Tioridazin
When ATH:
N05AC02
Characteristic.
Anxiolytic, piperidine phenothiazines. Tioridazina hydrochloride-powder, water-soluble (1:9), easily soluble in ethanol (1:10), methanol, xloroforme (1:5), insoluble in ether.
Pharmacological action.
Antipsychotic, sedation.
Application.
Schizophrenia, affective insanity; neuroses, accompanied by fear, voltage, excitation, compulsions; tics, withdrawal syndrome in chronic alcoholism and substance abuse, the state of agitation of various origins.
Contraindications.
Hypersensitivity, severe cardiovascular diseases (decompensated chronic heart failure, hypotension), pronounced inhibition of the central nervous system and coma of any etiology; ChMT, progressive systemic diseases of the brain and spinal cord, porphyria, pregnancy, lactation, childhood (to 2 years).
Restrictions apply.
Alcoholism (predisposition to hepatotoxicity), blood dyscrasias (hemodyscrasia), mammary cancer (as a result of phenothiazine-induced prolactin increase the potential risk of disease progression and resistance to treatment with endocrine and cytostatic drugs), zakrыtougolynaya glaucoma, prostatic hyperplasia with clinical manifestations, liver and / or kidney failure, gastric ulcer and duodenal ulcer (during the exacerbation); disease, accompanied by an increased risk of thromboembolic complications; Parkinson's disease (intensified extrapyramidal effects); epilepsy; myxedema; chronic diseases, accompanied by respiratory failure (especially in children); Reye's syndrome (increased risk of hepatotoxicity in children and adolescents); kaxeksija, vomiting (antiemetic effect of phenothiazines may mask vomiting, associated with an overdose of other drugs), advanced age.
Side effects.
From the nervous system and sensory organs: fainting, confusion, psychomotor disturbances, pozdnyaya dyskinesia, ažitaciâ, excitation, insomnia, hallucinations, increased psychotic reactions, and extrapyramidal dystonic reactions, parkinsonizm, emotional disturbances, violation of thermoregulation, decrease seizure threshold, photophobia, blurred vision.
From the digestive tract: giposalivaciâ, Hypertrophy of tongue papillae, decrease / increase in appetite, dyspepsia, nausea, vomiting, diarrhea, paralytic ileus, cholestatic hepatitis.
On the part of the endocrine system: dysmenorrhoea, hyperprolactinemia, gynecomastia, false positive pregnancy tests, weight gain.
Cardio-vascular system and blood (hematopoiesis, hemostasis): decrease in blood pressure, tachycardia, nonspecific ECG changes, inhibition of bone marrow hematopoiesis (agranulocytosis, leukopenia, granulocytopenia, eozinofilija, thrombocytopenia, aplasticheskaya anemia, pancytopenia).
From the respiratory system: bronhospastichesky syndrome, nasal congestion.
With the genitourinary system: paradoxical urinary retention, dizurija, decreased libido, sexual dysfunction (incl. retrograde ejaculation), priapism.
Allergic reactions: skin rash (incl. эritematoznaya), angioedema, exfoliative dermatitis.
Other: melasma (long-term use in high doses). When receiving neuroleptics phenothiazine series were cases of sudden death (incl. due to cardiac causes); possible extension QT interval — the risk of ventricular arrhythmias (especially against the background of the initial bradycardia, hypokalemia, удлиненного QT).
Cooperation.
It enhances the effect of hypnotics, analgesic, narcotic drugs and alcohol, weakens-levodopa and amphetamine. Atropine increases anticholinergic activity, antidiabetic agents increase the likelihood of abnormal liver function. Reduces anorectics PM (except for fenfluramine). It decreases the effect of apomorphine hydrochloride vomitoxin, enhances its depressing effect on the central nervous system. Increases in plasma concentration of prolactin and inhibits the action of bromocriptine. The synergy of action with general anesthetics. When concomitantly with antiepileptic drugs (incl. ʙarʙituratami) reduces their effect (It lowers the seizure threshold). In combination with beta-blockers enhanced hypotensive effect, It increases the risk of irreversible retinopathy, arrhythmias and tardive dyskinesia. Probucol, astemizol, cisapride, disopyramide, Erythromycin, pimozid, procainamide, quinidine, and promote further lengthening of the QT interval, which increases the risk of ventricular tachycardia. Ephedrine helps paradoxical decrease in blood pressure. Agonists enhance the arrhythmogenic effect. Antithyroid drugs increase the risk of agranulocytosis. In a joint application with tricyclic antidepressants, Maprotiline, MAO inhibitors, antihistamines possible lengthening and strengthening of sedative and anticholinergic effects, with tiazidnami dioretikami — strengthening of hyponatremia, with preparations Li+ - Reduced absorption in the gastrointestinal tract of phenothiazine, increasing the rate of excretion of Li+ kidney, increased severity of extrapyramidal disorders (early signs of intoxication lithium-nausea and vomiting-can be masked by the effect of antiemetic tioridazina). PM, suppress bone marrow hematopoiesis, increase the risk of myelosuppression.
Overdose.
Symptoms: drowsiness, confusion, urinary retention, disorientation, coma, areflexia, hyperreflexia, dry mouth, nasal congestion, orthostatic hypotension, depression of the respiratory center, convulsions, gipotermiя.
Treatment: simptomaticheskaya therapy, aimed at reducing the suction and the acceleration of Withdrawal. No specific antidote.
Dosing and Administration.
Inside. The mode set individually, depending on the evidence, portability, etc.. Treatment should start with the lowest effective dose. During treatment, the dose is gradually increased until the maximum effective dose. The daily dose is usually divided into 2-4 reception. Adults, mild mental and emotional disorders — 30-75 mg/day, with moderate disorders is 50-200 mg/day. In acute psychosis, mania, schizophrenia and depression azhitatsionnyh: in the outpatient setting is 150-400 mg/day, in the hospital — 250-800 mg/day. Children 4-7 years is 10-20 mg/day 2-3 reception, 8-14 years are 20-30 mg/day 3 once a day, 15-18 years — 30-50 mg/day. The treatment ends with a gradual decrease in dosage.
Precautions.
It is advisable to periodically monitor the morphological composition of the peripheral blood. Be wary appoint elderly patients because of the risk of paradoxical reactions.
Chronic administration of high doses often, other than phenothiazines, cause pigmentary retinopathy (blurred vision, breach of color vision, day-blindness).
During the reception it is not recommended to drive vehicles and work with complex mechanisms. Eliminates alcohol.
