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Ageing, Dementia, and Palliative Care
Published in Margaret O’Connor, Sanchia Aranda, Susie Wilkinson, Palliative Care Nursing, 2018
For people who suffer from dementia, agitation and loss of touch with reality can cause distress to the person, family, and staff. Antipsychotic medication such as haloperidol (Serenace), pericyazine (Neulactil), and thioridazine (Mellerill) can be helpful, but these drugs can have marked side-effects, including extra-pyramidal effects, anticholinergic effects, and orthostatic hypotension (with a danger of falls). A person with dementia can be close to death, but still be mobile and agitated. Assisting these people to a dignified, peaceful death might require an increase in antipsychotic medication, with increased risk of side-effects. The use of these drugs in this way can be considered a form of restraint, but their use can be a much kinder way of ensuring safety and providing relief from suffering than the use of physical restraints. However, keeping a person in bed and giving him or her ice-cubes to suck for dry mouth, can help to reduce suffering without drug side-effects. Again, best practice involves working out the best way to provide comfort for an agitated, dying person.
Drug profiles: generic names A–Z
Published in Jerome Z. Litt, Neil H. Shear, Litt's Drug Eruption & Reaction Manual, 2017
Clinically important, potentially hazardous interactions with: ACE inhibitors, acebutolol, alfuzosin, alpha blockers, amisulpride, ampicillin, angiotensin II receptor antagonists, anti-hypertensives, antimuscarinics, antipsychotics, baclofen, benzodiazepines, beta blockers, bupropion, calcium channel blockers, captopril, chloramphenicol, cholestyramine, cilazapril, clobazam, clonidine, darifenacin, diazoxide, diuretics, dopamine D2 receptor antagonists, enalapril, erythromycin, fosinopril, hydralazine, irbesartan, iron salts, isoniazid, levomepromazine, linezolid, lisinopril, MAO inhibitors, memantine, methyldopa, metoclopramide, minoxidil, moclobemide, moxonidine, nitrates, olanzapine, olmesartan, oral iron, oxybutynin, paliperidone, papaverine, pericyazine, phenelzine, phenytoin, probenecid, pyridoxine, quetiapine, quinapril, ramipril, rifampin, risperidone, sapropterin, selegiline, sodium nitroprusside, sulpiride, tetrabenazine, tiotropium, trandolapril, tranylcypromine, tricyclic antidepressants, trospium, volatile liquid general anesthetics, ziprasidone, zuclopenthixol, zuclopenthixol acetate, zuclopenthixol decanoate, zuclopenthixol dihydrochloride
Drug profiles: generic names A-Z
Published in Jerome Z. Litt, Neil H. Shear, Litt's Drug Eruption & Reaction Manual, 2017
Clinically important, potentially hazardous interactions with: ACE inhibitors, acebutolol, alfuzosin, alpha blockers, amisulpride, ampicillin, angiotensin II receptor antagonists, antihypertensives, antimuscarinics, antipsychotics, baclofen, benzodiazepines, beta blockers, bupropion, calcium channel blockers, captopril, chloramphenicol, cholestyramine, cilazapril, clobazam, clonidine, darifenacin, diazoxide, diuretics, dopamine D2 receptor antagonists, enalapril, erythromycin, fosinopril, hydralazine, irbesartan, iron salts, isoniazid, levomepromazine, linezolid, lisinopril, MAO inhibitors, memantine, methyldopa, metoclopramide, minoxidil, moclobemide, moxonidine, nitrates, olanzapine, olmesartan, oral iron, oxybutynin, paliperidone, papaverine, pericyazine, phenelzine, phenytoin, probenecid, pyridoxine, quetiapine, quinapril, ramipril, rifampin, risperidone, sapropterin, selegiline, sodium nitroprusside, sulpiride, tetrabenazine, tiotropium, trandolapril, tranylcypromine, tricyclic antidepressants, trospium, volatile liquid general anesthetics, ziprasidone, zuclopenthixol, zuclopenthixol acetate, zuclopenthixol decanoate, zuclopenthixol dihydrochloride
Advocacy for better metabolic monitoring after antipsychotic initiation: based on data from a French health insurance database
Published in Expert Opinion on Drug Safety, 2021
Samuel Bulteau, Marine Le Pierres, Pascal Artarit, Bastien Forestier, Emmanuelle Michaud, Anicet Chaslerie, Olivier Bonnot, Caroline Victorri-Vigneau
We include all new users (without any dispensing in the previous 6 months) of antipsychotic drugs, whatever the administration route, between 1 July 2013 and 31 December 2017, living in one area of France (Pays de la Loire, 3 787 411 inhabitants). The prevalence of AP exposure and demographic characteristics of the sample were compared to those of another nearby French area with the same population size (Brittany, 3.336 million inhabitants). Drugs were categorized using the Anatomical Therapeutic Chemical (ATC) classification system. The N05A and the N07XX06 groups included all APs with labels in France during the study period: chlorpromazine, levomepromazine, cyamemazine, periciazine, pipamperone, pimozide, fluphenazine, pipotiazine, haloperidol, flupentixol, zuclopenthixol, loxapine, clozapine, olanzapine, quetiapine, sulpiride, amisulpride, risperidone, aripiprazole, paliperidone, tiapride which belong to the N05A group and is used for agitation and neurologic conditions, tetrabenazine which belong to the N07XX06 group and used for hyperkinetic movement disorders, ziprasidone that reached approval in France in 2018 in treatment-resistant schizophrenia under nominative temporary authorization, and asenapine that received approval in 2011 in France for manic episode in bipolar disorder but is not available on the market anymore.
Pharmacogenetics of tardive dyskinesia in schizophrenia: The role of CHRM1 and CHRM2 muscarinic receptors
Published in The World Journal of Biological Psychiatry, 2020
Anastasiia S. Boiko, Svetlana A. Ivanova, Ivan V. Pozhidaev, Maxim B. Freidin, Diana Z. Osmanova, Olga Yu Fedorenko, Arkadyi V. Semke, Nikolay A. Bokhan, Bob Wilffert, Anton J. M. Loonen
A total of 194 patients received typical antipsychotics (of which haloperidol was the most often used: 115 patients; chlorpromazine, 44 patients (as well as chlorprothixene, zuclopenthixol, thioridazine and periciazine)). A total of 172 patients received atypical antipsychotics (mainly risperidone, clozapine and quetiapine, and to a lesser extent olanzapine, sertindole, paliperidone, and amisulpride), and 83 patients received combined therapy. Patients were assessed once for the presence or absence of dyskinesia according to the abnormal involuntary movement scale (AIMS) (Loonen and Van Praag 2007; Loonen et al. 2000, 2001). The AIMS scores were transformed into a binary form (presence or absence of dyskinesia) with Schooler and Kane's criteria (1982). Schooler–Kane criteria require: (i) at least 3 months of cumulative exposure to neuroleptics; (ii) the absence of other conditions that might cause involuntary movements and (iii) at least moderate dyskinetic movements in one body area (≥3 on AIMS) or mild dyskinetic movements in two body areas (≥2 on AIMS).
The pharmacologic treatment of problematic sexual interests, paraphilic disorders, and sexual preoccupation in adult men who have committed a sexual offence
Published in International Review of Psychiatry, 2019
Belinda Winder, J. Paul Fedoroff, Don Grubin, Kateřina Klapilová, Maxim Kamenskov, Douglas Tucker, Irina A. Basinskaya, Georgy E. Vvedensky
In Russia, studies were conducted by Vvedensky et al. (2011) on 80 adult males who had committed sexual offences and had been sentenced by court order to compulsory treatment. All participants had been admitted as sufficiently severely mentally disordered as to be classified as legally certifiable. In this regard, 39 of the participants were also diagnosed with paranoid schizophrenia, 23 with organic personality disorder, and 18 with an intellectual disability. These mental disorders were, in most cases, combined with alcohol or drug dependence. Two groups of patients were identified, including one which comprised 52 patients with paraphilias (25 with paedophilia and 27 with multiple deviant sexual preferences), and a second group of 28 patients who were non-paraphilic, but had been diagnosed with hypersexual disorder. All patients had been receiving 10 years of complex psychotropic medication treatment based on their individual diagnoses, including antidepressant, mood-stabilizing, and/or antipsychotic drug classes. Specific agents included SSRIs, lithium, carbamazepine, zuclopenthixol, amisulpride, risperidone, and/or pericyazine. All patients received testosterone-lowering medication to reduce sexual drive, including an average biweekly intramuscular dose of 300 mg of Cyproterone Acetate (CPA; Androcur depot). Side-effects in the first month included tiredness, apathy, drowsiness, a feeling of lack of air, and hot flushes for approximately a third of patients. Reported side-effects after 1–3 months included depression, anxiety, nervousness, and agitation in ∼15% of participants. Gynecomastia appeared in 8.75% after 6 months of treatment. After 8 months of treatment, metabolic and alimentary disorders were reported in just under a quarter of participants.