Precautions and warnings

This medication should be used with caution during pregnancy, breastfeeding, and in people with kidney or liver problems, or epilepsy. An ECG and electrolyte levels should be checked before starting treatment, after every dose increase, and every six months after that. If you are on this medicine for a long time, your vision should be monitored regularly. The drug can affect your ability to do tasks that require skill. If you need to stop taking it, gradually reduce the dose over 1–2 weeks.

Drug Interactions

Thioridazine can increase the side effects of anticholinergic drugs. Taking tricyclic antidepressants (TCAs) at the same time raises the levels of both medications in the blood. Thioridazine may reduce the effectiveness of levodopa, bromocriptine, and other medicines that boost dopamine. Do not use thioridazine with drugs that can cause electrolyte imbalance. If you are taking phenytoin, monitor your therapy because thioridazine can unpredictably affect its levels.

Serious Risks: Thioridazine can increase the risk of dangerous heart rhythm problems (QT prolongation) when combined with certain drugs, such as class IA and II antiarrhythmics, astemizole, cisapride, pimozide, droperidol, IV erythromycin, sparfloxacin, terfenadine, clarithromycin, and other medicines that lengthen the QT interval. Thioridazine also increases drowsiness when used with opioids and raises the risk of irregular heartbeats if used with drugs like phenylpropanolamine. Drugs like fluvoxamine, pindolol, propranolol, ritonavir, and other CYP2D6 inhibitors (including fluoxetine and paroxetine) can increase thioridazine levels in the blood.

Contraindications

Do not use phenothiazines in people who are allergic to them, are in a coma, or already have serious central nervous system (CNS) depression or severe heart problems. They should also be avoided in those with untreated low potassium or other electrolyte imbalances, a known or suspected long QT interval on ECG, a history of certain abnormal heart rhythms (like torsades de pointes), or porphyria. Other conditions where phenothiazines should not be used include bone marrow suppression, pheochromocytoma, hormone-sensitive tumors, angle-closure glaucoma, past jaundice, Parkinson’s disease, diabetes, hypothyroidism, myasthenia gravis, blocked intestines (paralytic ileus), enlarged prostate, or trouble urinating. Caution is also needed in people who have lower activity of the liver enzyme CYP2D6.

Mode of actions

Thioridazine is a type of antipsychotic medicine from the phenothiazine group. It strongly blocks beta-adrenergic receptors and reduces the release of certain hormones from the hypothalamus and pituitary gland by blocking dopamine receptors in the brain’s mesolimbic pathway.

Dosage & Administration

Schizophrenia Adult: Initially, 50-100 tid daily and slowly titrated upwards at no more than 100 mg wkly. Max: 800 mg daily in 2-4 divided doses.

Child: 2-12 yr: Initially, 0.5 mg/kg daily in divided doses, increased gradually until optimum effect obtained. Max: 3 mg/kg daily.

DepressionAdult: Initially, 25 mg tid, titrated to 20-200 mg daily.

Renal impairment: Lower initial doses and more gradual dosage increase.Hepatic impairment: Lower initial doses and more gradual dosage increase.

Pregnancy & Lactation

Although animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in pregnant women, but during pregnancy, this medicine can be used just when definitely required despite potential risks.

Mothers with a newborn baby who have used this drug during the last 3 months of pregnancy may seldom create symptoms including drowsiness, muscle stiffness or shakiness, feeding or breathing troubles, constant crying. If you notice any of these symptoms of your baby's particularly during their first month, tell the doctor immediately.

This medicine passes into breast milk. Talk to your doctor before breastfeeding.

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