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Psychotropic Use during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Fluphenazine is a piperazine phenothiazine used to treat psychosis. The frequency of congenital anomalies was not increased among 226 infants whose mothers who took fluphenazine as an antiemetic during the first trimester, (King et al., 1963). Transient extrapyramidal signs in the newborn were observed several weeks after delivery of a newborn exposed to fluphenazine in utero (Cleary, 1977). The frequency of congenital anomalies was not increased in the offspring of pregnant rats exposed to this phenothiazine during organogenesis compared to unexposed controls (Jahn and Adrian, 1969; Adrian, 1973).
Antiemetics and Cancer Chemotherapy
Published in John Kucharczyk, David J. Stewart, Alan D. Miller, Nausea and Vomiting: Recent Research and Clinical Advances, 2017
The antidopaminergic action of phenothiazines is also responsible for much of the toxicity associated with these agents (Table 4). Individual phenothiazines vary markedly in the degree of side effects produced and it is for this reason that a particular agent such as prochlorperazine is chosen. Some phenothiazines with more potent antiemetic effects such as fluphenazine and trifluoperazine are associated with undesirably severe extrapyramidal side effects.19 These can include tremor, rigidity, akathisia, dystonia, dyskinesia, tardive dyskinesia, and oculogyric crisis. The latter side effect can be very disconcerting as the patient may present in a mute state with the eyeballs rotated upward, seeming to disappear into the top of the forehead (Figure 1). Fortunately, oculogyric crisis is readily reversed by the i.v. administration of anticholinergic agents such as diphenhydramine (Benadryl®) or benztropine (Cogentin®). The usual diphenhydramine dose is 50 mg i.v. This is often administered prophylactically with the initial dose of phenothiazine antiemetic. The use dose of benztropine is 2 mg given i.v.
100 MCQs from Dr. Guy Molyneaux and Colleagues
Published in David Browne, Selena Morgan Pillay, Guy Molyneaux, Brenda Wright, Bangaru Raju, Ijaz Hussein, Mohamed Ali Ahmed, Michael Reilly, MCQs for the New MRCPsych Paper A, 2017
Dr Pauline Devitt, Dr Angela Noonan, Dr Klaus Oliver Schubert, Prof Finian O’Brien
It produces less extrapyramidal side effects than fluphenazine. The maximum licensed dose of flupenthixol is 400 mg per week, according to the BNF, which is actually 20 times higher than the commonly administered dose of 40 mg per fortnight. Fluphenazine decanoate can cause acute dystonic reactions within the first 24 hours following the injection, as a consequence of the abrupt rise in blood levels of the drug. Haloperidol decanoate can be given every 6–8 weeks in some patients because of its long half-life. The maximum dose of zuclopenthixol decanoate is 600 mg weekly. (21, pp 250–2)
Current and emerging pharmacotherapeutic strategies for Tourette syndrome
Published in Expert Opinion on Pharmacotherapy, 2022
Pimozide is both a dopamine D2 receptor antagonist and a calcium channel blocker. Throughout the 1980s, pimozide was increasingly being used as an alternative anti-tic agent to haloperidol, as it was associated with fewer extrapyramidal adverse effects. However, pimozide can cause cardiac arrhythmias and prolongation of the QTc interval, in addition to sedation, weight gain and hyperprolactinemia as commonly reported tolerability issues. This medication is currently regarded as possibly more likely than placebo to reduce tic severity, and its use in the treatment of TS is recommended only for severe and treatment resistant cases [39,40]. Among first-generation antidopaminergic medications, comparatively less is known about the use of fluphenazine for the treatment of TS. Based on suggestions about a better tolerability profile compared to haloperidol (especially with regard to sedation and extrapyramidal symptoms), fluphenazine is listed in the AAN guidelines as an additional first-generation antidopaminergic agent for which evidence is promising but limited [28].
Role of amino acids at positions 34, 296, and 486 of cytochrome P450 2D6 in the stimulatory and inhibitory effects of psychotropic agents on dopamine formation from p-tyramine
Published in Xenobiotica, 2021
Toshiro Niwa, Juri Arima, Yurina Michihiro
Milnacipran, a serotonin and norepinephrine reuptake inhibitor (SNRI), is used as an antidepressant and SSRI (Keks et al. 2018). Fluphenazine, a phenothiazine derivative with a trifluoromethyl group, is used to treat schizophrenia (Matar et al. 2018).
Familial abnormalities of endocannabinoid signaling in schizophrenia
Published in The World Journal of Biological Psychiatry, 2019
Dagmar Koethe, Franziska Pahlisch, Martin Hellmich, Cathrin Rohleder, Juliane K. Mueller, Andreas Meyer-Lindenberg, E. Fuller Torrey, Daniele Piomelli, F. Markus Leweke
Twin plasma sample from 25 pairs (50 subjects) of monozygotic twins discordant for schizophrenia (one twin suffering schizophrenia (SCZ), the other twin healthy), seven twin pairs (14 subjects) discordant for bipolar disorder (one twin suffering from bipolar disorder (BPD), the other twin healthy), and eight pairs (16 subjects) of healthy control twins (HC) were collected under standardized conditions by Dr E. Fuller Torrey, Stanley Medical Research Institute, Bethesda (Torrey et al. 1994). All participants in the study had their zygosity confirmed by the typing of 19 red blood cell antigens, additionally, photos and questionnaires were used to assess zygosity (Torrey et al. 1994). The study was approved by an Institutional Review Board and all study participants gave written informed consent. The patients were recruited in an outpatient setting and had been non-acute patients in a stable condition to participate the study. The small group of bipolar patients added to the sample were originally thought as an internal standard for the measurements of endocannabinoids. Of those, none were reported as euthymic or a rapid cycler, though four were in a mixed state and another four showed psychotic features, mainly mood congruent (Torrey et al. 1994). A structured clinical interview for DSM-III-R axis I disorders for each individual was derived in consensus between two psychiatrists. Further, the participants underwent a SANS (Scale of Assessment of Negative Symptoms) interview. The unaffected twins as well as the healthy control twins were asked to complete a Minnesota Multiphasic Personality Inventory (MMPI) and all underwent a SCID:NP interview for diagnoses on both axes I and II with two experienced clinical psychiatrists. In addition, clinical records of their psychiatric history were reviewed in affected twins for schizophrenia and bipolar disorder. Furthermore, the overall level of functioning of the subject was assessed by the Global-Assessment of Functioning (GAF) Scale, DSM-III-R axis V (Table 1). The participants underwent a urine drug screening test to exclude current substance abuse. Thirteen twin pairs reported about substance abuse of cannabis in the past during high school years, in another 11 pairs, one or both reported using alcohol more than a minimal amount, but neither met DSM-III-R criteria for abuse or dependence. Antipsychotic medication taken by patients was standardized to fluphenazine equivalents. All twins were followed-up regularly through a newsletter and by personal contact. Five non-affected schizophrenia and three non-affected bipolar twins transitioned into disorder state within 5 years (transit-twins) (Torrey et al. 1994).