Thioridazine HCl

A to Z Drug Facts

Thioridazine HCl

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(THIGH-oh-RID-uh-zeen HIGH-droe-KLOR-ide)

Mellaril, Mellaril-S, Thioridazine HCl Intensol, Apo-Thioridazine, Novo-Ridazine, PMS-Thioridazine

Class: Antipsychotic/phenothiazine; antiemetic

Action Effects apparently due to dopamine receptor blocking in CNS.

Indications Management of psychotic disorders (eg, schizophrenia); short-term treatment of moderate to marked depression with variable degrees of anxiety in adults; reatment of multiple symptoms (eg, agitation, anxiety, depressed mood, tension, sleep disturbances and fears) in geriatric patients; treatment of severe behavioral problems in children marked by combativeness or explosive hyper-excitable behavior; short-term treatment of hyperactive children who show excessive motor activity with accompanying conduct disorders. Treatment of Tourette's syndrome, acute agitation in elderly and some symptoms of dementia.

Contraindications Comatose or severely depressed states; allergy to this or any phenothiazine; resence of large amounts of other CNS depressants; bone marrow depression or blood dyscrasias; liver damage; extensive cerebral arteriosclerosis; severe coronary artery disease; severe hypotension or hypertension; subcortical brain damage.

Route/Dosage

ADULTS: PO 200–800 mg/day in divided doses. For moderate disorders, start with 10 mg bid-tid. Do not exceed 800 mg/day. CHILDREN 13–18 YR: PO 25–800 mg/day. CHILDREN 7–12 YR: PO 25–500 mg/day. CHILDREN 3–6 YR: PO 10–100 mg/day. CHILDREN 2–12 YR: PO Usually 0.5–3 mg/kg/day. HOSPITALIZED, SEVERELY DISTURBED, OR PSYCHOTIC CHILDREN: PO 25 mg bid-tid. ELDERLY: PO 20–200 mg/day.

Interactions

Alcohol and other CNS depressants: May result in increased CNS depression and may precipitate extrapyramidal reaction. Anticholinergics: May reduce therapeutic effects of thioridazine and worsen anticholinergic effects of thioridazine. May lead to tardive dyskinesia. Barbiturate anesthetics: Frequency and severity of neuromuscular excitation and hypotension may increase. Beta-blockers: May result in increased plasma levels of beta-blocker and thioridazine. Epinephrine: May antagonize effects of epinephrine. Lithium: May cause disorientation, unconsciousness and extrapyramidal effects.

Lab Test Interferences May discolor urine pink to red-brown. False-positive pregnancy test results may occur, but are less likely to occur with serum test. Increases in protein bound iodine have been reported.

Adverse Reactions

CV: Orthostatic hypotension; hypertension; tachycardia; bradycardia; yncope; cardiac arrest; circulatory collapse; lightheadedness; faintness; izziness; Ekg changes. CNS: Pseudoparkinsonism; dystonias; motor restlessness; headache; weakness; remor; fatigue; slurring; insomnia; vertigo; seizures; tardive dyskinesia; rowsiness; paradoxical excitement; headache; confusion. DERM: Photosensitivity; skin pigmentation; dry skin; exfoliative dermatitis; rticarial rash; maculopapular hypersensitivity reaction; seborrhea; eczema. EENT: Pigmentary retinopathy; glaucoma; photophobia; blurred vision; mydriasis; ncreased IOP; dry throat; nasal congestion. GI: Dyspepsia; constipation; dry mouth; adynamic ileus. GU: Urinary hesitancy or retention; impotence; sexual dysfunction; dysmenorrhea; enstrual irregularities. HEMA: Agranulocytosis; eosinophilia; leukopenia; hemolytic anemia; hrombocytopenic purpura. HEPA: Jaundice. META: Decreased cholesterol. RESP: Laryngospasm; respiratory depression; bronchospasm; dyspnea. OTHER: Increase in appetite and weight; polydipsia; breast enlargement; galactorrhea; euroleptic malignant syndrome.

Precautions

Pregnancy: Safety not established. Lactation: Safety not established. Children: Not recommended in children < 2 yr. Elderly patients: More susceptible to effects; consider lower dose. Special risk patients: Use caution in patients with cardiovascular disease or mitral insufficiency, history of glaucoma, EEG abnormalities or seizure disorders, prior brain damage, hepatic or renal impairment. CNS effects: May impair mental or physical abilities, especially during first few days of therapy. Hepatic effects: Jaundice usually occurs between 2nd and 4th weeks of treatment; considered hypersensitivity reaction. Usually reversible. Neuroleptic malignant syndrome (NMS): Has occurred with agents of this class; is potentially fatal. Signs and symptoms are hyperpyrexia, muscle rigidity, altered mental status, irregular pulse, irregular blood pressure, tachycardia and diaphoresis. Pulmonary: Cases of bronchopneumonia, some fatal, have occurred. Sudden death: Has been reported; predisposing factors may be seizures or previous brain damage. Flareups of psychotic behavior may precede death.

PATIENT CARE CONSIDERATIONS

Administration/Storage

If using concentrate, do not mix with beverages containing caffeine, tannins or apple juice. Examples of possible mixing solutions include milk, saline, pineapple, orange-flavored soda, tomato juice, apricot or grapefruit juice.
Avoid contact with skin.
Store in tight, light-resistant container.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Assess mental status before initial administration.
Check to ensure patient has swallowed drug.
Monitor vital signs and check orthostatic BP and pulse before treatment and q 4 hr during therapy.
Assess for signs of liver dysfunction (jaundice, light-colored stools, palpable liver).
Monitor bilirubin, CBC and LFTs monthly.
Assess alcohol consumption.
Monitor for signs of tardive dyskinesia and other extrapyramidal symptoms and assess need for antiparkinson agent.
Assess ECG for rhythm disturbances.
Notify physician of changes in vital signs, ECG, or cardiac status.
Notify physician if patient demonstrates psychiatric changes.
Monitor I&O. Palpate bladder if urine output is decreased.
Supervise ambulation until patient is stable.
Increase fluid intake to prevent constipation.
Provide sips of water, sugarless candy or sugarless gum to relieve dry mouth.

OVERDOSAGE: SIGNS & SYMPTOMS
	Decreased consciousness, arrhythmias, extrapyramidal effects, confusion, agitation, respiratory depression, anticholinergic effects

Patient/Family Education

Caution patient not to consume alcohol and to avoid otc medications while taking drug.
Explain changes in urine color that may occur with this medication.
Tell patient to report flank pain or changes in urination other than expected color changes.
Tell patient to report signs of liver dysfunction, such as light-colored stools or jaundice.
Explain type and potential significance of tardive dyskinesia such as changes in control of facial muscles.
Instruct patient to avoid sudden position changes to prevent orthostatic hypotension.
Caution patient to avoid hot tubs and hot showers and baths since hypotension may occur.
Tell patient/family to report seizures, headaches, faint feeling, dizziness, or changes in mental function.
Tell patient to use precautions against photosensitivity reactions. Advise use of sunscreen.
Stress good oral hygiene.
Caution patient not to drive while on medication, as may cause drowsiness or dizziness.
Inform patient that in hot weather patient may have increased risk of heat stroke and increased sensitivity to sun.