malignant Syndrome (NMS)
A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status (including catatonic signs) and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmias). Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis) and acute renal failure.
The diagnostic evaluation of patients with this syndrome is complicated. In arriving at a diagnosis, it is important to identify cases where the clinical presentation includes both serious medical illness (e.g., pneumonia, systemic infection, etc.) and untreated or inadequately treated extrapyramidal signs and symptoms (EPS). Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever and primary central nervous system (CNS) pathology.
The management of NMS should include 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy, 2) intensive symptomatic treatment and medical monitoring, and 3) treatment of any concomitant serious medical problems for which specific treatments are available. There is no general agreement about specific pharmacological treatment regimens for uncomplicated NMS.
If a patient requires antipsychotic drug treatment after recovery from NMS, the potential reintroduction of drug therapy should be carefully considered. The patient should be carefully monitored, since recurrences of NMS have been reported.
Hyperpyrexia and heat stroke, not associated with the above symptom complex, have also been reported with haloperidol.
A severe extrapyramidal side effect that occurs in 15% to 25% of patients after prolonged neuroleptic treatment, is characterized by stereotyped, involuntary, repetitive, choreiform movements of the face, eyelids, mouth, tongue, extremities, and trunk.
Neutropenia and/or Agranulocytosis (rare), Rare, transient, non-specific T wave Δ's have been reported (association with a clinical syndrome has not been established),
Hyperprolactinemia Drugs to Avoid in Congenital Long QT Side Effects: akathisia, rash, EPS, drowsiness, lenticular opacities, amenorrhea (rare)
- structurally unrelated to any of the other marketed neuroleptics
has no appreciable affinity at serotonin, cholinergic, adrenergic, or histaminergic receptors
more likely to cause weight loss than weight gain
Category C—Studies in pregnant patients have not been carried out. Animal reproductive studies have not demonstrated a teratogenic potential. The anticipated benefits must be weighed against the unknown risks to the fetus if used in pregnant patients.
Data are not available on the content of molindone in the milk of nursing mothers.
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Elderly and debilitated patients should be started on lower dosage.
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Last updated August 27 2018 18:45:06. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.
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