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Overview

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Name

Thioridazine hydrochloride

Precaution

Before using **Thioridazine hydrochloride**, it is essential for patients to consult with their healthcare provider to ensure the medication is suitable for their specific condition. The following precautions should be observed: - **Cardiovascular Conditions**: Thioridazine can cause **QT interval prolongation**, leading to serious heart rhythm abnormalities, including **torsades de pointes** (a life-threatening arrhythmia). Patients with **pre-existing heart conditions** such as arrhythmias, heart failure, or a history of **stroke** should be carefully monitored. - **Liver Dysfunction**: Patients with **liver disease** may require dose adjustments due to reduced drug metabolism. Liver function should be monitored throughout treatment. - **Neurological Disorders**: Thioridazine is an **antipsychotic** and may cause extrapyramidal symptoms (EPS), including **tremors**, **rigidity**, and **tardive dyskinesia** (a potentially irreversible movement disorder). These side effects should be promptly reported to the healthcare provider. - **Elderly Patients**: Older adults may be more susceptible to **sedation**, **orthostatic hypotension**, and **extrapyramidal symptoms** when using thioridazine, requiring careful monitoring. - **Pregnancy and Breastfeeding**: Thioridazine should only be used during pregnancy if absolutely necessary. It may pass into breast milk and could harm a breastfeeding infant, so its use during lactation is not recommended without a doctor’s approval.

Indication

Thioridazine hydrochloride is primarily indicated for the treatment of **schizophrenia** and other psychotic disorders. It is also used for: - **Schizophrenia**: Thioridazine is used to treat **positive symptoms** of schizophrenia, such as **hallucinations**, **delusions**, and **disorganized thinking**. It is typically prescribed when other antipsychotic medications are not effective or well-tolerated. - **Psychosis**: Thioridazine may be used for managing symptoms of **psychosis** in certain conditions other than schizophrenia, as determined by a healthcare provider. - **Severe Agitation or Aggression**: In certain cases, thioridazine may be used for controlling **severe agitation** or **aggressive behavior** related to psychosis or other mental health conditions, although this is less common.

Contra indication

Thioridazine is contraindicated in the following situations: - **Hypersensitivity**: It should not be used in individuals who are allergic to **thioridazine** or other **phenothiazine-class** medications. - **Severe Cardiovascular Conditions**: **Severe arrhythmias**, **heart block**, or **prolonged QT interval** are contraindications, as thioridazine can exacerbate these issues and cause potentially fatal arrhythmias. - **Comatose or Severely Depressed Patients**: Thioridazine should not be administered to patients who are in a **coma** or have a **severe CNS depression**, as it could worsen these conditions. - **Concurrent Use with Certain Medications**: Thioridazine should not be used in combination with certain drugs that prolong the **QT interval**, such as **antiarrhythmic agents**, certain **antibiotics**, and other **antipsychotics**, due to the risk of life-threatening arrhythmias. - **Severe Hepatic Dysfunction**: It should not be used in patients with **severe liver disease** or significant liver dysfunction, as its metabolism may be impaired.

Side Effect

Thioridazine may cause a range of side effects, both mild and severe. Patients should report any unusual symptoms to their healthcare provider: - **Common Side Effects**: - **Drowsiness** or **sedation** - **Dizziness** or **lightheadedness** - **Dry mouth** - **Constipation** - **Blurry vision** - **Weight gain** - **Severe Side Effects**: - **Tardive dyskinesia**: An irreversible condition characterized by repetitive, involuntary movements such as lip-smacking, tongue thrusting, or facial tics. - **Extrapyramidal Symptoms (EPS)**: This includes symptoms like **tremors**, **rigidity**, **shuffling gait**, and **restlessness**. - **QT Prolongation**: Thioridazine can cause **prolonged QT intervals**, increasing the risk of **life-threatening arrhythmias**, such as **torsades de pointes**. - **Neuroleptic Malignant Syndrome (NMS)**: A rare but potentially fatal condition that includes **high fever**, **muscle rigidity**, **altered mental status**, and **autonomic dysfunction**. - **Agranulocytosis**: A severe reduction in white blood cell count, which can make patients more susceptible to infections. - **Severe hypotension**: **Low blood pressure** can occur, leading to dizziness, fainting, or even shock in extreme cases.

Pregnancy Category ID

3

Mode of Action

Thioridazine hydrochloride is a **first-generation antipsychotic** belonging to the **phenothiazine class**. Its mechanism of action includes: - **Dopamine Receptor Blockade**: Thioridazine primarily works by blocking **dopamine receptors** (particularly **D2 receptors**) in the brain. This reduces the effects of dopamine, a neurotransmitter associated with **psychosis** and **schizophrenia**. The blocking of these receptors helps alleviate symptoms such as **delusions** and **hallucinations**. - **Anticholinergic Activity**: Thioridazine also exhibits **anticholinergic** properties, which can contribute to **dry mouth**, **blurred vision**, and **constipation**. This mechanism may also help in reducing certain types of motor symptoms (like tremors) in psychotic patients. - **Alpha-Adrenergic Blockade**: It has some **alpha-adrenergic antagonist activity**, which can cause **sedation** and **hypotension** as side effects. - **Serotonin Receptor Blockade**: There may also be some blockade of serotonin receptors, contributing to its **mood-stabilizing** effects in some patients.

Interaction

Thioridazine interacts with various medications and substances, potentially altering its effects or increasing the risk of side effects: - **QT-Prolonging Drugs**: The combination of thioridazine with other medications that prolong the QT interval, such as **antiarrhythmics**, **antibiotics** (like **erythromycin** or **clarithromycin**), and some **antidepressants**, increases the risk of **serious arrhythmias**. - **CNS Depressants**: Concurrent use of thioridazine with other central nervous system (CNS) depressants, including **alcohol**, **benzodiazepines**, or **opioids**, can cause excessive **sedation**, **respiratory depression**, and increased risk of **overdose**. - **CYP450 Inhibitors**: Thioridazine is metabolized by the liver enzyme **CYP2D6**. Drugs that inhibit this enzyme, such as **fluoxetine** and **paroxetine**, may increase thioridazine's plasma concentration, increasing the risk of side effects. - **Antihypertensive Drugs**: The use of thioridazine with **antihypertensive medications** may exacerbate its **hypotensive effects**, causing **low blood pressure** or dizziness. - **Levodopa**: Thioridazine may antagonize the effects of **levodopa**, a medication used to treat **Parkinson’s disease**, reducing its efficacy.

Pregnancy Category Note

Information not available

Adult Dose

The recommended dosage of **Thioridazine hydrochloride** varies based on the severity of the condition: - **Schizophrenia**: - Initial dose: Typically starts at **25 mg** taken 2-3 times daily. - Maintenance dose: The usual effective dose is between **200 mg and 400 mg** daily, divided into 2-3 doses. - Maximum dose: **800 mg/day** in divided doses may be prescribed in severe cases, although this higher dose should be used with caution due to the risk of serious side effects.

Child Dose

Thioridazine is not commonly prescribed for pediatric patients and should only be used in children under the guidance of a specialist. For children, dosing would depend on the severity of the condition and the specific diagnosis. In general, **lower doses** and careful monitoring for side effects are required: - **Starting dose**: Typically, children would start with **2.5 mg to 5 mg** daily, gradually increasing the dose if necessary. - **Typical dosing range**: **2.5 mg to 10 mg** daily in divided doses, depending on the child's weight and response to treatment. Pediatric dosing should always be determined by a healthcare professional to avoid complications and ensure safety.

Renal Dose

Thioridazine hydrochloride should be used cautiously in patients with **renal impairment**. The drug is primarily metabolized by the liver, but impaired renal function may slow the clearance of certain metabolites, increasing the risk of side effects. **Dose adjustments** may be necessary for patients with moderate to severe renal dysfunction, and these patients should be monitored closely for **sedation** and **hypotension**.

Administration

Information not available