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Psychotropic Use during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Management of psychosis during pregnancy frequently requires hospitalization because of the patient’s confusion, hostility, disorientation, anxiety, and possible suicidal tendencies. Psychiatric consultation and psychological evaluation are mandatory for patients with psychosis. Antipsychotic agents are frequently necessary in the treatment of psychosis. The agent of choice for acute psychotic reactions is haloperidol 1–5 mg PO (or IM) every six to eight hours. Chlorpromazine is another agent that is used in the acutely psychotic patient with a starting dose of 100 mg PO every 8–12 hours. Upon achievement of a stable dose, chlorpromazine can be administered once daily at bedtime. Some authorities recommend high-potency agents, haloperidol or trifluoperazine, over the low-potency neuroleptics (Miller, 1994a, 1996). The daily dose of haloperidol (Haldol) is 5–10 mg/day and of trifluoperazine (Stelazine), 10–40 mg/day (Yonkers and Cunningham, 1993).
Prescribing for a first episode of schizophrenia-like psychosis
Published in Kathy J Aitchison, Karena Meehan, Robin M Murray, First Episode Psychosis, 2021
Kathy J Aitchison, Karena Meehan, Robin M Murray
Do clinical studies support the above theoretical dose ranges? It has been shown that 5 mg haloperidol daily is effective in the treatment of schizo-phrenia.173 In an early fixed-dose study,174 three doses of chlorpromazine (200 mg, 400 mg and 600 mg) were compared over 4 weeks, and it was found that in the 200 mg group there were more drop-outs due to insufficient efficacy, while EPS and other side-effects were more frequently observed in the patients taking 600 mg. The results of 19 controlled trials showed that after 2 to 10 days’ treatment, there was an overall 50% response rate to less than 250 mg of chlorpromazine equivalents (see Table 12 for equivalent doses of other antipsychotics), a 56% response rate to 300-600 mg chlorpromazine equivalents and a 38% response rate to doses greater than 800 mg chlorpromazine equivalents, with more side-effects being experienced in the third group.175 The data group therefore showed that the response rate in the medium-dose group was the best, with a lower response rate in the low- and high-dose groups, with the additional disadvantage of more adverse effects in the high-dose group.
Headache
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Other nonspecific drugs: Chlorpromazine: intramuscular, but long-term considerations (e.g. tardive dyskinesia).Opioid/narcotic analgesic use is highly controversial, not evidence-based, and is associated with prominent adverse effects, a high risk of dependency, and the tendency to make future attacks harder to treat.
Common systemic medications that every optometrist should know
Published in Clinical and Experimental Optometry, 2022
Ocular pigmentation can also occur in the retinal pigment epithelium (RPE) and neurosensory retina due to the deposition of thioridazine and chlorpromazine medications. For patients taking thioridazine, large daily doses (> 800 mg/day) should be considered as an increased risk. For patients on chlorpromazine, daily dose and longer duration are associated with greater risk. Early detection is key in preventing permanent vision loss. Cases have shown retinal damage resulting in peripheral vision loss, nyctalopia, and blindness.5 A yearly retinal screening is indicated in patients taking these medications. Ophthalmoscopy and FAF can be used to search for drug deposits in the RPE or sensory retina. If discovered, prompt communication with the patient’s medication prescriber is essential in determining drug discontinuation or a decreased dosage.
Considerations of the effects of commonly investigated drugs for COVID-19 in the cholesterol synthesis pathway
Published in Expert Opinion on Pharmacotherapy, 2021
Juan Luis Gomez Marti, Adam M. Brufsky
Coronaviruses undergo early clathrin-mediated endosomal uptake. Early viral fusion takes place at the furin-cleavage site in the S protein. Without this cleavage, endosomes require maturation into lysosomes for viral fusion to occur [30]. Chlorpromazine and CQ/HCQ block this phase of viral infection [1]. These display potent replication inhibition in vitro, and reduced disease severity in a mouse model [1]. Clinically, they do not seem to reduce viral titers or even prevent the development of symptoms [17], but could minimize the clinical course if used post-exposure based on a preprint study [31]. Chlorpromazine constitutes another ‘old drug’ with a broad spectrum and tolerable safety profile, which is also used for non-psychiatric uses such as nausea and vomiting of pregnancy [32]. A trial record has been posted where chlorpromazine will be added to the standard therapeutic protocol (NCT04366739).
Neurodevelopmental and growth follow-up of the baby exposed to antipsychotics during pregnancy and lactation: a case report
Published in Psychiatry and Clinical Psychopharmacology, 2019
According to the current literature, the first option for breastfeeding women with schizophrenia should be olanzapine [34]. So, we started olanzapine and gradually increased the dose during breastfeeding. No side effect was observed on baby. There are more data on olanzapine in SGA exposure during breastfeeding. The mean relative infant dose for olanzapine has been reported to be 1.6%, which is much low compared with the levels that are generally accepted to be clinically significant are 10% or more [35]. Considering the high relative infant dosage and the reported adverse effects in infants, the use of clozapine, lithium, and sulpiride is contraindicated during breastfeeding. Chlorpromazine and olanzapine could be considered the first-choice drugs for treatment of psychotic disorders in breastfeeding mothers because they have the lowest degree of excretion into human breast milk and scant adverse effects in breastfed infants [36]. Most of the data on side effects in infants exposed to olanzapine come from the manufacturer’s pharmacovigilance database. According to these data, 102 women using olanzapine during breastfeeding (mean dose 7.4 mg) had some adverse effects including most commonly sleepiness, irritability, tremor and insomnia were reported in their babies [37].