sign in sign up
<<
Home , Acetophenazine, Benzoctamine, Captodiame, Carbromal, Chlorproethazine, Cyclarbamate

Appendix of *

• Editor's Note: This appendix includes some of the most widely used trade names but should in no way be regarded as fully comprehensive. 374 maleate

Acepromazine maleate but causes less potentiation of (Available as NotensilR , PlegizilR ) noradrenaline. Dosage is normally 25 mg Acepromazine is a derivative tds but this is often increased to SO mg tds. with and activity, The commonest side effects are drowsiness having its greatest use in psychotic patients and dry mouth. Other anti- with excitement and aggressiveness. The effects are not uncommon. dose is 10-25 mg tds for neuroses; should be used cautiously in patients with 50-100 mg tds for psychoses. Side cardiovascular disorders, and it is contra• effects resemble those of indicated in glaucoma, prostatic enlarge• (g.v.) but occur less frequently and the ment and . Care should contra-indications are as for chlorproma• be taken when amitriptyline is given at the zine. same time as anti-hypertensive drugs. Except in special circumstances it should Acetylcarbromal not be combined with a monoamine (AbasinR ) oxidase inhibitor, and usually it is pre• Acetylcarbromal is a mild with ferable to wait at least three weeks after less effect than (q.v.). discontinuing a I t produces sleep of short duration and is inhibitor before starting treatment with also used as an ambulatory sedative. The amitriptyline. normal dose is 250-500 mg tds. Few side effects occur at therapeutic doses but over sulphate longer periods symptoms resembling Amphetamine is a sympathomimetic chronic poisoning may occur. amine with central nervous system stimu• lant and anorectic activity. It is used to maleate treat mild depressive neuroses and as an (TindaIR ) adjuvant in the treatment of chronic A phenothiazine derivative with action and alcoholism. The dose is 5 to 10 mg uses as chlorpromazine (q. v.) in morning and midday. Side effects include and . The daily dose ranges dryness of the mouth, restlessness, head• from 40-80 mg. Its usefulness has not been ache, , irritability, , fully established. and . Larger doses may give rise to fatigue, mental depression, an Amiphenazole hydrochloride increase in BP, fever, cardiovascular (DaptazoleR ) reactions, cyanosis and respiratory failure, Amiphenazole is an analeptic with an disorientation, hallucinations, convulsions, action similar to leptazol (q.v.) but less and coma. Continued use of amphetamine potent. I t is used in respiratory depression sulphate may cause addiction in some or failure and where large doses of mor• patients. It is contra-indicated in cardio• phine are necessary: Dosage is 15-20 mg vascular disease and thyrotoxicosis, and in with each dose of , intramuscu• those patients showing anxiety, hyper• larly, and 100-200 mg tds or qds in excitability and restlessness. respiratory insufficiency. Side effects in• The should be used with caution in clude , , skin rashes and patients with anorexia, insomnia and insomnia. Amiphenazole may lead to bone nephritis. Caution should be taken if marrow depression following long term amphetamine is used concurrently with usage. monoamine oxidase inhibitors. Due to the liability of abuse the use of amphetamine Amitriptyline hydrochloride is no longer recommended. (LaroxyIR, LentizolR and SarotenR , TryptizolR; also a constituent of combina• Amylobarbitone tions with various tranquillizers) (AmytaIR) Amitriptyline is a dibenzocycloheptadiene Amylobarbitone is an intermediate-acting derivative with potent anti- . It is used as a sedative and activity and mild anxiolytic properties. It hypnotic. The sedative dose is 15-50 is used in all forms of depression. It has mg bd or tds and 100-300 mg as a hypnotic. stronger anti-cholinergic and anti• Its action, side effects and contra-indica• histaminic ~.ctions than (q.v.), tions are as for (q.v.) generally. Benzguinamide 375

Amylobarbitone sodium otherwise its properties are the same. (Sodium AmytalR ) Dose: 300 to 600 mg nocte. Being more speedily absorbed, amylo• barbitone sodium provides a quicker hypnotic action, otherwise its properties (MegimideR ) are the same as amylobarbitone (q.v.). An analeptic drug with a similar, but Hypnotic dose 100 to 200 mg nocte. longer, action to leptazol (q.v.) and nike• I ts action, side effects and contra-indica• thamide (g.v.), but less potent than tions are as for barbiturates (q.\".) generally. (q.y.). In use 10 ml of injection solution (50 mg of bemegride) are injected Anisoperidone every three to five minutes until the desired Anisoperidone is a result is obtained, or until a total dose of derivative used as a tranguillizer. It is less 1 g is reached. effective than in schizophrenia, Toxic effects include retching, \·omiting, but greater anxiolytic activity than chlor• muscular twitching and . (q.v.) has been reported. Dose: 5 to 20 mg daily. Side effects include lack hydrochloride of drive, mild catatonia, nausea, vomiting (Formerly marketed as CafronR , and Parkinsonism. The place of this CevonoJlt, Lucidillt, NutinalR , SuavitilR , substance in clinical therapeutics has not and as an ingredient of Deprol R, Procalm R, yet been established. StoikonR) A diphenylmethane derivative with actions hydrochloride similar to meprobomate (g.v.). Used as a Apomorphine at a dose of 2-8 mg sub• tranquillizer but now in disfavour owing to cutaneously is used as an emetic in the the number of side effects. Dosage 3-5 mg treatment of non-corrosive poisoning and tds. for aversion therapy in alcoholism. At 2 mg it has sedative and hypnotic effects. Benanserin Adverse reactions include hypotension, An indole derivative, benanserin has tachycardia and . It is psychotropic properties. The place of this contra-indicated in patients in shock or substance in clinical therapeutics has not deep narcosis. yet been established.

Azocyclonol hydrochloride Benzoctarnine hydrochloride (Formerly available as Frenquel) (TacitinR) Azocyclonol is a neuroleptic found effective is an derivative mainly in the treatment of acute schizo• with anxiolytic and phrenia. The dose of 20 to 100 mg tds properties. It is used in anxiety and tension produces few side effects, no sedation in dosages between 10 and 20 mg tds. Side results but skin rashes may occur. effects include lassitude, hypotension, impaired vision, sweating, gastrointestinal upsets and tachycardia. Barbitone (HypnogenR , formerly VeronalR ) Benzperidol Barbitone is one of the long-acting group (Synonym: benzperidol) of barbiturates, but is slow in producing (AnquiIR, FrenactylR, GlianimonR ) hypnosis. Although one of the least toxic A butyrophenone derivative reputed to be of the barbiturates, an intermediate or particularly effective in schizophrenia in short-acting barbiturate is preferred as a agitated geriatric patients and in the hypnotic. Normal dose is 300 to 600 mg. control of deviant and anti-social be• As barbitone is excreted slowly its cumula• haviour. The recommended daily dose is tion is a problem. 0·25-1·5 mg. Side effects are typical of the . Barbitone sodium (Previously available as MedinalR ) Barbitone sodium produces hypnosis (QuantriIR; QuantrilR in the UK is a rather quicker than barbitone (g.v.), brand of citrate) 376

Benzquinamide is a weak tranquilii2;er used Butobarbitone in the treatment of anxiety and tension. (SoneryIR) The dose varies from 0·3 to 1 g daily and Butobarbitone is a member of the inter• side effects include extrapyramidal effects, mediate acting barbiturates and used , vomiting, and dizziness. mainly as a hypnotic in insomnia, nervous or mental excitement and anxiety states. Bromazepam Dose: 100~200 mg. Side effects are those (LexomiIR , LexotanR , LexotaneR , Lexo• normally associated with barbiturates (q.v .). tanillt) Bromazepam is a new member of the hydrochloride group. It resembles (EvadyneR ) (q.v.) in clinical effects, par• Butriptyline is a moderately sedative tri• ticularly as an antianxiety agent at a cyclic used in patients with daily dose of 4· 5~9 mg. Its side effects are depression associated with anxiety. The also similar to those of diazepam. daily dosage is between 75 and 150 mg/ day. side effects are present. A which increases the production of prolactin inhibitory factor Butyrylperazine in the hypothalamus. A recent study sug• SEE . gests that bromocriptine may have a part to play in the treatment of certain cases of hydrochloride . (Formerly marketed in the United King• dom as CovantinR, CovatixR) Bromvaletone (Marketed in USA as SuvrenR) (BromuraIH ) Captodiame hydrochloride has sedative Bromvaletone is chemically related to and anti-spasmodic properties and carbromal. It is a mild, rapidly acting has been used for the relief of tension, hypnotic with moderately short length of agitation and anxiety in minor neuroses action. It has low toxicity but the habitua• and psychosomatic disorders. Dose: tion liability is similar to that of carbromal 50~100 mg tds. It is contra-indicated in (q.v.). It is of no value in insomnia asso• coma due to central nervous ciated with pain. Dose: 300~600 mg. such as , barbiturates and . Chronic intoxication may produce bromism. Carbromal (AdalinR) hydrochloride Carbromal is a mild hypnotic of value in (VibazineR, SoftranR) mild insomnia. The dose is 300~1000 mg. Buclizine is an anti- also used for Side effects resemble those of its anti-emetic properties, which are hydrate (q.v.). After long periods, symp• potent but not prolonged. Sedative effect toms of chronic toxicity resembling is pronounced and buclizine has been used bromism may occur. as an anxiolytic. Used for the sympto• matic treatment of allergic conditions and Carphenazine maleate of vertigo. The usual dose is 20~50 mg tds. (Marketed in the USA as ProketazineR Maleate) Butaperazine A phenothiazine derivative with tran• (Synonym: butyrylperazine) quillizing properties similar to those of (RandolectiIR) chlorpromazine (q.v.). It is used in the Butaperazine is an anti-psychotic related treatment of anxiey and schizophrenia, to phenothiazine with strong tranquillizing but in the latter maximum response is often properties. It is used in treating chronic slow. Its mild stimulating effect is valuable schizophrenia in doses ranging from 30 to in the apathetic withdrawn schizophrenic. 200 mg. daily. Side effects including The dose is gradually increased at intervals , hypotension, of seven to fourteen days, being between and blurred vision are those 25 and 4UU mg. Side effects and contra• associated with the . indication are as for chlorpromazine (q.v.). Chlorproheptadiene 377

Centrophenoxine hydrochloride Chlorhexadol (LucidriIR ) (Medodorm R ; Dormaxl\ Danish; LovaR , SEE hydrochloride. USA) Chlorhexadol, a (q.v.) derivative, is a sedative and hypnotic. The (Formerly marketed as SomilanR ) dose is 200-800 mg tds as a sedative and A complex of chloral hydrate and betaine 0·8-1·6 g as a hypnotic. Toxic effects and with similar actions and uses to chloral contra-indications are as for chloral hydrate. It is claimed not to cause gastric hydrate (q.v.). irritation. Hypnotic dose 0,87-1,75 g half an hour before bedtime. Toxic effects Chlorimipramine and contra-indications as for chloral SEE hydrate (q.v.). Chlormethazanone Chloral hydrate SEE (SomnosR , NoctecR ) Chloral hydrate has been in use as a Chlormethiazole edisylate hypnotic for over 100 years. The dose is (HeminevrinR ) 300 mg-2g. Although considered a safe Chlormethiazole is a hypnotic with muscle hypnotic, an adult death occurred with a relaxant and anti-convulsant properties. 1·3 g dose. It should not be given as tablets It is used mainly in the treatment of as damage of the mucous membrane of the delerium tremens, acute withdrawal alimentary tract may occur. symptoms in alcoholics and drug addicts, Side effects include deep stupor, vasodila• sleep disturbances and pre-eclamptic tion, hypotension, hypothermia and toxaemia. Dosage for insomnia is 1-2 g respiratory depression. Gastric irritation nocte. Side effects include gastrointestinal may cause vomiting. Fatal dose averages upsets and it is contra-indicated in about 10 g and doses over 2 g should be depression. Due to additive or potentiating used with caution. effects, chlormethiazole should be used Chronic poisoning resembles chronic with caution with other drugs. alcoholism. It is contra-indicated in patients with marked hepatic or renal Chlormezanone impairment or severe cardiac disease and (Synonym: Chlormethazanone) is best avoided in gastritis. (TrancopaIR ) Chlormezanone is a minor tranquillizer with actions similar to those of meproba• (LibriumR , CalmodenR ) mate (q.v.), and is used in the treatment of (Also a constituent of LimbitrolR ) mild tension and anxiety states. It also Chlordiazepoxide is a minor tranquillizer relieves muscle spasm. Dose: 200 mg tds. and widely used prototype member of the Side effects are mild and relatively in• (q.v.). This compound has frequent. Its use is contra-indicated with a strong anxiolytic effect, but less muscle phenothiazines or monoamine oxidase relaxant properties than diazepam. It is inhibitors. valuable in all disorders in which anxiety is either causative, or a prominent symptom: Chlorperphanazine these include the psychosomatic disorders. SEE . The normal dose is 10 mg tds. In chronic alcoholism up to 100 mg may be given. Excellent tolerance is reported and the side (NeuripU:ge R ) effects which are few and mild include A phenothiazine derivative chlorproetha• ataxia and drowsiness. If psychological zine is a tranquillizer with actions and uses dependence does occur it is very weak. as chlorpromazine (q.v.). Although additive sedative effects may be encountered, chlordiazepoxide may be Chlorproheptadiene given safely with other psychotropic Chlorproheptadiene is a cycloheptene drugs. derivative which shows possible tran• quillizing properties. The place of this 378 Chlorpromazine hydrochloride

substance in clinical therapeutics has not Clomacran yet been established. Clomacran is an acrid an derivative used as a neuroleptic in schizophrenia in dosages Chlorpromazine hydrochloride between 100 to 600 mg daily. Side effects (LargactiIR , MegaphenR , PropaphenR and include drowsiness, akathisia (to an exte.nt in various combinations) that anti-Parkinsonism treatment may be (ThorazineR, Hydrochloride in the USA) required) and insomnia. The place of this Chlorpromazine is a major tranquillizer substance in clinical therapeutics has not (neuroleptic) and widely used prototype yet been established. member of the phenothiazine (q.v.) group, having sedative and anxiolytic properties. Clomipramine hydrochloride It is used to alleviate anxiety, tension and (Synonym: chlorimipramine) agitation in neurotic and psychotic (Anafranil R) patients. It is especially valuable in schizo• Clomipramine is an iminodibenzyl phrenia. The dose varies from 25 to 100 mg derivative with anti-depressant properties. tds. Side effects include drowsiness, The dose is 25 mg tds for two to three dryness of the mouth, dizziness, headache, days, increasing to 50 mg tds. constipation, lassitude, Parkinsonism, Side effects include dry mouth, difficulty hypotension, skin disorders, occasionally with accommodation, disturbances of severe and rarely fatal blood dyscrasias and micturition, hypotension, and gastro• jaundice. intestinal upsets, and are similar to those Chlorpromazine is contra-indicated in of the other iminodibenzyl derivatives cases of coma due to direct central nervous (e.g. imipramine (q.v.) ). system depression such as with alcohol, Contra-indications include damage, barbiturates; in patients with liver and circulatory failure, glaucoma and urinary cardiovascular disease. retention. It should not be used con• currently or within fourteen days of treat• ment with monoamine oxidase inhibitors. (TaractanR , TruxalR ) Chlorprothixene is a deriva• tive with similar actions and uses as (Rivotril R) chlorpromazine (q.v.) and with some Clonazepam is one of the most recently anti-depressant effect. It is used in the introduced benzodiazepines with anti• treatment of agitation, anxiety, hallucina• epileptic properties. The adult daily tions and delusions without the risk of dosage is 4-8 mg. Side effects are those exacerbating any underlying depression. of the benzodiazepines. Dose: 10-50 mg tds. Side effects include dryness of mouth, sweating, tachycardia, drowsiness and hypotension. (SordinoIR ) Clopenthixol is a thioxanthene derivative Citrated calcium carbimide with anxiolytic activity and similar uses to (AbstemR ) the phenothiazines. It is used to produce Citrated calcium carbimide is used as an sedation in the treatment of severe agitatiOl adjunct in alcoholism therapy. Like acute schizophrenia and manic depression. (q.v.) it interferes with normal Side effects include extrapyramidal alcohol , an increase of acet• symptoms, dyskinesia, hypotension and aldehyde in the blood producing an tachycardia. Dose: 30-150 mg tds. unpleasant syndrome, flushing, headache, giddiness, and tachycardia. The dose is (as potassium salt) 1 tablet bd. It produces fewer and milder (TranxeneR , TranxiliumR ) side effects than disulfiram, but mild or An anxiolytic benzodiazepine used in transitory leucocytosis has been reported. anxiety states at a dosage of 15 mg at It is contra-indicated in patients with night. Side effects resemble those of other myocardial or coronary artery disease. benzodiazepines. 379

Clorgyline acting barbiturates (q.v.) with a com• A non- monoamine oxidase paratively mild action. It is used as a inhibitor, clorgyline has anti-depressant sedative and hypnotic in anxiety states activity. The usual dose is 5 mg tds. Side and insomnia. effects reported include postural hypo• Dose: 200 to 400 mg. tension and fainting. The place of this substance in clinical therapeutics has not Cyclobarbitone calcium yet been established. (RapidaIR , PhanodormR ) Cyclobarbitone calcium has the same Clothiapine action and uses as cyclobarbitone, but (EtuminR , EtomineR , EtominaR ) since cyclobarbitone gradually decomposes Clothiapine is a tranquillizer of the diben• the more stable cyclobarbitone calcium is zothiazepine group. Used in schizo• preferred. phrenia, the dose varies between 30 and 360 mg daily. The place of clothiapine in Cyprolidol medical practice is not yet established. A pyridyl- derivative, cyprolidol has anti-depressant activity and is used in the treatment of depression. (LeponexR ) The daily dose is 500-600 mg. The place Clozapine is a dibenzodiazepine derivative of cyprolidol in therapy is not yet with neuroleptic activity at a daily dose of established. 100-300 mg. The place of this substance in therapeutics is still not clear. Deanol acetamidobenzoate (Previously available as DeanerR ) Deanol was claimed to stimulate the Codeine, a narcotic (q.v.), is central nervous system including the methylated morphine, much less toxic reticular activating system so improving than morphine and death directly attribu• mood and behaviour, but its value was not table to codeine is rare. Tolerance and proven. It was reputed to be of value in addiction (q.v.) can occur. Orally its chronic fatigue states, mild depression and euphoric action is weak, but large doses in chronic and migraine. Dose: subcutaneously can act as a morphine 50 mg initially, maintenance 25-75 mg substitute for the addict. Codeine has a daily. Side effects were typical of a mild hypnotic action and less analgesic parasympathomimetic agent. potency than morphine. It causes less Contra-indicated in grand mal. respiratory depression and is less con• stipating than morphine. It is used as an Dehydrobenzperidol analgesic and to relieve dry cough. Dose: (Drol eptan It) 10-60 mg. The signs of codeine intoxica• SEE . tion are narcosis, sometimes preceded by exhilaration and followed by convulsions; Deserpidine nausea and vomiting are prominent, the (HarmonyR) pupils are contracted and the pulse rate is ])eserpidine is a Rauwolfia with increased. Codeine is also contained in central depressant and sedative action and many analgesic and antitussive com• an antihypertensive effect. It is used for binations. mild anxiety states and chronic psychoses. Dosage in mild mental disturbances is 0·1 mg od and in 0,5-1 mg tds. (CalmaloneR ) Although deserpidine produces less leth• A cyclopentane derivative with muscle argy and depression than (q.v.), relaxant and tranquillizer activity cyclarba• na8al congestion, drowsiness, gastro• mate has a dosage of 0·5 to 1·5 g daily, in intestinal upsets and depression may occur. divided doses. It is specifically contra-indicated when there is any evidence of depression. Cyclobarbitone (PhanodormR ) Cyclobarbitone is a member of the short- 380 hydrochloride

Desipramine hydrochloride Diamorphine hydrochloride (PertofranR , NorpraminR ) (Synonym: ) An iminodibenzyl derivative with anti• Diamorphine hydrochloride (heroin) is a depressant activity and side effects similar derivative of the natural alkaloid morphine. to imipramine (q.v.). The initial dose is I t is a powerful analgesic and narcotic, 25 mg tds for three days, increasing as having a more potent, but shorter analgesic necessary to a maximum of 50 mg tds or action than morphine. Although it is a qds; the usual maintenance dose is 50-100 very effective cough suppressant, it should mg daily. Contra-indications and special not be used for this purpose, because of precautions as imipramine (q.v.). In severe its addictive properties. When administered depression and retardation, supervision is subcutaneously or intramuscularly, it is necessary because the suicidal risk is often used for the relief of severe pain in the temporarily enhanced. terminal stages of cancer when morphine in safe dosage is no longer effective. It is Dexamphetamine sulphate also occasionally used in the immediate (DephadrenR , DexamedR , DexedrineR ) post-operative period. The oral, intra• SEE . muscular or intravenous dose is 5 to 10 mg. Heroin produces intense euphoria and tartrate fewer side effects than morphine, such as (PalfiumR ) constipation, nausea and vomiting, al• Dextromoramide is a narcotic analgesic though it has a more powerful respiratory used in severe pain. The dose is 5 mg, depressant action than morphine. increasing up to 20 mg if necessary. There The treatment of the heroin addict is the is addiction liability (q.v.) and side effects same as for morphine addiction, but heroin include light-headedness, dizziness, nau• addiction is considered to be much more sea, vomiting and sleepiness. Respiratory difficult to break and the mental and moral depression may occur after intravenous deterioration of the addict is much worse administration. Contra-indications include than with morphine. patients with hepatic disease, hypotension and cerebral disease. The action of bar• Diazepam biturates, chlorpromazine and anaesthetics (ValiumR ) is enhanced. Diazepam is a benzodiazepine with stronger anxiolytic properties than chlor• hydrochloride diazepoxide, is sedative an<~ shows central (DoloxeneR , Depronal; DarvonR , in muscle-relaxant action. It is used in USA.) Also available in analgesic com• anxiety and tension states, psychosomatic binations and organic illnesses with associated Dextropropoxyphene is a narcotic analgesic anxiety, in muscle spasm and as pre• used in acute and chronic pain. Unlike . The dose varies from 2 mg levopropoxyphene, it has little antitussive tds in mild anxiety to 15-30 mg tds in activity. It has some addiction (q.v.) lia• severe anxiety and other psychiatric dis• bility and side effects include nausea, orders. In muscle spasm the dose is 2-60 vomiting and in high doses, drowsiness mg tds. 10-20 mg is given intravenously and dizziness. Dose: 30-65 mg tds or qds. for minor operations. Side effects are similar to chlordiazepoxide. hydrochloride (NoverilR , NeodalitR )" Dibenzepin is a dibenzodiazin anti• (WelldormR , BonadormR in Australia, depressant with effectiveness intermediate and DormwellR , elsewhere) between imipramine and amitriptyline. (FenzoIR ) Side effects include dryness of mouth and Dichloralphenazone is a complex of chloral precipitation of manic phases. Initial dose hydrate and used as a hypnotic is 80 mg to 120 mg tds with maintenance and sedative. The hypnotic dose is 1·3 g doses of 80 mg tds. and the sedative dose is 650 mg bd or tds. Side effects include hypersensitivity Diacetylmorphine hydrochloride reaction, rashes and nausea. It is contra• SEE Diamctrphine hydrochloride. indicated in acute intermittent , hydrochloride 381

marked hepatic or renal impairment and Dipiperon in severe cardiac disease. (Synonyms: Pipamperon, Floropipamide), (Dipiperonl\ PiperonyJI\ Propitanlt) acid tartrate Dipiperon is a butyrophenone derivative (DF 118 R ) used as a tranquilliser in chronic schizo• Dihydrocodeine acid tartrate is a codeine phrenia. The initial dose is 60 mg daily derivative used as an analgesic and a cough increasing to 200 to 600 mg daily. Side suppressant. Side effects are less pro• effects include extrapyramidal symptoms nounced than with morphine (q.v.) and and hypotension. are similar to codeine (q.v.). Tolerance and addiction (q.v.) may occur. It is Disulfiram contra-indicated in and (Synonym: tenraethylthirum disulphide) asthma. Dose: 10-60 mg. (AntabuseR 200) (Also available as: AbstinylR, Sweden; Dimethacrine tartrate AlcophobinR , USA) (Istonil R) Disulfiram taken by itself rarely produces Dimethacrine is an acridan derivative any pharmacological effects other than having antidepressant activity. The dose is perhaps peripheral neuropathy, but when 25 to 75 mg tds orally or 50 mg tds intra• taken with alcohol unpleasant side effects venously or intramuscularly occur, e.g. flushing, palpitations, dizziness. For this reason, it is used·in the treatment of chronic alcoholism. It is not curative A sedative which is used as and requires concomitant psychotherapy. a component of certain hypnotic com• Because of the varying intensity of the side binations, typically with effects produced, initial treatment should (q.v.). be carried om in hospital. There are numerous contra-indications and doubt Diphenoxylate hydrochloride now exists about the merits of disulfiram (as a constituent in Lomotipt) therapy. Diphenoxylate is a narcotic analgesic used mainly in the treatment of acute and chronic diarrhoea. The usual dose is 5 mg (EsucosR) tds or qds. Side effects include rash, Dixyrazine is a phenothiazine derivative pruritis, drowsiness, insomnia, dizziness, with actions and uses similar to chlor• restlessness, euphoria, depression, ab• promazine hydrochloride (q.v.). Side dominal distension and nausea. Diphen• effects reported include fatigue, alopecia oxylate is contra-indicated in patients with and other scalp and skin disorders. Dose: impaired liver function. Long term 15-75mgbd. administration of diphenoxylate carries the risk of addiction (q. v.) Dothiepin (Prothiaden R) Dothiepin is a anti-depressant (PipadoneR • Also a constituent of compound used in the treatment of de• DiconalR ) pression and anxiety. The dose is 25 mg Dipipanone is a potent analgesic (25 mg==' tds, increasing °to 50 mg tds or as neces• 10 mg morphine sulphate) with a rapid sary. Contra-indications include glaucoma, on~et of action. Its side effects include urinary retention, . It should be drowsiness, nausea and vomiting; and given with caution with or within two or there is a risk of addiction (q.v.). Contra• three weeks of cessation of treatment with indications are severe lung and a monoamine oxidase inhibitor. disease and in patients who have under• gone thoracic operations. Administration Doxepin hydrochloride is usually by subcutaneous or intra• (SinequanR , SinquanR , AponalR ) muscular injection, 25 mg bd or qds. A tricyclic anti-depressant claimed to have associated anxiolytic properties, indicated in the treatment of depression and anxiety. Dose: 10 to 100 mg tds depending on 382 Droperidol

severity of condition. Contra-indications mouth. It is also a constituent of many include glaucoma and urinary retention. combination preparations. Side effects include drowsiness, dryness of the mouth, tremor, blurring of vision, Ethamivan urinary retention, and constipation. (VandidR) Ethamivan is an analeptic with quick Droperidol action and short duration. It is used as a (Synonymdehydrobenzperidol) respiratory in barbiturate poison• (DroleptanR, ThalamonalR) ing, in comatose states where respiration Droperidol is a butyrophenone derivative is depressed, and in neonatal asphyxia. with actions similar to haloperidol. It Side effects include spontaneous motor produces a state of mental detachment and activity, and in overdosage, convulsions. indifference to surroundings. It is used for Ethamivan is contra-indicated in epileptic the technique of neuroleptanalgesia and patients or in respiratory failure caused by for premedication. Dose: 10-20 mg orally, a convulsive drug. It should not be given 5 mg intravenously, 10 mg intramuscu• at the same time as a monoamine oxidase larly. Side effects include extrapyramidal inhibitor. effects. It is contra-indicated in depressive illness or in severe hepatic disease. (ArvynoIR, SerenesilR) Ectylurea Ethchlorvynol is a chlorinated carbinol (LevaniIR, NostynR) with a mild hypnotic action and anti• A mild sedative, ectylurea, is used in convulsant activity approximately equiva• treating simple anxiety and tension. It lent to that of phenobarbitone. I t is used appears to be of low toxicity, but it may for the treatment of simple insomnia cause skin rashes and occasionally, jaun• without pain, but the possibility of dice. It is contra-indicated in liver disease. dependence should be borne in mind. Dose: 150-300 mg tds or qds. Hypnotic dose: 500 mg nocte. Side effects include dizziness, bad taste in the mouth, Emetine hydrochloride vomiting, and ataxia which may be lessened Emetine hydrochloride has been used in by taking ethchlorvynol with milk. Hypo• the past as a nauseant in aversion therapy of tension, skin rashes, hangover effect and chronic alcoholism (q.v.). mental confusion may also occur.

Emylcamate (NuncitaIR, ResteralR) (ValmidateR, formerly known as Valmid) (Formerly marketed as StriatranR) Ethinamate is an unsaturated carbinol has tranquillizing and muscle• with mild hypnotic properties, used in relaxant properties. It is used as an adjunct simple insomnia at a dose of 500-1,000 mg in the treatment of fractures, muscle pain, nocte. Side effects include vomiting and and inflammation. Dose: 20 mg tds before hangover. Dependence has been reported. food and at night ifnecessary. Side effects include various gastro-intes• citrate tinal upsets, headache, palpitations, and Ethoheptazine is a narcotic analgesic skin rash. If used over long periods or in chemically allied to . It is used in large doses periodic blood counts and liver the treatment of moderately severe pain, function tests should be carried out espe• particularly associated with musculo• cially if the patient already has hepatic skeletal disorders. It is only available in disease. combination with other such as or (EquagesicR , ZactiparR, and Zactirin R. Side effects Ephedrine is a sympathomimetic amine. include nausea, dizziness, epigastric It has a more prolonged though less potent distress and pruritus. Dose: 75-150 mg action than , and is effective tds or qds. orally. It possesses a central stimulant action and is used in narcolepsy and catalepsy in doses of 8 to 60 mg tds by 383

Ethotrimeprazine Flupenthixol (Synonym: Ethylisobutrazine, Etymena• (FluanxoIR , DapixolR and FluanxolR zine) Depot) (DiqueIR , SergetyeR ) Flupenthixol is a thioxanthene derivative Ethotrimeprozine is a phenothiozine showing anti-anxiety properties. It has derivative with sedative properties. It is been used in chronic schizophrenia in an effective neuroleptic at a daily dose of doses of 1 to 6 mg daily. Side effects in• 5-80 mg and the side effects are similar clude extra-pyramidal symptoms. The to those of chlorpromazine. depot form has several advantages for maintenance th erapy. hydrochloride (EuvitoIR ) decanoate Fencamfamin hydrochloride is claimed to (ModecateR , ModitanR enanthate, act as a central nervous stimulant and to DarpotumR D, LyogenR Depot) be of value in the treatment of fatigue and Fluphenazine decanoate and enanthate are depression following illness. Dose: 10-20 prolonged injectable forms of fluphena• mg bd. It is contra-indicated in conditions zine, with uses and properties similar to of hyperexcitability and thyrotoxicosis. It fluphenazine hydrochloride (q.v.). should be used cautiously in patients with Their chief advantage is the ease of angina pectoris. administration for they can be given at intervals of one to four weeks. This is an citrate important feature for it has been shown (SublimazeR ) that 48 % of schizophrenics do not take Fentanyl citrate is a potent narcotic anal• their tablets as prescribed and relapse is gesic with actions similar to morphine often due to stopping medication pre• (q.v.). It is used in conjunction with a maturely. neuroleptic drug such as droperidol, to While the side effects are similar to those produce anaesthesia. Side effects include of oral fluphenazine, depressions may depression of respiration and addiction occur more commonly. may develop. Fentanyl should not be given with monoamine oxidase inhibitors (q.v.). Fluphenazine enanthate Dose: 0·1 to 0·6 mg intravenously. SEE Fluphenazine decanoate.

Flunitrazeparn Fluphenazine hydrochloride. (Rohypnol R) (ModitenH , LyogenR , OmcaR , SevenalR ) is one of the new benzo• (ProlixinR and PermitilR in USA) diazepine compounds with marked seda• Fluphenazine is a phenothiazine derivative tive effects. It is therefore used mainly as with actions and uses similar to chlor• a hypnotic and a dose each night of 1-2 promazine (q.v.), but it has greater tran• mg. The side effects are those of sedative quillizing action and less sedative effect. benzodiazepines. I t is used for the relief of anxiety and tension in manic-depressive states and Floropipamide schizophrenia. It has a powerful anti• (Synonyms: Dipiperon, Pipamperon) emetic action and is used to control post• SEE Dipiperon. operative vomi~ing. Dose: 1 to 5 mg od, although up to i 5 mg od may be necessary in severe cases. Side effects see trifluo• (SedalandeR , HaloanisoneR ) hydrochloride. SEE Haloanisone. Flurazepam Fluopromazine (DalmaneR , DalmadormR , USA) (PsyquiIR , SiquilR ) Flurazepam is a benzodiazepine (q.v.) with Fluopromazine hydrochloride has actions potent hypnotic properties. It has greater and side effects similar to those of hypnotic activity than (q.v.) chlorpromazine and has its main place in but otherwise it has similar actions and the treatment of schizophrenia. The daily uses. The usual dose is 15 to 30 mg nocte. dose is 20-150 mg daily. In common with benzodiazepines the 384

safety of flurazepam is good and side Heptabarbitone effects are of a minor nature. (MedominR) A short acting barbiturate, heptabarbitone Fluspirilene is used as a sedative and hypnotic. The (RedeptinR, ImapR) sedative dose is 50 to 100 mg bd or tds and Fluspirilene is a the usual hypnotic dose is 200 to 400 mg derivative with antipsychotic activity used nocte. Side effects and contra-indications in the treatment of schizophrenia. It is are as for barbiturates (q.v.) generally. long acting and initially a 2 mg dose i~ given im weekly. The dose is then increased Heroin in 2 mg increments weekly, up to 8 mg (Synonyms: diamorphine hydrochloride; which is the maintenance dose. Side effects diacetylmorphine hydrochloride) include extrapyramidal symptoms, nausea SEE Diamorphine hydrochloride. and vomiting. (MerinaxR ) (DoridenR) Hexapropymate is a non-barbiturate hyp• Glutethimide is a piperidinedione deriva• notic which promptly induces sleep of tive with hypnotic properties. Its action good duration. Dose: 200 to 600 mg nocte. may be compared with the intermediate acting barbiturates, inducing sleep in Hexobarbitone about 20 minutes with some 6 hours Hexobarbitone is a short acting barbiturate duration. It is used for the treatment of (q.v.) used as a hypnotic, often in conjunc• insomnia but is not effective in the pre• tion with other barbiturates (e.g. sence of pain or mental disturbance. The EvidormR). Its sodium salt (q.v.) is a very usual dose is 500 mg nocte. Side effects short-acting barbiturate. The hypnotic include nausea, excitement, and occasional dose of hexobarbitone is 250 to 500 mg. skin rashes. It is contra-indicated in the Side effects and contra-indications are as first trimester of pregnancy. for the barbiturates (q.v.).

Haloanisone Hexobarbitone sodium (Synonym fluanisone) (Previously available as Cyclonal So• (SedalandeR) diumR and as combinations) Haloanisone is a butyrophenone derivative Hexobarbitone sodium is a very short• having tranquillising activity. It is used in acting barbiturate used for' inducing schizophrenia. Dosage varies between 75 anaesthesia before the administration of and 300 mg. Side effects include extra• gaseous anaesthetics and also as a general pyramidal symptoms and hypotension. anaesthetic for short minor operations. Hexobarbitone has been largely superseded Haloperidol by thiopentone sodium. (SerenaceR) Convulsions may be controlled by the (HaldoIR , in the USA) intramuscular injection of hexobarbitone A butyrophenone derivative, haloperidol sodium, and up to 1 g has been used in is a tranquillizer with particular value in status epilepticus. Dose: 0·2 to 1 g intra• the treatment of mania and schizophrenic venously; 40 mg per kg bodyweight with a excitement. Delusions, hallucinations and maximum dose of 2 g by rectal injection. paranoia are controlled and behaviour I t is contra-indicated in respiratory tract disorders in the mentally subnormal also infections, in impaired liver function and respond. It is also used in thc treatment of low . phobic anxiety. The dose is O· 5 mg bd in anxiety states, but in severe agitation up to 5 mg bd may be given. Side effects include (ListicaR ) extrapyramidal symptoms, motor restless• Hydroxyphenamate is a tranquillizer ness and dystonic reactions. Other side resembling in its sedative effects include drowsiness, dizziness, and properties. It is used in the treatment of it should not be given alone where depres• anxiety and tension. Dose: 600 to 800 mg sion is prominent as this may be worsened. daily. Side effects include drowsiness, 385

dizziness, depression and occasionally the response is apparent at a dose of 25 to hypotension and urticaria. 50 mg tds. Side effects include • like side effects, and imipramine is contra• hydrochloride indicated in glaucoma and epilepsy. Cau• (AtaraxR ) tion should be observed where pronounced (VistarilR in the USA) circulatory or cardiac failure exists. Hydroxyzine, a diphenylmethane deriva• tive, is a central nervous depressant with antihistaminic and antispasmodic actions. (ProndoIR , GalaturR , TertranR ) I t is used in anxiety and tension states and Iprindole is a hexahydrocycloocta [b] as an adjuvant in the treatment of urticaria indole derivative with potent antidepres• and dermatoses where emotional distur• sant activity. It is used in all forms of bances are prominent. Dose: 25 to 100 mg depression. The dose is usually 30 mg tds tds or qds. Side effects include slight and 15 mg tds for elderly patients. hypotension, headache, drowsiness, and Side effects include dry-mouth, blurred dry mouth. Hydroxyzine should be used vision, dizziness, unsteadiness on standing, cautiously with , analgesics and and hypotension. Iprindole should dicoumarol type anticoagulants. Its use has not be given concurrently or within two been largely replaced by more effective weeks of treatment with monoamine oxi• . dase inhibitors. It is contra-indicated with a previous history of hepatic disorders and Hyoscine hydrobromide caution is necessary in patients with (KwellsR brand) enlarged prostate or glaucoma. Hyoscine is a member of the Belladonna group of having central and peripheral actions. Unlike atropine it (SursumR ) depresses the motor areas of the cerebral Iproclozide is an antidepressant, of the cortex and acts as a hypnotic and does not hydrazine monoamine oxidase inhibitor have the stimulating effect of atropine on group. In depression the dose is 10 mg the brain. It is used to calm and induce three times daily. The side effects and sleep in delirium, acute mania, and in contra-indications are as for other mono• severe agitation. Hyoscine is a sympto• amine oxidase inhibitors (q.v.). matic treatment for Parkinson's syndrome, and is used to prevent motion sickness, and in pre-operative medication. Dose: (MarsilidR ) 0·3 to 0·6mg; larger doses are given in The anti-depressant iproniazid is the Parkinson's syndrome. prototype monoamine oxidase inhibitor Side effects include dry mouth, blurring of the group. It is used in the of vision, constipation, and drowsiness. treatment of exogenous and reactive depression. The initial dose is 50 to 100 Imipramine hydrochloride mg tds; maintenance, 25 to 50 mg tds. For (TofraniIR , BerkomineR , NorpramineR , general side effects and contra-indications DimipressinR , IA-PramR , ImpaminR , see monoamine oxidase inhibitors. Ipro• PraminalR ) niazid is one of the most effective mono• (Also a constituent of TofranilR with amine oxidase inhibitors but its use should Promazine) be limited to patients who have failed to Imipramine hydrochloride is the prototype respond to other drugs for the toxic and iminodibenzyl derivative with anti• side effects (particularly jaundice and depressant activity (thymoleptic). It is hypotension) are more common and used mainly in the treatment of endoge• serious than with some other amine oxi• nous depression. It may be less effective dase inhibitors. than the monoamine oxidase inhibitors in the treatment of neurotic or reactive Isocarboxazid depression. Unfortunately it is difficult to (MarplanR ) recognise in advance which patient is best Isocarboxazid, a hydrazine derivative, is treated with which drug. Two or three a monoamine oxidase inhibitor anti• weeks treatment may be necessary before depressant drug used in the treatment of 386 Laevopromazine

depression. The initial dose is 10 mg tds, morphine and less morphine-like side when the optimal effect may be seen be• effects generally. tween one and four weeks. A dose of 10 fig od or bd is then sufficient for main• carbonate tenance. Isocarboxazide has the general (PriadeIR , CamcolitR ) side effects and contra-indications of the (LithaneR , EskalithR , and LithonateR in monoamine oxidase inhibitors (q.v.). The the USA) incidence of the side effects is however is used in the treatment less than with most drugs in this class. of manic phases of manic depressive psychoses, and as a prophylactic in Laevopromazine recurrent affective disorders. To avoid (Veractil R) tremor and nausea initial dosage should be SEE lVIethotrimeprazine maleate. small and gradually increased to between 600 and 1600 mg daily. Leptazol The drug is potentially toxic and (CardiazoIR ) treatment should be maintained under (MetrazoIR, USA) careful clinical and laboratory control. (PentrazoIR, USA) Early morning serum lithium levels should An analeptic, leptazol stimulates the be between 0·8-1·2 mEq/litre. respiratory and motor centres. Its action Vomiting, ataxia, coarse tremor, is more potent but shorter than picrotoxin. fasciculation, marked drowsiness, slurred Leptazol is used to counteract respiratory speech and confusion are signs of over• depression caused by drugs. Electro• dosage, and lithium poisoning results in convulsive therapy has now superseded coma with hyper-refiexia, muscle tremor. convulsive therapy in psychiatry induced Contra-indications include cardiac or renal by intravenous leptazol. Dose: 50-100 mg. decompensation. Side effects on high doses include epileptiform convulsions. (AtivanR , TavorR , TemestaR ) tartrate Lorazepam is a benzodiazepine with (LorfanR ) moderate anxiolytic activity and some Levallorphan is a narcotic antagonist sedation and muscle relaxant effects. It is having greater potency and more prolonged used in anxiety and tension states. The action than nalorphine (q.v.). In small dosage for mild anxiety is 1-9 mg daily doses it is used to counteract the and for severe cases up to 10 mg daily. respiratory depression caused by Side effects resemble those found with all morphine-like drugs with minimal benzodiazepines. alteration of the analgesic effect. Levallorphan can be given either before succinate or with the analgesic. Dose: O· 5 to 1 mg (Synonym: Oxilapine) intravenously to restore respiration. Half Loxapine is a dibenzoxazepin derivative the initial dose may be repeated after 10 used in the treatment of schizophrenia. minutes if necessary. Dose ranges from 20-140 mg with a mean daily dose of 50 mg. Side-effects include facial dystonia, extrapyramidal reactions, (Veractil R) liver and haematological abnormalities. SEE Methotrimeprazine maleate. L- tartrate (A constituent of OptimaxR ) (DromoranR ) L-tryptophan is a naturally occurring Levorphanol tartrate is a more potent, amino acid which when metabolised to longer acting narcotic analgesic than 5-hydroxytryptamine exerts antidepressant morphine (q.v.). It is used in severe, acute properties. In the treatment of depression and chronic pain. Dose: 1 ·5-3 mg orally the daily dose of L-tryptophan is 2/6 g. bd, and 2--4 mg by injection in very severe Half the dose should be taken in the pain. Levorphanol is well tolerated evening and the remaining half given in' producing less hypnotic effect than divided doses during the day. Side effects 387

include nausea, hypotension and has been used as a tranqUillizer. The dose drowsiness. Optimax also contains is 0·6-1·2 g daily in divided doses. Side ascorbic acid and pyridoxine which is effects include dizziness, headache, nausea utilised in the metabolism of L-tryptophan and constipation. to S-hydroxytryptamine. Meclofenoxate hydrochloride Lyseq~ic Acid Diethylamide (Synonym centrophenoxine hydrochloride) SEE Lysergide (LucidriIR) Meclofenoxate hydrochloride is a central Lyseq~ide nervous stimulant used in the treatment Synonyms: Lysergic Acid Diethylamide; of confusional states in the elderly, anoxia LSD of newborn, intoxication by alcohol or Lysergide is a hallucinogen producing carbon monoxide. It has also been used transient mental perceptional and in delirium tremens and depression. The behavioural changes resembling the dose is 300--400 mg tds but the oral dose symptoms of psychotic disease. does not take effect for 4-6 days. Perceptional changes produced especially Intravenously or intramuscularly the dose affect the visual system with alteration of is 2S0-S00 mg. Side effects include colour perception, illusions and hallu• agitation and insomnia. cinations. Personality changes occur and the sense of time and space is affected. Lysergide has been used to assist (NobriumR) psychotherapy of neurotic patients, Medazepam is a minor tranquillizer of including obsessional neuroses, character the benzodiazepine (q.v.) group. It has disorders and psychopaths. Latent potent anxiolytic activity and is used in schizophrenia may develop and depressive anxiety, tension and psychosomatic states occasionally develop leading to disorders affecting the skin, cardiovascular, suicidal intent. The greatest danger of respiratory, or gastrointestinal systems. treatment lies in the production of a drug• The usual dose is S mg tds with a further dependent sociopathic individual, and the S mg nocte if insomnia is a problem. therapeutic use of lysergide is now Tolerance is good. Side effects are rare, condemned by many psychiatrists. dose related and include fatigue and drowsiness. hydrochloride (LudiomilR) Melitracene Maprotiline is a novel antidepressant in (TrausabunR) the dibenzobicyclo-octadiene group. It is A dihydroanthracene derivative used in one of sedative and is used the treatment of depression with anxiety in doses of 20-1S0 mg daily. Side effects in daily doses of SO-2S0 mg. Side effects resemble those of tricyclic antidepressants reported include dryness of the mouth, with sedative properties. palpitation, sweating, and fatigue. The place of this substance in clinical thera• peutics has not yet been established. (ActomoIR) A hydrazine derivative, mebanazine is an Mepazine anti-depressant with monoamine oxidase SEE Pecazine inhibitor activity. Used for depression the dose is S mg bd to qds with a maximum Mephenesin daily dose of 30 mg. The usual (MyanesinR and TolseramR, mephenesin maintenance dose is S mg bd or tds. For ) side effects, contra-indications and pre• Having muscle relaxant, sedative and cautions see monoamine oxidase inhibitors. anxiolytic activity mephenesin is used in the treatment of anxiety, tension and insomnia. However, its therapeutic (Formerly available as CaplaR) efficacy has not been firmly established. Related to meprobamate, mebutamate is a The dose is O' S -1 g one to six times daily central nervous system depressant which after meals. Orally mephenesin has low 388

toxicity but lassitude, anorexia, nausea and including gastro-intestinal upsets, vomiting may occur. drowsiness, dizziness, blood disorders and The somewhat longer acting carbamate abnormal liver function tests the use of less (Tolseram R) has a dose of 1-3 g, three to toxic drugs has been recommended. five times daily after meals. hydrochloride Mephenoxalone (PhyseptoneR ) (Available in the USA as: Methadone hydrochloride is a narcotic LenetranR , TranpoiseR , TrepidoneR ) analgesic having a longer duration of A mild tranquillizer, mephenoxalone action than morphine but with less sedative resembles meprobamate in its effect. I t is used for the relief of severe pain pharmacological activity. Used for the and to control non-productive coughing. treatment of anxiety and tension, but The side effects are generally milc;l but the ineffective in psychoses. The usual dose is danger of addiction should be borne in 400 mg qds. Side effects include mind. Dose: 5-10 mg orally or drowsiness, headache, dizziness, nausea subcutaneously. and skin reactions. Meprobamate SEE Methylamphetamine hydrochloride. (EquaniIR , Mepavlon R, MiltownR ) Meprobamate is a mild tranquillizer Methaqualone hydrochloride having slight muscle relaxant properties. (MelsedinR, QuaaludeR, SedaquinR, It is used for anxiety, nervous tension and MequelonR , TuazoleR , PaxidormR , insomnia in doses of 200-400 mg tds. For RevonalR) insomnia 400 mg nocte. Some patients (A constituent of MandraxR and Mattho• show idiosyncrasy to meprobamate when dormR ) skin reactions may be produced. There is MelsedR contains methaqualone base. an addiction risk and patients should be Methaqualone is a hypnotic producing warned of the effects of their lowered sleep of 6 to 10 hours duration. I t is used tolerance to alcohol. in insomnia and as a daytime sedative. The usual hypnotic dose is 150 mg and for daytime sedation 75 mg bd or tds. Anti• (Synonym: mesuridazine) convulsant action is also claimed. Side (Available in the USA as SerentilR, effects include gastric upsets, headache LidanarR, LidaniJI\ LidanorR ) and hang-over effects. The drug has been A phenothiazine, mesoridazine is a liable to abuse. metabolite of (q. v.). It is used SEE ALSO Mandrax R and MatthodormR. in the treatment of chronic schizophrenia and depression. Doses of75 mg daily, Metharbitone increased over five weeks to a maximum (MetharbitaIR) of 300 mg daily have been used. Side Metharbitone is a long-acting barbiturate effects include parkinsonism, with weak hypnotic activity but potent , dyskinesia, anticonvulsive properties. It is used in the sedation and agranulocytosis. treatment of grand and petit mal. The dose is 100 mg tds but due to tolerance up to Mesuridazine 800 mg daily to control seizures may be SEE Mesoridazine. required. The side effects and contra-indications are as for barbiturates (q.v.). (Available in the USA as SkeiaxinR, and ZoraneR ) Methiomeprazine Metaxalone is a muscle relaxant with A phenothiazine derivative with anti• anxiolytic and sedative properties similar anxiety properties possibly useful in to mephenesin having additional chronic alcoholism. The place of this analgesic properties. The dose is 2·4-3·2 g substance in clinical therapeutics has not daily for not more than 10 consecutive yet been established. days. Because of the reported side effects Methyl phenidate hydrochloride 389

Methotrimeprazine maleate judgement may be produced and the (Synonyms: laevopromazine, patient should be advised not to drive. levomepromazine) (VeractiIR , NeurocilR , MinozinanR , Carbamate LevopromeR , NozinanR ) ObJivon-CR has the same uses as methyl• Methotrimeprazine is a phenothiazine pentynol but has a longer duration of used in the treatment of psychotic illnesses action. As a sedative the dose is 200 mg as an alternative to chlorpromazine (q.v.), tds and for hypnosis the dose is 200- but additionally it has been used in the 600 mg. treatment of moderate depression. It may be given alone or with analgesics or Methylperidol narcotics for the relief of pain and anxiety. (LuvatrenR ) The usual ambulatory dose is 10-15 mg (Synonym: Moperon) tds or qds, increasing slowly to the most Methylperidol is a hu,yrophenone effective dose. The most common side derivative with antipsychotic properties effects are drowsiness and hypotension. used mainly in the treatment of chronic Extrapyramidal symptoms and tachycardia schizophrenia. The usual daily dose is occur less than with chlorpromazine, but 15-30 mg and side effects include a few cases, some fatal, of agranulocytosis extrapyramidal symptoms. have.occurred. Methylperone Methoxypromazine maleate (BuraniIH ) (TentoneR, USA) A butyrophenone derivative effective in A phenothiazine derivative, severe agitation, mania and schizophrenia methoxyproThazine has actions and uses at a daily dose of 75-300 mg. The main similar to those of chlorpromazine side effects are drowsiness and the extra• hydrochloride (q.v.) Dose: 10-125 mg pyramidal syndrome. tds or qds. Methylphenobarbitone Methperine sulphate (ProminaIR ) SEE Modaline sulphate. Methylphenobarbitone has a more pronounced anti-convulsant action and less Methylamphetamine hydrochloride marked hypnotic action than (Synonym: methamphetamine). phenobarbitone (q.v.). It is used in the (Methedrine~, BophenR and PervitinR ) treatment of epilepsy when the average Methylamphetamine has the same actions dose is between 400-600 mg daily. Its and uses as amphetamine sulphate (q.v.), side effects and contra-indications are as but it has a more rapid and prolonged for barbiturates (q.v.) generally. action. Methedrine R is supplied only to hospitals, as a precaution against abuse, Methyl phenidate hydrochloride and is used to restore blood pressure (Ritalin It) during surgery and for abreaction in Methyl phenidate hydrochloride is a psychiatric diagnosis. Dose: 10-30 mg central nervous stimulant resembling the intravenously. For side effects and activity of amphetamine (q.v.) but with contra-indications see amphetamines little action on the appetite, blood pressure, (q.v.). heart rate, or respiration. It is used to improve mental activity, to relieve mild Methylpentynol depression and fatigue, and is of value in (Oblivon1t, InsomnolR ) treating lassitude and exhaustion following Methylpentynol has anxiolytic and debilitating illness. The usual dose is 20 hypnotic properties with a rapid but mg bd or tds. Side effects are as for short action lasting about 3 hours. As a amphetamines (q.v.), but are less tranquillizer the dose is 250-500 mg, while pronounced and occur less frequently. the hypnotic dose is 0'5-1·0 g. Although Contra-indications include patients with methylpentynol seldom produces side agitation and hyperexcitability, and it effects, repeated use may induce toxic should be used cautiously with pressor or skin and liver reactions. Errors of hypertensive drugs. 390 Methyprylone

Methyprylone with discrimination. Dose: 8 to 20 mg. (NodularR ) Toxic effects in large doses include coma, A piperidinedione derivative, with slow respiration, cyanosis, methyprylone is a central nervous hypotension. In smaller doses nausea, depressant with sedative and hypnotic vomiting, tremors, constipation and miosis properties which last about 6 hours. It is occur. used in mild or moderate insomnia and as a daytime sedative. Sedative dose: 50-100 Nalorphine hydrobromide mg tds or qds, hypnotic dose: 200-400 mg (LethidroneR ) nocte. Methyprylone has about half the Nalorphine is a narcotic antagonist which acute toxicity of phenobarbitone and is in small doses counteracts most of the generally well tolerated. Minor side effects characteristic actions of morphine-like include dizziness, nausea, vomiting, drugs, especially respiratory depression, headache and diarrhoea .. without appreciably altering the analgesic effect. Nalorphine is used as an in Methyserllide the treatment of overdosage produced by (DesiriIR , SansertR) narcotic analgesics (q. v.). Dose: 5-10 mg is a antagonist intravenously, repeated according to and is used as a prophylactic in migraine. patient's needs to a total dose not It is not recommended for treatment of exceeding 40 mg. Side effects seldom acute attack. Dose: 1-2 mg bd or tds. Side occur but drowsiness, irritability, hypo• effects resemble those of ergot (q.v.) and tension, and sweating may arise. include nausea, gastric disorders, dizziness, lassitude and drowsiness. Inflammatory Nealbarbitone fibrosis in various areas, vascular reaction (CensedaIR , NeventalR ) including arterial spasm may also occur. Nealbarbitone is a member of the inter• Contra-indications include peripheral mediate acting barbiturates and has slight vascular disease, phlebitis, impaired liver anti-convulsant properties similar to and kidney function and heart disease. phenobarbitone. It is used as a daytime Regular clinical supervision of patients sedative for anxiety and tension, in phobic under treatment is essential. and psychotic states, and it is claimed to rarely produce drowsiness. Dose: 60 to Modaline sulphate 200 mg tds, adjusting to the patient's needs. (Synonym: methperine sulphate). Toxic effects and contra-indications are An antidepressant of the monoamine those of the barbiturates (q. v.). oxidase inhibitor group, modaline has actions, uses, and side effects as described for monoamine oxidase inhibitors (q.v.). (NiamidR ) It has been given in a dosage equivalent Nialamide is an anti-depressant of the to 10-30 mg of modaline base tds. monoamine oxidase inhibitor group. It is used in treating reactive, mixed and Moperon psychotic depressive states. Dose: 25 mg. SEE Methylperidol - 100 mg tds. Side effects and contra• indications are as for the monoamine Morphine oxidase inhibitors (q.v.). (DuramorphR ) The principal alkaloid of , morphine Nitrazepam is a narcotic analgesic also having central (MogadonR, MogadanR) stimulant action. It is used for the relief Nitrazepam is a benzodiazepine derivative of severe pain, as a hypnotic where sleep• with hypnotic properties. It is used for lessness is due to pain, the arrest of insomnia and sleep disturbance due to haemorrhagic shock, the checking of anxiety, tension, depression, overwork or peristalsis, the suppression of cough and conflict. The dose is 5-10 mg pm. Unlike the relief of anxiety and apprehension. other hypnotics nitrazepam does not Morphine produces euphoria and tolerance enforce sleep by generalised depression of is rapidly acquired. There is a danger of the brain, but induces sleep lasting six to addiction and it should therefore be used eight hours by blocking some inflow areas. hydrochloride 391

The safety of nitrazepam is good; over• phenothiazines, butyrophenones, or dosage up to 70 times the normal dose has to control the extrapyramidal produced no harmful effects. Side effects side effects produced by these drugs in or hang-over occur only very rarely. higher doses.

Nortriptyline hydrochloride (AllegronR, AventylR, AltilevR, AcetexaR, (QuiactinR ) NoritrenR, NortrilenR, SensivalR) Oxanamide has anxiolytic properties with is a dibenzocycloheptadiene actions similar to meprobamate (q.v.) with derivative chemically very similar to some additional muscle relaxant properties. amitriptyline (q.v.). It has anti-depressant I t is used in the treatment of anxiety and properties, and uses, side effects and tension. Dose: 400 mg qds. contra-indications similar to those of amitriptyline. Dose: 25 mg tds or qds, to 50 mg tds. (SerenidR-D., Adumbran n, Anxiolitn, PraxitenR, SeroxR , SerepaxH , SerestaR) Noxiptyline A benzodiazepine, oxazepam is chemically (AgedaIR) closely related to chlordiazepoxide (q.v.). A dibenzocycloheptadiene derivative, It has anxiolytic properties and is used in noxiptyline is used in simple depression or the treatment of anxiety, tension and in mixed anxiety with depression. Efficacy agitation. Dose: 15-30 mg tds. Side effects is reported to be similar to amitriptyline and contra-indications are as for chlor• (q.v.). The average daily dose is 120-200 diazepoxide. mg. Side effects include dryness of the mouth, tremor of fingers, vertigo, disturbed Oxilapine binocular vision, sweating, and distur• Oxilapine is a dibenzthiazepine derivative bance of micturition. having anxiolytic activity. It is not yet established in clinical practice. hydrochloride (InsidonR) pectinate An iminostilbene derivative, opipramol (Proladonen) possesses sedative and mild anti-depressant Oxycodone is a narcotic analgesic used for properties. It is used in the treatment of the control of post-operative pain and mild depression and emotional fatigue inoperable cancer. It is effective intra• resulting from anxiety and tension. Dose: muscularly for about 10 hours. Dose: initial, 50 mg tds ; maintenance, 5-15 mg every eight to twelve hours. Side 50 mg bd. Side effects include nausea, effects and contra-indications are as for giddiness, and dryness of the mouth. It morphine (q.v.). should not be given concurrently with or within two to three weeks of cessation of Oxypendyl therapy with monamine oxidase inhibitors. (Pervetral It) A substituted phenothiazine with anti• psychotic activity. The place of this (as the hydrochloride - Disipal R, substance in clinical therapeutics has not (as the citrate - NorflexR ) yet been established. Orphenadrine has an inhibitory effect on the cerebral motor areas and also produces Oxypertine hydrochloride a euphoriant effect. It is used in the (Integrin R) symptomatic treatment of paralysis Oxypertine, a butyrophenone derivative, is agitans relieving rigidity but having little a tranquillizer used in the treatment of effect on tremors. An initial 50 mg tds schizophrenia, particulariy in withdrawn dose is adjusted according to the response or apathetic patients. Dose: 40 mg bd or and side effects. Up to 100 mg qds may be tds. Used in anxiety neuroses the dose is used. The side effects are mild atropine• 10 mg tds or qds. Side effects include like effects which tend to disappear as drowsiness, dry mouth and dizziness. It tolerance develops. should not be given concurrently with or I t may be given in conjunction with within two or three weeks of cessation of 392 Papaverine hydrochloride

treatment with a monoamine oxidase Pecazine hydrochloride inhibitor. Blood counts and liver function (PacataIR, LaevminR) tests are desirable for patients on long A phenothiazine derivative, pecazine is a term dosage. tranquillizer with actions and uses similar to chlorpromazine (q.v.). Papaverine hydrochloride Being less potent than chlorpromazine it (Available as a component of: produces less side-effects. The concomitant HypersinR, MonotreanR, PlacadolR) use of chlorpromazine and pecazine An opium alkaloid, papaverine has no produces fewer side-effects than an equal analgesic or hypnotic actions. It is used as use of either drug alone. Dose: 50-400 mg an anti-spasmodic to produce relaxation of daily, in divided doses. involuntary muscle in peripheral vascular disease, coronary spasm, intestinal, ureteric and biliary colic, and dysmenorrhoea. (KethamedR, RonylR, VoJitalR, Delta• Dose: 60-300 mg orally. Side effects mineR, HytonR, PioxolR, StimulR) include cardiac arrhythmias. It should be A central nervous stimulant, pemoline is used cautiously intravenously owing to its used in the treatment of fatigue, epilepsy action on cardiac muscle. complicated by lethargy, drowsiness, and reactive depression. It is claimed to stimulate respiration depressed by mor• Paraldehyde has a depressant effect on the phine and to shorten barbiturate anaes• nervous system similar to that produced by thesia. Dose: 10-20 mg tds. Side effects in chloral hydrate (q.v.). It acts as a sedative large doses include nervousness and tachy• and hypnotic. It induces sleep of about cardia. If given in the evening insomnia is eight hours duration and is useful as a likely. sedative in the treatment of status epilepticus and in the control of delirium tremens. The dose is 5-10 ml by mouth or (FortraIR) by intramuscular injection, and 15-30 ml Pentazocine is a benzmorphan with by rectal injection. Side effects include narcotic analgesic properties, having a erythematous rash and gastric irritation. potency between that of morphine and It is contra-indicated in gastro-enteritis, codeine. The usual oral dose is 25 mg to broncho-pulmonary disease, and hepatic 100 mg. every 3 to 4 hours after meals or insufficiency. Paraldehyde decomposes on im 30 mg tds. Side effects include storage and deaths have occurred from the nausea, vomiting, dizziness and drowsiness. use of such material. It must not be used if Sweating, vertigo, tachycardia and hyper• it has a brownish colour or an odour of tension may also occur. In larger doses acetic acid. hallucinations and delusions may result together with feelings of depersonalization. However a low addiction potential is (EutonyIR) likely. Pargyline is a monoamine oxidase inhibitor Contra-indications include respiratory with a pronounced orthostatic hypotensive disease, raised intracranial pressure, head action and negligible anti-depressant injury, convulsive states, , . effect. It is used mainly in the treatment of hepatic and renal disease. It is not recom• benign hypertension. Dose: 10-50 mg od mended for children under 12. increasing according to the patient's needs. Side effects and contra-indications are as Penthrichloral for monamine oxidase inhibitors (q.v.). (ClorasedR, DanucteneR) Additionally pargyline is contra-indicated Penthrichloral has sedative and hypnotic in severe myocardial ischaemia, uraemia, properties similar to those of chloral renal failure, pyloric stenosis, glaucoma, hydrate but it is more palatable and causes and shock or severe haemorrhage. less gastric irritation. Side effects and contra-indications are as for chloral hydrate (q.v). Dose: 0·5-1 g. hydrobromide 393

Pentobarbitone sodium drowsiness, dryness of the mouth. Contra• (NembutaIR , and in combinations) indications are as for chlorpromazine. Pentobarbitone sodium is a short-acting SEE ALSO TriptafenR-DA. barbiturate having hypnotic and anti• convulsant activity. It is used in insomnia, Pethidine hydrochloride as a basal hypnotic prior to anaesthesia, and Pethidine hydrochloride is a narcotic as an obstetric amnesiant. As an anti• analgesic which relieves most types of convulsant it is used to control seizures due pain. Pethidine analgesia lasts two to five to chorea, eclampsia, tetanus, and strych• hours. Usually 100 mg intramuscularly is nine or picrotoxin poisoning. Relaxation effective, but 200 mg may be given. It is and hypnosis occur in about a minute. used for obstetric analgesia and as an Dese: 100-200 mg. Side effects and adjunct in /oxygen anaes• contra-indications are as for barbiturates. thesia. Side effects include dizziness, , dry mouth, nausea, and Perazine vomiting, but are less frequent than with (TaxilanR) morphine (q.v.). Pethidine is contra• Perazine is a phenothiazine tranquillizer indicated in severe liver disease, head with actions and uses similar to those of injuries, and should not be used with some chlorpromazine (q.v.), but with a more monoamine oxidase inhibitors. pronounced anti-emetic effect. It is used in I ts use is accompanied by euphoria and the treatment of schizophrenia in doses addiction may occur, which in severe cases varying from 75 to 600 mg daily. Side is as difficult to break as morphine ad• effects include extra-pyramidal symptoms. diction. As tolerance develops doses as large as 3--4 g daily may be taken by Pericyazine addicts, at which doses muscle twitching, (Synonym propcriciazine). tremor, mental confusion, hallucination (Neulactil R, AoleptR) and sometimes convulsions may be present, Pericyazine is a phenothiazine derivative and occasionally death has occurred. The with actions and uses similar to chlorpro• abstinence syndrome (q. v.) is similar to mazine (q.v.). It is used in the treatment of that of morphine abstinence but appears schizophrenia and behaviour disorders in more readily. Addiction is treated as for severe psychiatric illness. It is also effective morphine addiction (q.v.). in the treatment of severe anxiety and tension states. Dose: 5-90 mg according to Petricbloral the condition under treatment. Side effects (PericlorR ) include extra-pyramidal effects, drows• is a chloral hydrate derivative. iness, postural hypotension, and tachy• It has similar sedative and hypnotic cardia. Other side effects and contra• properties to chloral hydrate (q.v.) but is indications are as chlorpromazine. more palatable and causes less gastric irritation. Dose: as a daytime sedative, Perphenazine 300 mg, qds, as a hypnotic, 0·5 -1 g nocte. (Synonym: chlorperphenazine) (FentazinR, DecentanR, TrilafonR) (Also a constituent of TriptafenR) (UltranR , SinforilR, AcaloR ) A phenothiazine derivative, perphenazine Phenaglycodol is a weak central nervous has actions and uses similar to those of system depressant which has tranquillizing chlorpromazine (q.v.), but is effective in properties. It is used for the relief of smaller doses. It produces sedation without anxiety and depression. Dose 0'8-1·2 g hypnosis and has little effect on the blood daily, in four to six divided doses. Side pressure. It is an effective anti-emetic. effects include drowsiness and dizziness. Perphenazine is used chiefly in the treat• ment of anxiety, tension, psychomotor Phenazocine hydro bromide activity, nausea, and vomiting. In anxiety (NarphenR ) and tension the dose is 2 mg tds. In psy• Phenazocine is a narcotic analgesic with chotic states, 8-16 mg tds or qds. Side similar actions and uses to morphine (q.v.) effects are as for chlorpromazine and in• but it is effective in smaller doses, acts clude extra-pyramidal dysfunction, quicker and its effects last longer. It is used 394 hydrochloride

pre-operatively as an adjunct to anaesthesia are slight, but similar to those of ampheta• or post-operatively. The usual dose is mine sulphate. Because large doses and 1-3 mg intramuscularly, or 5 mg orally. prolonged treatment may lead to addiction Its effects last about six hours. Side effects treatment should be limited to one month. resemble those of morphine although Contra-indications include severe hypo• phenazocine has less sedative effect and tension, thyrotoxicosis and acute coronary causes less constipation. Contra-indica• disease. tions are as for morphine. Phenobarbitone Phencyclidine hydrochloride (GardenaIR , LuminalR , Phenobarbitone (Available in the USA as SernylR and SpansuleR ) SernylanR) Phenobarbitone is a long-acting barbi• Phencyclidine is a potent analgesic and turate, used as a sedative, hypnotic and anaesthetic which is said not to cause anti-convulsant. In the treatment of depression of cardio-vascular and respira• anxiety and psychosomatic conditions the tory functions. When given intravenously dose ranges from 30-120 mg daily with a in doses of 0·2 mg per Kg an amnesic maximum of 600 mg in 24 hrs. trance-like state with analgesia is produced. Drowsiness and sedation accompany The chief disadvantage of phencyclidine daytime use and following hypnotic use is the small difference between the hangover effects are commonly reported. effective and toxic dose. The toxic effects The chief danger lies in a cumulative include hallucinations, agitation, and action on regular administration which catatonic rigidity and inco-ordination. It may result in chronic poisoning. has also been used in the treatment of The action, side effects and contra• psycho-neuroses and to assist psych• indications are as for barbiturates (q.v.) therapy in obsessional illness. generally.

Phendimetrazine tartrate hydrochloride (Available in the USA as PlegineR and in (OperidineR ) Canada as Dietrol) Phenoperidine is a narcotic analgesic with is a central nervous similar actions to morphine (q.v.). It stimulant used as an anorectic in the provides analgesic supplement in con• treatment of obesity in doses of 17· 5 - junction with the neuroleptic droperidol in 70 mg bd or tds, one hour before meals. anaesthesia. I t is also used in cases of Side-effects as for amphetamine sulphate. prolonged assisted ventilation where it acts Other side effects include glossitis, as a respiratory depressant and stomatitis, constipation and abdominal analgesic. cramps. Concra-indications as for am• phetamine sulphate (q.v.). maleate (DrazineR) Now discontinued. sulphate Phenoxypropazine is a monoamine (NardilR) oxidase inhibitor with antidepressant Phenelzine sulphate is a monoamine activity. It is a potent antidepressant, but oxidase inhibitor with anti-depressant serious side-effects including hepato• activity. The usual dose is the equivalent of toxicity outweighed the advantages of 15 mg of the base, tds or qds. Side effects effectiveness and the drug is no longer and contra-indications are as for mono• available. The usual dose was 10 mg bd. amine oxidase inhibitors (q.v.). For general toxic-effects and contra• indications see monoamine oxidase in• Phenm.etrazine hydrochloride hibitors. (PreludinR ) A sympathomimetic, has less stimulant action on the central nervous (GamaquilR ) system than amphetamine (q.v.). It has a Phenprobamate is a carbinol derivative potent anorectic action and is used in the showing muscle relaxant, anti-convulsant treatment of obesity. Dose: 25 mg bd or and tranquillizer properties. Dose: 400- tds, half an hour before meals. Side-effects 800 mg tds. It is used in the treatment of 395

anxiety and tension and side effects include 2 mg tds. Overdoses may cause nausea, disturbances of coordination. anorexia, anxiety and insomnia. It should be avoided when tension and agitation are Phenylmethylbarbituric acid present. (RutonaIR) Phenylmethylbarbituric acid is used as an Piritamide anti-convulsant and in epilepsy like (DipidolorR) phenobarbitone, but has half the potency Piritamide is a parenteral narcotic of phenobarbitone as an hypnotic. Dose: analgesic effective in severe pain. The up to 200 mg five times daily. maximum daily dose is 80 mg. It is metabolized in the liver and care should be exercised in patients with hepatic dis• (OrapR) orders. Although not yet recorded, de• Pimozide is a diphenylbutylpiperidine pendence may be anticipated. with antipsychotic activity used in the treatment of schizophrenia with the Pizotifan maleate exception of the manic phase. Pimozide's A thienobenzocycloheptene, pizotifan is a long action enables a single daily dose, serotonin, , histamine and initially 2-4 mg increasing to 10 mg as antagonist used in the treat• necessary. The usual dose is 6 mg daily. ment of migraine and which has re• Side effects include extrapyramidal effects, ported to show antidepressant activity. rashes and occasionally glycosuria. Pi• The dose ranges between 0'5-3 mg daily. mozide is contra-indicated in endogenous Side effects include drowsiness, venous depression, pre-existing Parkinsonism or thrombosis, peripheral paraesthesia. Dis• epilepsy. turbances of reality have also been re• ported. Pipamazine The place of pizotifan in therapeutics is not (MornidineR) yet established. Pipamazine is a phenothiazine derivative with actions similar to those of chlorpro• mazine (q.v.), but having less potent Prazepam is a benzodiazepine derivative tranquillizing activity than chlorpro• having tranquillizing, anti-convulsant and mazine it is no longer used for this purpose. muscle relaxant actions. It has been used Side effects and contra-indications as for as an anxiolytic and particular effectiveness chlorpromazine. Dose: 5 mg every four is claimed in somatised anxiety. The usual hours. dose is 20 mg tds and side effects include drowsiness, dizziness and mild nausea. The Pipethanate hydrochloride exact value of prazepam in therapy is yet (SycotroIR) to be established. Pipethanate hydrochloride is a minor tranquillizer. Since it also has peripheral Prochlorperazine anticholinergic activity it is used in the (StemetilR, CompazineR, TementilR) treatment of anxiety and tension associated Prochlorperazine is a phenothiazine with psychosomatic conditions and senile derivative having a more potent tran• paraesthesia. Dose: 3-6 mg tds. Side quillizing activity than chlorpromazine effects include drowsiness. (q. v.) It is used in mild to moderate anxiety, tension and agitation in doses of 5-10 mg Pipradol hydrochloride tds or qds. For psychotic disorders 5-25 (Available in the USA as MeratranR) mg tds or qds is given. Prochlorperazine is Pipradol is a central nervous stimulant effective in Meniere's syndrome and which increases mental activity without labyrinthitis when 5-10 mg tds or qds is causing after depression. It produces less given. It has less sedative effect than anorexia, insomnia and euphoria than chlorpromazine but it gives rise to extra• amphetamine (q.v.) and has little effect on pyramidal symptoms more frequently and blood pressure, heart rate and respiration. in greater intensity. Contra-indications as I t is used in the treatment of depression chlorpromazine (q.v.). without anxiety and in narcolepsy. Dose: 396 Proheptatriene

Proheptatriene A dibenzocycloheptatriene derivative (IndormR) which is reputed to have anti-depressant Propiomazine, a phenothiazine derivative, activity equivalent to or better than that of is a central nervous depressant. It is used other trycyclic compounds. Further assess• as a sedative or hypnotic. Dose: 10-20 mg. ment is required and the preparation is not Side effects include dry mouth, gastro• yet commercially available. intestinal upset, allergic rash, occasional mild mental confusion, and nightmares. Prornazine Care should be exercised when used with (SparineR, PrazineR, VerophenR) other central nervous depressants. (Also a constituent of TofranilR with Promazine) hydrochloride A phenothiazine closely related to chlor• (TolnateR, DominalR) proma7.ine «(j.v.) promazine is less potent l'rothipendyl is an azaphenothiazine and less liable to produce toxic side effects derivative with anxiolytic, sedative and such as jaundice and severe hypotension. anti-emetic properties. It is used to treat I t is used as a tranquillizer in psychotic anxiety and agitation in psychoneuroses conditions, in senile agitation, alcoholism, and psychoses. It is also used as a hypnotic and as an anti-emetic. Dose: 50 mg tds. in insomnia and as a sedative in surgical Side effects include dizziness and drowsi• premedication. Dose: 20 mg bd-qds. Side ness. Epileptic fits are provoked more effects may include dry mouth, abdominal often than with other phenothiazines. discomfort, and drowsiness. More serious Contra-indications as for chlorpromazine. side effects include photosensitivity and SEE A J. S 0 Tofranil H with Proma7.ine epilepsy. Tachycardia and hypotension may occur at higher dosages. PrOtl1ethazine hydrochloride (PhenerganR, AtosilR, ProthazinR) (Also a constituent of ProtamylR) (ConcordinR, MaximedR, Triptillt) is an antihistamine, particu• A dibenzocycloheptatriene derivative, larly effective in the treatment of urticaria protriptyline is chemically closely related and motion sickness. It has pronounced to amitriptyline, having similar anti• sedative effects and is used as a short acting depressant activity. It is used in psychotic hypnotic in psychiatric practice, and as an and reactive depression, the dose range anxiolytic in anxiety and tension. It also being 5-15 mg tds or (jds. For mainten• possesses anticholinergic properties and is ance the dosage should be reduced to the used in the treatment of parkinsonism. smallest necessary. Common side effects I )ose: 25 mg, od, bd or tds. Side effects include restlessness, tachycardia, excite• include those of the ment, and anticholinergic effects. It is generally. Jaundice and agranulocytosis contra-indicated in predisposition to have been reported. Contra-indications urinary retention and glaucoma. Caution include patients with hepatic disease. is necessary when used with SEE ALSO l'rotamylH. blocking agents, and it should not be administered with or within 2-3 weeks of Propanolol hydrochloride cessation of treatment with monoamine (InderaIR) oxidase inhibitors (q.v.). Propanolol is a beta- blocking drug which is effective in reduc• ing the somatic manifestations of anxiety. Pyrovalerone is an anti-depressant com• It has its greatest value in those patients pound. The place of this substance in showing maximum somatic sympto• clinical therapeutics has not yet been matology at a dosage of 80-160 mg/day. established. Side effects are uncommon but in patients at special risk, cardiac failure and Quinalbarbitone bronchospasm may occur. (Seconal SodiumR, QuinalspanR) Quinalbarbitone is a short-acting bar• Propericiazine biturate used in simple insomnia and SEE Pericyazine. anxiety states in doses of up to 100 mg Thialbarbitone sodium 397

tds. Side effects and contra-indications are been used in the treatment of acute and as for barbiturates (g.v.). chronic mental disorders. More recently it has found successful use in hyperkinesia Reserpine and Huntingdon's chorea (g.v.). Toxic (SerpasiIR , RausedanR , ReserpinR , effects include Parkinsonism, agitation SedaraupinR ) and suicidal depression. Dose: 25-50 mg Reserpine is a Rauwolfia alkaloid (g.v.) bd or tds. Contra-indicated with or with central depressant and sedative action immediately after a course of monoamine and an anti-hypertensive effect. It is used oxidase inhibitors. for its sedative action in mild anxiety states and chronic psychoses. Dose in mild Tetraethylthiuram disulphide anxiety states, 0·5 to 2 mg. and in severe SEE Disulfiram. psychoses, 2 -3 mg od or bd. Side effects include nasal congestion, lethargy, drowsi· Thalidomide ness and gastro-intestinal upset. Higher Preparations previously marketed in the doses may cause insomnia, bradycardia, UK or abroad included: parkinsonian-like syndrome and severe Algosedir, Asmaval, Calmorex, Contergan, depression which may lead to suicide. Countergan Forte, Distaval, Distaval I t is contra-indicated in anxiety depressive Forte, Enterosedir, Gastrimide, Grippex, states, in gastric ulcer, and in cardiac I mida-Lab, Imidan, Imidene, Kevadon, damage. Lulamin, Neosedyn, Pentosedir, Peracon• Expectorans, Polygripan, Predni-Sedir, Spiroperidol Profarmil, Quetimiol, Quietoplex, Sedalis, Spiroperidol is a butyrophenone derivative Sedi-Lab, Sedimide, Sedoval K-t 7, with anti-psychotic activity particularly Softenon, Softenon Forte, Talimol, useful in schizophrenia. The usual daily Tensival, Theophyl-, Ulcerfen, dose is 0·3 mg to 0·9 mg. Side effects Valgis, and Valgraine. include extra-pyramidal symptoms, per• A piperidinedione deri vative, Thalidomide spiration, dry mouth, hypotension, and was an effective hypnotic available in the urinary' retention. United Kingdom in t 958. In November t 96 t the first report of teratogenic effects Sulphonal appeared and in December t 961 it was Sulphonal is now seldom prescribed, but it withdrawn from the British market. was formerly used as a hypnotic for pro• When given during the first trimester of ducing prolonged sleep in psychiatric cases pregnancy, inhibition of limb bud and in nervous insomnia. Sui phonal is development in the foetus was likely. slowly excreted and has a cumulative effect Thalidomide has been shown to have which makes it one of the most dangerous immunosuppressive activity and it has hypnotics. Side effects include gastric therefore also been used in the treatment disturbances, liver damage and the forma• of cancer and of lepra reactions. tion of methaemoglobin. Dose: 0·3 to 1 ·2 g. Contra-indicated in heart disease. Thialbarbitone sodium (KemithaIR , Sodium) Thialbarbitone sodium is a very short• Temazepam is a benzodiazcpine with acting barbiturate about half as potent as anxiolytic properties. It has been used as a thiopentone sodium, but with a similar tranguillizer but its place in therapeutics is duration of action. It is used as a basal not yet established. narcotic producing anaesthesia of short or long duration intravenously. Respiratory depression is said to be less than with (NitomanR ) other intravenous barbiturates and laryn• Tetrabenazine has central effects similar geal spasm occurs less. General side to those of reserpine (g.v.), but its action effects and contra-indications are as for is more rapid and of shorter duration. It barbiturates (g.v.). causes depletion of serotonin (g.v.), dopamine (g.v.) and noradrenaline (g. v.) in brain tissue, but not peripherally. It has 398 hydrochloride

Thiopropazate hydrochloride used in the treatment of schizophrenia. (DartalanR, DartalR and in combinations Dose: 10-30 mg daily. Contra-indications TonoquilR and VesitanR) are circulatory collapse, coma, C.N.S. A phenothiazine derivative, thiopropazate depression due to any cause and blood has actions and uses similar to those of dyscrasias. It is not recommended for chlorpromazine (q.v.), but it is effective in children under 12 years. smaller doses. It is used in the treatment of psychoses where agitation and aggressive• hydrochloride ness predominate. It is used for psycho• (ElamoIR ) neuroses in anxiety states and as an anti• Tofenacin is a emetic and anti-nauseant. The dose is with mild sedative properties. It is ad• 5-10 mg tds. Side effects include blurring ministered in dosages up to 240 mg of vision, dryness of the mouth, hypo• daily. Side effects are those of anti• tension, nasal congestion, and extra• cholinergic drugs. pyramidal symptoms. Contra-indications as for chlorpromazine. Tolboxane (ClarmiIR, ClarphorilR) A propanediol derivative showing muscle (MajeptiIR, VontilR) relaxant and anxiolytic properties. Thioproperazine is a phenothiazine deriva• The place of this substance in clinical tive with tranquillizing activity similar to therapeutics has not yet been established. chlorpromazine (q.v.). Its sedative, hypotensive and hypothermic properties are less than those of chlorpromazine, but (ParnateR) it has a much more potent anti-emetic Tranylcypromine is a monoamine action. It is used in the treatment of acute oxidase inhibitor with anti-depressant and chronic schizophrenia, mania, and properties. It is used in the treatment of delirium, and to control excitement and severe mental depression. The initial dose aggression. The dose is 10-30 mg tds. is 10 mg bd. If there is no response after Side effects frequently include extra• 2 to 3 weeks, the dose is increased to pyramidal disturbances, respiratory 10 mg tds. Hypertensive crisis is an depression may occur and sweating, occasional side effect, which may lead to salivation and seborrhoea are severe. intracranial haemorrhage. Other side Contra-indications as for chlorpromazine. effects and contra-indications are as for monoamine oxidase inhibitors (q.v.). Thioridazine hydrochloride (Melleril R, Mellerettes) sodium A phenothiazine derivative, thioridazine (Tricloryl R) has anxiolytic activity and is used as a A chloral derivative, triclofos has similar tranquillizer in anxiety tension, psycho• sedative and hypnotic actions to chloral neuroses, senile agitation and confusion, hydrate but it is more palatable and and behavioural disorders in children. The relatively free from the tendency to cause dose is 10-30 mg tds initially, increasing gastric irritation. The dose for daytime to 200 mg tds as required. It is less effective sedation is 500 mg od or bd the hypnotic in schizophrenia than some other pheno• dose is 1 g (2 g in some cases) nocte. Some thiazines. Side effects are less than with gastric irritation and headache have been most other phenothiazines. Extra-pyra• reported. Contra-indications as for chloral midal effects are rare, and jaundice, hydrate (q.v.). agranulocytosis or severe dermititis are also rare. Drowsiness, dizziness and dry mouth may occur. It is contra-indicated in (TriperidoIR, PsicoperidolR) severely depressed or comatose states. A butyrophenone derivative, trifluperidol is a tranquillizer with properties similar to Thiothixene those of haloperidol (q.v.). It has been used (NavaneR, OrbinamonR) in the treatment of schizophrenia and A thioxanthene derivative, thiothixene is manic-depressive psychoses. The dose is, an anti-psychotic agent which has been initially, O'S mg od, increasing by O·S mg hydrochloride 399

at three day intervals until the desired Trirniprarnine effect is achieved. Maintenance: 1·5-2· 5 (SurmontiIR) mg od. Side effects include hypotension, An iminodibenzyl derivative, hyper-salivation, and effects similar to has anti-depressant properties resembling haloperidol. Contra-indications include those of imipramine (q.v.). It is used in pregnancy, neurological disorders ex• the treatment of all types of depression, hibiting pyramidal or extra-pyramidal particularly if associated with anxiety or symptoms. agitation. The initial dose is 25 mg tds increased by 25 mg daily to 50 -100 mg tds. hydrochloride The usual maintenance dose is 25 mg bd to (StelazineR , Amylozine SpansuleR, 50 mg tds. Side effects and contra• EskazinylR, JatronevralR) indications are as for imipramine. Trifluoperazine hydrochloride is a tran• quillizer of the phenothiazine group. In Tybarnate low doses, 2-4 mg bd, it is used to treat (BenviIR) anxiety states, nervous and emotional Chemically related to meprobamate (q.v.), stress, senile agitation and confusion. At is a minor tranquillizer used in higher dosages, 5-10 mg bd or tds it is the treatment of anxiety and tension. Dose: used to treat acute mania, delirium 1 tablet tds or qds. The sedative effects are tremens and schizophrenia. Side effects less than those of meprobamate otherwise include agitation, dizziness, drowsiness, the side effects and contra-indications are insomnia and nasal congestion. Above as for meprobamate. 10 mg tds reversible extra-pyramidal symptoms are frequently produced. Blood Valnoctarnide dyscrasias have occasionally been reported. (AxiqueIR, NirvanilR) Contra-indications include existing blood is a valeramide derivative dyscrasias, bone marrow depression, and having tranquillizing action reported to be liver damage. of value in anxiety and tension. Dose: 400-800 mg daily in divided doses. Trifluprornazine hydrochloride (Formerly available in Great Britain as Viloxazine hydrochloride VespralR Available in the USA as (VivalanR ) VesprinR) Viloxazine is a novel antidepressant with• is a member of the out sedative or anticholinergic side effects. phenothiazine group of tranquillizers, It also possesses anti-epileptic properties. having actions and uses similar to those of It is used at a daily dosage of 150-300 mg. chlorpromazine (q.v.). It has been used in Its place in therapy has not yet been the management of acute and chronic thoroughly assessed. psychoses when hallucinations and delu• sions are prominent. Uses also include treatment of anxiety and tension. The dose is 10 to 50 mg depending on the severity of the condition. Side effects and contra• indications are as for chlorpromazine.

Trirnetozine (TrioxazineR) is a morpho line derivative used as a sedative and tranquillizer. Usual dose 300 mg. three to six times daily. Although few side effects are reported its weak anxiolytic activity has probably precluded widespread use. The Concise Encyclopaedia of Psychiatry is based upon II series of publications spdnsored under the Roche Continuing Medical Education campaign. The contributors to the original series were:

K. Bergmann, MD, FRCPSYCH, DPM, Professor R. E. Kendell, MD, FRCP, Department of Psychological Medicine, MRCPSYCH, DPM, Department of Psychiatry, Newcastle General Hospital, Newcastle University of Edinburgh upon Tyne M. H. Lader, MD, PHD, MRCPSYCH, CPM, J. A. Bonn, MB, MRCP, MRCPSYCH, DPM, Institute of Psychiatry, The Maudsley Department of Psychological Medicine, Hospital, London SE5 St Bartholomew's Hospital, London E C I Denis Leigh, MD, BSC, FRCP, FRCPSYCH, Valerie Cowie, MD, PHD, FRCPSYCH, DPM, The Maudsley Hospital, London S E 5 Queen Mary's Hospital for Children, Carshalton, Surrey C. McDonald, MD, MRCPSYCH, MANZCP, DPM, Warlingham Park Hospital, Surrey A. D. Forrest, MD, MRCP, FRCPE, FRCPSYCH, DPM, Department of Psychiatry, J. Marks, MA, MD, FRCP, FRCPATH, University of Edinburgh MRCPSYCH, Downing College, University of Cambridge H. L. Freeman, MA, BM, FRCPSYCH, DPM, Psychiatry Department, C. M. B. Pare, MD, FRCP, FRCPSYCH, DPM, Hope Hospital, Salford Department of Psychological Medicine, St Bartholomew's Hospital, London EC t Professor J. L. Gibbons, MD, FRCP, 1. B. Pearson, MD, MRCPSYCH, DPM, FRCPSYCH, DPM, Department of Psychiatry, University Department of Psychiatry,· The Medical School, Southampton University Mapperley Hospital, Nottingham P. J. Graham, MB, FRCP, FRCPSYCH, A. A. Robin, MD, FRCPSYCH, DPM, DPM, Department of Psychological Medicine, Runwell Hospital, Wickford, Essex The Hospital for Sick Children, Great Ormond Street, London W C 1 Professor J. R. Smythies, MA, MSC, MD, FRCP, FRCPSYCH, FAPA, DPM, School of J. C. Gunn, MD, MRCPSYCH, DPM, Medicine, Birmingham, Alabama, USA Director of the Special Hospital Research Unit, Institute of Psychiatry, London SE5 J. Stevenson, PHD, M.R.C. Unit on the Development and Integration of Behaviour, Professor H. Gwynne Jones, BSC, FBPSS, Madingley, University of Cambridge Department of Psychology, University of Leeds D. C. Taylor, MD, MRCP, FRCPSYCH, DPM, Human Development Research Unit, Professor R. A. Hinde, FRS, SCD, DPHIL, The Park Hospital for Children, Headington, M.R.C. Unit on the Development and Oxford Integration of Behaviour, Sub-Department of Animal Behaviour, Madingley, J. M. Taylor, BPHARM, MPS, Bishop's University of Cambridge Stortford, Hertfordshire

J. Johnson, MD, FRCPE, FRCPSYCH, Professor J. P. Watson, MD, MRCP, University Department of Psychiatry, MRCPSYCH, DPM, DCH, Guy's Hospital, Manchester Royal Infirmary London, SEt

D. W. Kay, DM, FRCP, FRCPSYCH, DPM, D. Watt, BSC, MD, FRCPSYCH, DPM, St John's Department of Psychiatry, University of Hospital, Stone, Bucks Tasmania, Hobart, Tasmania J. H. P. Willis, MB, FRCPE, FRCPSYCH, DPM, D. H. W. Kelly, MD, MRCP, FRCPSYCH, Department of Psychological Medicine, DPM, St George's Hospital, London SWI Guy's Hospital, London S E 1

The editors wish to express their appreciation for the help provided by the original contributors. For the new book the editors have tried to bring the entries up to date and in consequence, take full responsibility for the opinions expressed.