FAM001159-0001 intervals of 4-7 days to usual dose of 75-100 mg Dolmatil® (Sanofi-Synthelabo) ~ 100 rag/5 mL, thioridazine 100 rag/ per course and max. 4 injections; max. duration of daily according to response; CHILD not recom- Tablets, both scored, sulpiride 200 rag, net price ’ net price 300 mL = £7.14. Label: 2 treatment 2 weeks---if maintenance treatment mended 100-tabpack=£13.85;400mg(f/c), 100-tab ! fNote. These suspensions should not be diluted but the necessary change to an oral antipsychotic 2-3 Short-term adjunctive management of severe pack = £36¯29. Label: 2 .: :~t~a preparations may be mixed with each other to days after last injection, or to a longer acting anti- anxiety, 15-20rag daily in divided doses; max. Sulpltil® (Pharmacia) I~ ~0iovid¢ intermediate strengths psychotic depot injection given concomitantly 40 mg daily; CHILD not recommended Tablets, scored, sulpiride 200 rag. Net price 28-tab "ff~-~p, brown, thioridazine (as hydrochloride) with last injection of zuclopenthixol acetate; By deep intramuscular injection, psychoses, mania, pack = £4.29; 112-tab pack = £12.85. Label: 2 ~ff.~5"~mg/5 mL, net price 300 mL = £1.98. Label: 2 CHILD not recommended prochlorperazine mesilate 12.5-25 mg 2-3 times Sulpor® (Rosemont) IPoMI Clopi~ol Acuphase® (Lundbeck) daily; CHILD not recommended Oral solution, sugar-free, lemon- and aniseed-fla. LUOPERAZINE Injection (oily), zuclopenthixol acetate 50 mg/mL. By rectum in suppositories, psychoses, mania, the voured, sulpiride 200 mg/5 mL, net price 150 mL (’~’n~ications: see under Dose; anti-emetic (section Net price I-mL amp = £5.20; 2-mL amp = £10.03 equivalent of prochlorperazine maleate 25 mg 2- = £27.00. Label: 2 3 times daily; CHILD not recommended ~,6) ... , .~autions: see notes anove ZUCLOPENTHIXOL THIORIDAZlNE Contra-indications: see notes above DIHYDROCHLORIDE Preparations , b’qdc;-effects: see notes above; extmpyramidal Indications: under specialist supervision, second. Indications: schizophrenia and other psychoses, Section 4.6 more frequent, especially at doses line treatment of schizophrenia in adults (see 6 mg daily; pancytopeniai thrombocy- particularly when associated with agitated, Contra-indicationa, below) aggressive, or hostile behaviour PROMAZINE HYDROCHLORIDE Cautions: see notes above; avoid in porphyria Cautions: see notes above; ECG screening and by mouth (reduce initial doses in elderly by Indications: see under Dose electrolyte measurement before treatment, after (section 9.8.2) each dose increase and at 6-month intervals; also Contra-indications: see notes above; apathetic or Cautions: see notes above; also cerebral arterio- Schizophrenia and other psychoses, short-term monitor for visual defects on prolonged use; withdrawn states sclerosis ldjunctiv¢ management of psychomotor agita- avoid in porphyria (section 9.8.2) Slde-effects: see notes above; urinary frequency Contr’a-indications: see notes above tion; excitement, and violent or dangerously Contra-indications: see notes above or incontinence; weight loss (less common than impulsive behaviour, initially 5 mg twice daily, or Side-effects: see notes above; also haemolytic weight gain) " " ’ CARDIOTOXIClTY, Thioridazine is associated with QT- 10rag daily in mod fled-release form, jncreased anaemia interval prolongation and increased risk of ventriculat 5 mg after 1 week, then at intervals of 3 days, Dose: initially 20-30mg daily in divided doses, Dose: by mouth, short-term adjunctive manage- arrhythmias. The CSM has advised that thioridazinc increasing to a max. of 150 mg daily if necessary; ~¢ording to the response; CHILD Lip to 12 years, ment of psychomotor agitation, 100-200mg 4 should be restricted to second-line treatment of schizo- usual maintenance dose 20-50 mg daily; ELDERLY phrenia in adults under specialist supervision. Thiorid. up to 5mg daily in divided doses, times daily; CHILD not recommended (or debilitated) initially quarter to half adult dose; Agitation and restlessness in elderly, 25-50 mg 4 azine is contra-indleated in patients with: according to response, age, and body- ¯ significant cardiac disease, such as angina, brady- CHILD not recommended times daily eardia, second- or third-degree heart block, cardiac adjunctive management Of severe By.intramuscular injection, short-term adjunctive failure; Clopixol® (Lundbeck) ~,Laaxiety, 2--4 mg daily in divided doses or 2--4 mg management of psychomotor agitation, 50mg ¯ history of ventricular arrhythraia; " Tablets, all fi’c, pink, zuclopenthixol (as dihydro- ,iSd,ai’iy in modified-release form, increased if nec- (25 mg in elderly or debilitated), repeated if nec- ¯ QT-interval prolongation or a family history of th~ chloride) 2 mg, net price 20.= 62p; 10 rag, 20 = essary after 6-8 hours; CHILD not recommended condition; - = "~ e~ay to 6mg daily; CHILD 3-5 years up to I mg £1.73; 25 mg, 20 = £3.47. Label: 2 ¯ uncorrected hypokalaemia or hypomagnesaemia; _~d~’!y, 6-12 years up to 4 mg daily Depot injection (zuclopenthixol decanoate): sec- ¯ concomitant use with other drugs known to cause tion 4.2.2 Promazine (Non-proprietary) . QT-interval prolongation; : :; ~’~;ifluop’erazine (Non-proprietary) Tablets ~, coated, promazine hydrochloride ¯ reduced cytochmme P450 21)6 activity; ,(Tablets, coated, trifluoperazine (as hydrochloride) ¯ concomitant use with drugs that inhibit or are metab- 25 mg, net price 20 = 49p; 50 mg, 20 = 87p. : -iil mg, net price 20 = 57p; 5 mg, 20 = 87p. Label: 2 Atypical antipsychotics ¯ olised by cytochrome P450 2D6. Label: 2 rJWailable from most genetic manufacturers The ’atypical antipsychotics’ amisulpride, cloz- Side-effects: see notes above; less sedating than Available from Biorex =pral solution, trifluoperazine (as hydrochlo~’ide) apine, olanzapine, quetiapine, risperidone, and chlorpromazine, and extrapyramidat symptoms Oral solution ~, pr0mazine hydrochloride ~mg/5 mL. Net price 200-mL = £11.07. Label: 2 zotepine may be better tolerated than other antipsy- and hypothermia rarely occur; more likely to 25 mg/5 mL, net price 150 mL = £ 1.60; 50 mg/ ~..rAy~lable from Rosemont (sugar-free) chotics; extrapyramidal symptoms and prolactin induce hypotension and increased risk of cardio- 5mL, 150mL =£2.06. Label: 2 oStelazine® (Goldshield) elevation may be less frequent than with older anti- toxicity and prolongation of QT interval (see i A’,;ailable from Rosemont Tablets, both blue, f/c, tfifluoperazine (as hydro- psychotics. above); pigmentary retinopathy (with reduced Injection, promazine hydrochloride 50 mg/mL. chl0ride) I mg, net price 20 = 61p; 5 mg, 20 = The atypical antipsychotics may be used as first- visual acuity, brownish colouring of vision, and Net price 1-mL amp = 30p ~: Label: 2 line treatment for schizophrenia, but clozapine is impaired night vision) occurs rarely with high Note. May be difficult to obtain licensed for the treatment of schizophrenia only in doses; sexual dysfunction, particularly retrograde ; dark blue, light blue, and white pellets, patients unresponsive to, or intolerant of, conven- ejaculation, may occur tional antipsychotic drugs. It can cause agranulo- SULPIRIDE Dose: 50-300 mg daily (initially in divided doses); £4.36; 10 mg, 30-cap pack = £2.83; cytosis and its use is restricted to patients registered max’. 600mg daily (in hospital patients only); Indications: schizophrenia !.mg~ 30-cap pack = £4.27. Label: 2, 25 with the Clozaril Patient Monitoring Service (see CHILD not recommended Cautions: see notes above; also excited, agitated, trifluoperazine (as under Clozapine, below). or aggressive patients (even low doses may mg/5 mL. Net price 200-mL Sertindole has been suspended following reports aggravate symptoms) Thioridazlne (Non-proprietary) 2 of arrhythmias and sudden cardiac death; it remains Contra-indications: see notes above; also por- Tablets, coated, thioridazine hydrochloride 25 mg~ available on a named-patient basis (from Lund- phyria (section 9.8.2) net price 20 = 35p; 50 mg, 20 = £1.02; 100 rag, 20 ZUCLOPENTHIXOL ACETATE beck~erdolect~) for patients already stabilised on Side-effects: see notes above; also hepatitis = £1.57. Label: 2 the drug in whom other antipsychotics are inappro- Available from Alpharma, DDSA (Rideril~), Hillemss, Indications: short-term management of acute psy- Dose: 200-400 mg twice daily; max. 800mg daily priate. IVAX .’ chosis, mania, or exacerbations of chronic psy- in predominantly negative symptoms, and 2.4 g Oral solution, thioridazine (as hydrochloride) CAUTIONS AND CONTRA-INDICATIONS. daily in mainly positive symptoms; ELDEaLY, 25 mg/5 mL. Net price 500-mL = £2.67. Label: 2 Cautions: see notes above; avoid in porphyria While most atypical antipsychotics have not gener- lower initial dose, increased gradually according Available from Hillcross, Rosemont c;: ally been associated with prolongation of the QT to response; CHILD under 14 years not recom- (section 9.8.2) Plelleril® (Novartis) IPoHI COntra-indications: see notes above interval, caution should be exercised if they are pre- mended Tablets, all f/c, thioridazine hydrochloride 10 mg, Side-effects: see notes above scribed with other drugs known to increase the QT net price 84-tab pack = £ 1.01 ; 25 mg, 84-tab pack ~DOse: by deep intramuscular injection into the glu- interval. Atypical antipsychotics should be used Sulpiride (Non-proprietary) = £1.66; 50mg, 84-tab pack = £3.23; 100 rag, 84- ,,teal muscle or lateral thigh, 50-150mg (elderly with caution in patients with cardiovascular disease, Tablets. sulpiride 200 mg, net price 100-tab pack = tab pack = £6.24. Label: