Antiemetics and Cancer Chemotherapy
John Kucharczyk, David J. Stewart, Alan D. Miller in 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.
Drug interactions
Alan Weiss in The Electroconvulsive Therapy Workbook, 2018
In a systematic review of the combined use of ECT and antipsychotic medication, Braga and Petrides (2005) identified 42 reports including 1371 patients, with the majority of studies focused on typical antipsychotic mediation. Results from open studies showed that the combination was very safe and useful but these findings were not confirmed in the eight double-blind trials owing to a low number of patients included in the trials, ethical concerns submitting patients to long sham conditions and the use of short course of ECT, six to 11 sessions. Most studies preferred bitemporal ECT. Typical antipsychotic drugs studies were chlorpromazine, haloperidol, tifluoperazine, perphenazine, loxapine, flupenthixol, fluphenazine and thiothixene.
Psychotropic Use during Pregnancy
“Bert” Bertis Britt Little in 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).
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].
Increasing Antipsychotic Dose Versus Switching Antipsychotic for Non Response in Schizophrenia
Published in Issues in Mental Health Nursing, 2020
One study (n = 29 participants) met the inclusion criteria and was included in this review (Kinon et al., 1993). The study included people who were non-responsive to the drug fluphenazinne at the dose of 20 mg per day. The interventions considered were an increase in the dose administered to 80 mg per day or switching the person to a different antipsychotic medication, namely haloperidol. The control group continued on the original 20 mg per day dose of fluphenazine. Overall no clear difference was identified for three outcome measure: global state, general mental state and negative symptoms, however these findings were based on very low quality evidence. No data were reported for the outcome measures leaving the study early, adverse effects, time in hospital, quality of life, satisfaction with care and functioning.
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).
Related Knowledge Centers
- Antipsychotic
- Chlorpromazine
- Intramuscular Injection
- Psychosis
- Schizophrenia
- Sedation
- Oral Administration
- Subcutaneous Administration
- Depot Injection
- Extrapyramidal Symptoms