Thus, this study suggests that drugs that inhibit P450 2D6 or the presence of reduced activity levels of this isozyme will produce elevated plasma levels of Thioridazine. Strategies include: cross-titration (gradually discontinuing the first antipsychotic while gradually increasing the new antipsychotic) and abrupt change (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose). Monitor therapy, Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy, Dronabinol: May enhance the CNS depressant effect of CNS Depressants. Due to its potential for significant, possibly life threatening, proarrhythmic effects, Thioridazine should be reserved for use in the treatment of schizophrenic patients who fail to show an acceptable response to adequate courses of treatment with other antipsychotic drugs, either because of insufficient effectiveness or the inability to achieve an effective dose due to intolerable adverse effects from those drugs (see, Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Monitor therapy, CYP2D6 Inhibitors (Moderate): May increase the serum concentration of Thioridazine. Avoid combination, AtoMOXetine: CYP2D6 Inhibitors (Moderate) may increase the serum concentration of AtoMOXetine. The syndrome is characterized by involuntary choreoathetoid movements which variously involve the tongue, face, mouth, lips, or jaw (e.g., protrusion of the tongue, puffing of cheeks, puckering of the mouth, chewing movements), trunk, and extremities. Monitor therapy, Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy, QUEtiapine: QT-prolonging Antipsychotics (Moderate Risk) may enhance the QTc-prolonging effect of QUEtiapine. Neither clinical studies nor epidemiologic studies conducted to date, however, have shown an association between chronic administration of these drugs and mammary tumorigenesis; the available evidence is considered too limited to be conclusive at this time. Autonomic Nervous System: Mydriasis, miosis, dry skin, dry mouth, nasal congestion, urinary retention, blurred vision. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. In that case, your doctor may not prescribe Viagra for you. Avoid combination, Lithium: May enhance the neurotoxic effect of Antipsychotic Agents. Avoid combination, Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Avoid combination, Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). An airway must be established and maintained. Beta-Blockers may decrease the metabolism of Antipsychotic Agents (Phenothiazines). Effects and clinical complications of acute overdose involving phenothiazines may include: Cardiovascular: Cardiac arrhythmias, hypotension, shock, ECG changes, increased QT and PR intervals, non-specific ST and T wave changes, bradycardia, sinus tachycardia, atrioventricular block, ventricular tachycardia, ventricular fibrillation, Torsades de pointes, myocardial depression. Patients with additional risk factors for QTc prolongation may be at even higher risk. Last updated on Sep 21, 2022. Monitor therapy, Saquinavir: May enhance the QTc-prolonging effect of Thioridazine. decreased sex drive, impotence, or difficulty having an orgasm. Falls: May increase the risk for falls due to somnolence, orthostatic hypotension, and motor or sensory instability (Landi 2005; Seppala 2018). . Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. No such dose change is recommended for women. Monitor therapy, QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk): May enhance the QTc-prolonging effect of QT-prolonging Antipsychotics (Moderate Risk). Propranolol and Thioridazine should not be coadministered. Avoid combination, Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. Others: Hyperpyrexia. Monitor therapy, Olmutinib: CYP2D6 Inhibitors (Moderate) may increase the serum concentration of Olmutinib. Hepatotoxicity: Jaundice, biliary stasis. Description Clinical Pharmacology Indications and Usage Contraindications Warnings Precautions Drug Interactions Patient Counseling Information Adverse Reactions/Side Effects Overdosage Dosage and Administration How Supplied/Storage and Handling Rx only WARNING Monitor therapy, Indoramin: CYP2D6 Inhibitors (Moderate) may increase the serum concentration of Indoramin. Therefore, Thioridazine is contraindicated with these drugs as well as in patients, comprising about 7% of the normal population, who are known to have a genetic defect leading to reduced levels of activity of P450 2D6 (see WARNINGS and PRECAUTIONS). Monitor therapy, Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy, Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. This is. Use with caution in patients at risk for aspiration pneumonia (ie, Alzheimer disease), particularly in patients >75 years (Herzig 2017; Maddalena 2004). Avoid combination, Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. The APA recommends giving preference to second generation antipsychotics over first generation antipsychotics in elderly patients with dementia-related psychosis due to a potentially greater risk of harm relative to second generation antipsychotics (APA [Reus 2016]). Monitor therapy, Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Monitor therapy, Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Consult drug interactions database for more information. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. When should I avoid Viagra? Monitor therapy, Kava Kava: May enhance the adverse/toxic effect of CNS Depressants. The diagnostic evaluation of patients with this syndrome is complicated. CYP2D6 Inhibitors (Moderate) may increase serum concentrations of the active metabolite(s) of Iloperidone. Monitor therapy, Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Due to concerns about cardiotoxicity and retinopathy at high doses, this drug is now prescribed less than previously and is mostly used for refractory cases. Management: If brexpiprazole is to be used together with both a moderate CYP2D6 inhibitor and a strong or moderate CYP3A4 inhibitor, the brexpiprazole dose should be reduced to 25% of the usual dose when treating indications other than major depressive disorder. Use caution with radiotherapy doses of amifostine. Patients with additional risk factors for QTc prolongation may be at even higher risk. If combined, monitor closely for QTc interval prolongation and arrhythmias. Monitor therapy, Thiopental: Antipsychotic Agents (Phenothiazines) may enhance the adverse/toxic effect of Thiopental. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Monitor therapy, Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Drugs with this potential, including thioridazine, have been associated with torsades de pointestype arrhythmias and sudden death. The resulting elevated levels of Thioridazine would be expected to augment the prolongation of the QTc interval associated with Thioridazine and may increase the risk of serious, potentially fatal, cardiac arrhythmias, such as Torsades de pointes type arrhythmias. Avoid combination, Valbenazine: CYP2D6 Inhibitors (Moderate) may increase serum concentrations of the active metabolite(s) of Valbenazine. Monitor therapy, Iohexol: Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iohexol. In schizophrenia, there is no reliable indicator to differentiate the minority who will not from the majority who will relapse with drug discontinuation. Other ECG changes have been reported (see Phenothiazine Derivatives: Cardiovascular Effects). Disopyramide, procainamide, and quinidine may produce additive QT-prolonging effects when administered to patients with acute overdosage of Thioridazine and should be avoided (see WARNINGS and CONTRAINDICATIONS). Avoid combination, Clarithromycin: QT-prolonging Antipsychotics (Moderate Risk) may enhance the QTc-prolonging effect of Clarithromycin. Ocular effects: May cause pigmentary retinopathy, characterized by diminution of visual acuity, brownish coloring of vision, and impairment of night vision, in patients exceeding recommended doses. Sildenafil (Viagra). If used, monitor closely for arrhythmia as well as general toxicity of chlorpheniramine. Hyperprolactinemia: Use associated with increased prolactin levels; clinical significance of hyperprolactinemia in patients with breast cancer or other prolactin-dependent tumors is unknown. Consider therapy modification, Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Monitor therapy, Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. What Are Side Effects of Thioridazine? Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Thioridazine hydrochloride tablets are indicated for the management of schizophrenic patients who fail to respond adequately to treatment with other antipsychotic drugs. Thioridazine (thioridazine hydrochloride) is an antipsychotic drug used to treat schizophrenia. Monitor therapy, Amifampridine: Agents With Seizure Threshold Lowering Potential may enhance the neuroexcitatory and/or seizure-potentiating effect of Amifampridine. Thioridazine hydrochloride is not approved for the treatment of patients with dementia-related psychosis (see BOXED WARNING). Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although outcome information has been published in case reports following maternal use of thioridazine in pregnancy, most information is available for phenothiazines as a class (Erkkola 1983; Heinonen 1977; Scanlan 1972; Slone 1977; Vince 1969). As in the case of other phenothiazines, Thioridazine is capable of potentiating central nervous system depressants (e.g., alcohol, anesthetics, barbiturates, narcotics, opiates, other psychoactive drugs, etc.) Consider therapy discontinuation with signs/symptoms of tardive dyskinesia. Monitor therapy, Sulpiride: Antipsychotic Agents may enhance the adverse/toxic effect of Sulpiride. Monitor therapy, Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy, Deutetrabenazine: May enhance the adverse/toxic effect of Antipsychotic Agents. Avoid combination, CYP2D6 Inhibitors (Strong): May increase the serum concentration of Thioridazine. Monitor therapy, Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Monitor therapy, Lemborexant: May enhance the CNS depressant effect of CNS Depressants. It has been reported that old age lowers the tolerance for phenothiazines. Management: Consider alternatives to this combination when possible. Medically reviewed by Drugs.com. Management: Avoid concomitant use of anticholinergic agents and secretin. Monitor patient closely for evidence of CNS depression. The physician should be aware that the following have occurred with one or more phenothiazines and should be considered whenever one of these drugs is used: Autonomic Reactions: Miosis, obstipation, anorexia, paralytic ileus. The patient should be carefully monitored, since recurrences of NMS have been reported. risk of QT prolongation, cardiac arrhythmias, severe hypotension (incl. Thioridazine is a piperidine antipsychotic drug that was previously widely used in the treatment of schizophrenia and psychosis. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away: WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Such an increased risk may result also from the additive effect of coadministering Thioridazine with other agents that prolong the QTc interval. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Discontinuation of therapy: When discontinuing antipsychotic therapy, gradual dose reduction is advised to avoid withdrawal symptoms (ie, insomnia, headache, GI symptoms), unless discontinuation is due to significant adverse effects. Specifically, the risk for seizures may be increased. The administration of epinephrine should be avoided in the treatment of drug-induced hypotension in view of the fact that phenothiazines may induce a reversed epinephrine effect on occasion. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. Patients with additional risk factors for QTc prolongation may be at even higher risk. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Antipsychotic Agents may enhance the serotonergic effect of Serotonergic Agents (High Risk). Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Patients with additional risk factors for QTc prolongation may be at even higher risk. 5 to 27 hours (Mrtensson 1973; Muusze 1977; Vanderheeren 1977). Monitor therapy, Quinagolide: Antipsychotic Agents may diminish the therapeutic effect of Quinagolide. Schizophrenia and psychosis with other Agents that prolong the QTc interval closely arrhythmia. Urinary retention, blurred vision Lithium: may enhance the neuroexcitatory and/or seizure-potentiating effect of Flunitrazepam of.... 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