Category:

• Miscellaneous

 Description:

• Antipsychotic

Indications:

• Psychoses, Gilles de la Tourette syndrome, severe behavioral problems

• Hyperactive children (short term)

• Prolonged parenteral neuroleptic therapy for chronic schizophrenia (decanoate)

Contraindications:

• Severe toxic CNS depression, Parkinson’s disease

• Comatose states from any cause

Precautions:

• Pregnancy category C; has been used for hyperemesis gravidarum, chorea gravidarum, and manic depressive illness during pregnancy; excreted in breast milk; effect on nursing infant unknown, but may be of concern

• Elderly, severe cardiac disorders, seizure disorder

• Hepatic dysfunction, child < 3 years, alcohol withdrawal

• Abrupt withdrawal, glaucoma

Adverse Reactions (Side Effects):

• CNS: agitation, anxiety, catatonic-like behavioral states, confusion, depression, drowsiness, EPS (pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia), euphoria, exacerbation of psychotic symptoms including hallucinations, headache, lethargy, neuroleptic malignant syndrome, restlessness, seizures, vertigo

• CV: ECG changes, hypertension, hypotension, tachycardia

• EENT: blurred vision, cataracts, dry eyes, glaucoma, retinopathy

• GI: anorexia, constipation, diarrhea, dry mouth, dyspepsia, hypersalivation, nausea, vomiting

• GU: priapism, urinary retention

• HEME: agranulocytosis, anemia, leukocytosis, minimal decreases in red blood cell counts, transient leukopenia

• METAB: breast engorgement, gynecomastia, hyperglycemia, hyperprolactinemia, impotence, increased libido, lactation, mastalgia, menstrual irregularities

• RESP: bronchospasm, increased depth of respiration, laryngospasm

• SKIN: diaphoresis, loss of hair, isolated cases of photosensitivity, maculopapular and acneiform skin reactions  

Dosage:

Administered orally and intramuscularly

• Adult:            

  • Psychosis/Tourette’s syndrome: PO 0.5-5mg 2-3 times daily initially depending on severity of condition, dose is increased to desired dose, max 100mg daily; IM 2-5mg every 1-8 hours

  • Chronic schizophrenia: IM 10-15 times the individual patient’s stabilized PO dose every 4 weeks (decanoate)

• Child 3-12 years: 

  • Psychosis: PO/IM 0.05-0.15 mg/kg/day in 2-3 divided doses

  • Tourette’s syndrome: PO 0.05-0.075 mg/kg/day in 2-3 divided doses

  • Hyperactivity: PO 0.05-0.075 mg/kg/day in 2-3 divided doses

Special considerations:

Do not mix liquid formulation with coffee or tea

Use calibrated dropper

Take with food or milk

Arise slowly from reclining position

Do not discontinue abruptly

Use a sunscreen during sun exposure to prevent burns

Take special precautions to stay cool in hot weather

Observe closely for signs of tardive dyskinesia

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Medicine
 Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
  January 1, 2001