Category:

• Miscellaneous

 Description:

• Antipsychotic

Indications:

• Psychoses, Gilles de la Tourette syndrome, severe behavioral problems

• Hyperactive children (short term)

• Prolonged parenteral neuroleptic therapy for chronic schizophrenia (decanoate)

Contraindications:

• Severe toxic CNS depression, Parkinson’s disease

• Comatose states from any cause

Precautions:

• Pregnancy category C; has been used for hyperemesis gravidarum, chorea gravidarum, and manic depressive illness during pregnancy; excreted in breast milk; effect on nursing infant unknown, but may be of concern

• Elderly, severe cardiac disorders, seizure disorder

• Hepatic dysfunction, child < 3 years, alcohol withdrawal

• Abrupt withdrawal, glaucoma

Adverse Reactions (Side Effects):

• CNS: agitation, anxiety, catatonic-like behavioral states, confusion, depression, drowsiness, EPS (pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia), euphoria, exacerbation of psychotic symptoms including hallucinations, headache, lethargy, neuroleptic malignant syndrome, restlessness, seizures, vertigo

• CV: ECG changes, hypertension, hypotension, tachycardia

• EENT: blurred vision, cataracts, dry eyes, glaucoma, retinopathy

• GI: anorexia, constipation, diarrhea, dry mouth, dyspepsia, hypersalivation, nausea, vomiting

• GU: priapism, urinary retention

• HEME: agranulocytosis, anemia, leukocytosis, minimal decreases in red blood cell counts, transient leukopenia

• METAB: breast engorgement, gynecomastia, hyperglycemia, hyperprolactinemia, impotence, increased libido, lactation, mastalgia, menstrual irregularities

• RESP: bronchospasm, increased depth of respiration, laryngospasm

• SKIN: diaphoresis, loss of hair, isolated cases of photosensitivity, maculopapular and acneiform skin reactions  

Dosage:

Administered orally and intramuscularly

• Adult:            

  • Psychosis/Tourette’s syndrome: PO 0.5-5mg 2-3 times daily initially depending on severity of condition, dose is increased to desired dose, max 100mg daily; IM 2-5mg every 1-8 hours

  • Chronic schizophrenia: IM 10-15 times the individual patient’s stabilized PO dose every 4 weeks (decanoate)

• Child 3-12 years: 

  • Psychosis: PO/IM 0.05-0.15 mg/kg/day in 2-3 divided doses

  • Tourette’s syndrome: PO 0.05-0.075 mg/kg/day in 2-3 divided doses

  • Hyperactivity: PO 0.05-0.075 mg/kg/day in 2-3 divided doses

Special considerations:

Do not mix liquid formulation with coffee or tea

Use calibrated dropper

Take with food or milk

Arise slowly from reclining position

Do not discontinue abruptly

Use a sunscreen during sun exposure to prevent burns

Take special precautions to stay cool in hot weather

Observe closely for signs of tardive dyskinesia