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Psychotropic Use during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Molindone is an indole derivative not related chemically to other antipsychotic drugs. No studies have been published of birth defects in newborns that were exposed to molindone in utero, and no studies in animals evaluating its teratogenic effects are available. In pregnant rats or rabbits given 6 and 69 times the usual human dose during organogenesis, no birth defects were reported (Gopalakrishnan et al., 2018).
Drugs That Can Precipitate Seizures
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Brian K. Alldredge, Roger P. Simon
Seizures have been associated with other phenothiazine and butyrophenone antipsychotic agents including haloperidol (4,119,120), trifluoperazine (115), perphenazine (4), thioridazine (4,115), and promazine (121). As is the case for antidepressants, there are no human studies that allow direct comparison of the convulsant potential of antipsychotic agents. On the basis of indirect evidence, Remick and Fine suggest that haloperidol and trifluoperazine have a low risk of seizures (116) and may therefore be preferred for patients at high risk. Molindone has been recommended on the basis of experimental studies which show no effect on neuronal excitability in guinea pig hippocampal slices. Haloperidol and fluphenazine also have a relatively favorable effect on neuronal excitability (122). However, clinical confirmation of reduced seizure risk with these agents, from well-designed epidemiologic studies, is not available.
Imaging Neuroreceptors to Study Drug Action in Living Human Brain
Published in Edythe D. London, Imaging Drug Action in the Brain, 2017
An important future application of PET scanning is the accurate measurement of occupancy of D2 dopamine receptors by various therapeutic drugs. Farde et al. (1986, 1988) found clinically effective doses of chemically distinct neuroleptics with approximately 85 to 90% occupancy of D2 receptors in the putamen of schizophrenic patients. More recently, Wolkin et al. (1989) and Smith et al. (1988) have demonstrated an inverse relationship between 18F-N-methylspiroperidol binding using striatal/cerebellar ratios and drug levels in plasma. These procedures can be used to monitor drug occupancy and relate the findings to clinical status and eventually provide better adjustment of drug dosages. Furthermore, these methods can be used to compare the relative in vivo affinities of drugs. For example, in a limited number of subjects, we have found identical blockade of 11C-NMSP uptake and occupancy of the D2 receptor for a 7.5 mg dose of haloperidol vs. a 37.5 mg dose of molindone (Wong et al., 1985). These dose ratios are the clinically equivalent efficacious dose ratios. However, this equivalency of occupancy was not predicted by in vitro receptor binding studies since the latter predicted a 1 in 30 relationship.
Impact of treatment-related discussions on healthcare resource use and costs among patients with severe mental illness
Published in Current Medical Research and Opinion, 2021
Felicia Forma, Eleena Koep, John White, Angela Belland, Heidi Waters, Carolyn Martin
In addition, patients were required to have at least 1 claim for an antipsychotic medication (aripiprazole, asenapine maleate, brexpiprazole, cariprazine, chlorpromazine, clozapine, droperidol, fluphenazine, haloperidol, iIoperidone, loxapine, lurasidone, mesoridazine besylate, molindone, olanzapine, paliperidone, perphenazine, pimavanserin tartrate, pimozide, prochlorperazine, promazine, quetiapine fumarate, risperidone, thioridazine, thiothixene, trifluoperazine, and ziprasidone) during the baseline period and within 60 d after the index date (minimum of 2 claims). Multiple claims were not required to be for the same medication. These inclusion criteria were selected specifically to identify patients with severe symptoms (with diagnosed MDD, bipolar disorder, or schizophrenia) for whom treatment compliance was critical to avoid future acute events. Patients were not excluded if claims for alternative classes of psychotropic therapies, such as antidepressants were also observed.
A proposed anti-maladaptive aggression agent classification: improving our approach to treating impulsive aggression
Published in Postgraduate Medicine, 2019
Adelaide S. Robb, Stefan Schwabe, Gianpiera Ceresoli-Borroni, Azmi Nasser, Chungping Yu, Ronald Marcus, Shawn A. Candler, Robert L. Findling
As mentioned above, one class of drugs utilized to treat aggressive symptoms is the typical antipsychotics (neuroleptics). Initially, both high- and low-potency neuroleptics (i.e. relating to the dosage required to achieve a similar therapeutic effect) were evaluated for the treatment of maladaptive aggression, with some success [32]. Low-potency neuroleptics had high rates of somnolence and other adverse events, however, and fell out of use in clinical practice [30,32,35]. Typical antipsychotics such as haloperidol showed promise but were associated with detrimental side effects such as extrapyramidal symptoms (EPS), including dystonia [36]. Further, while there are data supporting the use of haloperidol and it is indeed utilized to treat aggression, there is a clinical skepticism about whether typical antipsychotics are effective in specifically reducing maladaptive aggression [36,37]. Haloperidol, though still a commonly used antipsychotic for aggression, was recently reviewed as lacking high-quality evidence supporting its use for aggression in the context of psychosis [37]. Additionally, molindone, currently classified as a typical antipsychotic, was used in an early study in children aged 6–11 years who were hospitalized for undersocialized conduct disorder [38]. As will be discussed in more detail below, treatment with low doses of immediate-release molindone (0.5–2 mg/kg/day) significantly improved behavior associated with aggression [38]. While second-generation antipsychotics are believed to have a lower propensity for causing EPS such as tardive dyskinesia, the risk of developing such symptoms with low doses of molindone is thought to be low, except in susceptible individuals [39]. In adults with schizophrenia, for example, molindone was associated with a lower risk for tardive dyskinesia than haloperidol [40]. Further, although 23.5% of the child CD patients reported dystonic side effects with molindone, these did not include events of akathisia (which is common in adults being treated with molindone), and the low dosage administered was well tolerated [38].