No

Antipsychotic Agent, Phenothazine, Piperazine

Management of manifestations of psychotic disorders

C

Blood dyscrasias and bone marrow suppression, patients in coma or brain damage, known hypersensitivity to acetophenazine

>10%:

Cardiovascular: Hypotension, orthostatic hypotension

Central nervous system: Pseudoparkinsonism, akathisia, dystonias, tardive dyskinesia, dizziness

Gastrointestinal: Constipation

Ocular: Pigmentary retinopathy

Respiratory: Nasal congestion

Miscellaneous: Diaphoresis (decreased)

1% to 10%:

Dermatologic: Increased sensitivity to sun, rash

Endocrine & metabolic: Changes in menstrual cycle, breast pain, changes in libido

Gastrointestinal: Weight gain, nausea, vomiting, stomach pain

Genitourinary: Difficulty in urination, ejaculatory disturbances

Neuromuscular & skeletal: Trembling fingers

<1%:

Central nervous system: Neuroleptic malignant syndrome (NMS), impairment of temperature regulation, lowering of seizures threshold

Dermatologic: Discoloration of skin (blue-gray)

Endocrine & metabolic: Galactorrhea

Genitourinary: Priapism

Hematologic: Agranulocytosis, leukopenia

Hepatic: Cholestatic jaundice, hepatotoxicity

Ocular: Cornea and lens changes, pigmentary retinopathy

Methyldopa, propranolol, CNS depressants (including tricyclic antidepressants) can effect; lithium and fluoxetine can toxicities; antacids, carbamazepine, barbiturates, and anticholinergics can effect; phenothiazines effect of bromocriptine and valproic acid

Protect from light; dispense in amber or opaque vials

Antagonizes the effects of dopamine in the basal ganglia and limbic areas of the forebrain; this activity appears responsible for the antipsychotic efficacy, as well as the production of extrapyramidal symptoms; increases the secretion of prolactin and has a marked suppressive effect on the chemoreceptor trigger zone; also produces peripheral blockade of cholinergic neurons

Onset: 2-4 hours

Duration: ~24 hours, permitting daily dosing

Absorption: Tissue saturation, particularly in high lipid tissues such as the central nervous system

Serum half-life: Range: 20-40 hours

Adults: Oral: 20 mg 3 times/day up to 60-120 mg/day

Hemodialysis: Not dialyzable (0% to 5%)

No information available to require special precautions

Orthostatic hypotension and nasal congestion possible in dental patients. Since the drug is a dopamine antagonist, extrapyramidal symptoms of the TMJ is a possibility; increased motor activity of head, face, and neck may occur. This drug is also an anticholinergic causing xerostomia.

Do not take antacid within 1 hour of taking drug; may cause drowsiness, avoid alcohol; avoid excess sun exposure (use sun block); rise slowly from recumbent position; use of supportive stockings may help prevent orthostatic hypotension

Observe for tremor and abnormal movement or posturing (extrapyramidal symptoms), increased confusion or psychotic behavior, constipation, urinary retention, abnormal gait

Tablet, as maleate: 20 mg

Peabody CA, Warner MD, Whiteford HA, et al, "Neuroleptics and the Elderly," J Am Geriatr Soc, 1987, 35(3):233-8.

Risse SC and Barnes R, "Pharmacologic Treatment of Agitation Associated With Dementia," J Am Geriatr Soc, 1986, 34(5):368-76.

Saltz BL, Woerner MG, Kane JM, et al, "Prospective Study of Tardive Dyskinesia Incidence in the Elderly," JAMA, 1991, 266(17):2402-6.

Seifert RD, "Therapeutic Drug Monitoring: Psychotropic Drugs," J Pharm Pract, 1984, 6:403-16.