MELLERILMELLERILMelleril [Thioridazine] is anti-psychotic drug marketed by Novartis. It is a low potency 2-methylmercapto-10-[2-(N-methyl-2-piperidyl) ethyl] phenothiazine having marked anticholinergic action. It produces the lowest incidence of extra-pyramidal side effects; otherwise all its other effects are similar to phenothiazines. This drug however has a bad reputation to cause cardiac toxicity and retinopathy hence its use is reserved in those cases which do not respond to the regular anti-psychotic drugs or those who have contraindications for the same. Melleril [Thioridazine] is mainly indicated in schizophrenics and psychosis. However in high doses it can lead to prolonged QTc interval [QT prolongation in the EKG] in the heart which could lead to the risk of serious, potentially fatal, ventricular arrhythmias, such as torsade de pointes-type arrhythmias.Schizophrenia: It is a psychiatric diagnosis termed by Eugen Bleuler (1857–1939) in 1908 that describes a mental disorder characterized by abnormalities in the perception or expression of reality. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions or disorganized speech and thinking in the context of significant social or occupational dysfunction. In simple words, Schizophrenia is a severe, lifelong brain disorder. People who have it may hear voices, see things that aren't there or believe that others are reading or controlling their minds. In men, symptoms usually start in the late teens and early 20s. They include hallucinations, or seeing things, and delusions such as hearing voices. Other symptoms include • Disorders of movement • Unusual perceptions or thoughts • Problems with memory, attention and organization • Difficulty speaking and expressing emotionIndications: * Anxiety * Mixed anxiety depression * Tension and agitation * Psychosomatic disorders * Emotional disturbances accompanied by anxiety and tension * Sleep disturbances. * Geriatrics: additionally senile agitation and confusional states * Pediatrics: additionally difficulty of concentration, behavioral problems, hyperactivity and aggressiveness.Thioridazine is also known to kill multidrug-resistant mycobacterium tuberculosis and methicillin resistant staphylococcus aureus [MRSA] at clinical concentrations.Side effects and Contraindications:Most side effects with Melleril (Thioridazine) are mild and transient.Central Nervous System: - Drowsiness may be seen in the early days while starting the treatment or when large doses are given in higher doses. This effect generally subsides with continued treatment or decreasing the dosage. - Pseudo-parkinsonismExtra-pyramidal: - Tardive dyskinesia: characterized by involuntary movements of the lips, mouth, and tongue - Neuroleptic malignant syndrome: hyperthermia, fluctuating level of consciousness, muscular rigidityBoth the above conditions can be potentially fatal. On diagnosing these conditions, immediately discontinue the drug. Intensive symptomatic treatment and medical monitoring is to be done. Treatment of any concomitant serious medical problems for which specific treatments are available. If the patient requires Melleril [Thioridazine] after recovery from neuroleptic malignant syndrome, the potential reintroduction of this drug should be carefully considered and diligently monitored, since there are cases of recurrences of neuroleptic malignant syndromes being reported.Other rare side effects are - Nocturnal confusion - lethargy - hyperactivity - psychotic reactions - restlessness - HeadacheAutonomic Nervous System: - Dryness of mouth - nausea - vomiting, - diarrhea - constipation - blurred vision - nasal stuffiness - pallor - miosis - mydriasis - urinary retentionCardiovascular System: High doses can lead to prolonged QTc interval [QT prolongation in the EKG] in the heart which could lead to the risk of serious, potentially fatal, ventricular arrhythmias, such as torsade de pointes-type arrhythmias Both torsade de pointes-type arrhythmias and sudden death have been reported in association with Melleril [Thioridazine]Skin: - dermatitis - urticarial type of skin eruptions - photosensitivity [extremely rare]Endocrine System: - breast engorgement - galactorrhea: this is due to increase in the serum prolactin levels - amenorrhea - ejaculation problems - peripheral edemaBlood Dyscrasias: - pancytopenia - agranulocytosis - eosinophilia - thrombocytopenia - leucopenia - anemia - aplastic anemiaAllergic Reactions: - fever - laryngeal edema - angioneurotic edema - asthmaHepatotoxicity: - Jaundice, - biliary stasisOcular: - Pigmentary retinopathy: diminution of visual acuity, brownish coloring of vision, and impairment of night vision; examination of the fundus discloses deposits of pigment. - Opacities of the anterior lens and cornea described as irregular or stellate in shapeOthers: - Hyperpyrexia. - Behavioral effects suggestive of a paradoxical reaction like excitement, bizarre dreams, aggravation of psychoses, and toxic confusional states. - Systemic lupus erythematosus-like syndrome.Contraindications: - severe CNS depression - comatose states - history of blood dyscrasias - hypersensitivity to phenothiazines - bone marrow depressionDrug interactions: Terfenadine and astemizole may cause arrhythmias, potentiate CNS depression and cardiac and respiratory effects produced by hypnotics, narcotic analgesics, anesthetics. Effects of anti-hypertensive reduced. Risk of neurotoxicity is potentiated by lithium.Special Precautions: - driving or operating heavy machinery - hepatic impairment - cardiovascular disease - regular blood counts during therapyDosage:Adults The usual starting dose for adult schizophrenic patients is 50-100 mg three times a day, with a gradual increment to a maximum of 800 mg daily if necessary. Once effective control of symptoms has been achieved, the dosage may be reduced gradually to determine the minimum maintenance dose. The total daily dosage ranges from 200-800 mg, divided into two to four doses.Pediatric Patients For pediatric patients with schizophrenia who are unresponsive to other agents, the recommended initial dose is 0.5 mg/kg/day given in divided doses. Dosage may be increased gradually until optimum therapeutic effect is obtained or the maximum dose of 3 mg/kg/day has been reached.Samir is the author of Mellari , Thioridazine information located at Genericsmed.com siteReferences: * Drug Today, July-September 2005 Edition, pg 402 – 403 * Pharmacology and Pharmacotherapeutics, R.S.Satoskar, S.D.Bhandarkar, S.S.Ainapure, Revised 17th Edition, pg 187. * http://www.nlm.nih.gov/medlineplus/schizophrenia.html * http://en.wikipedia.org/wiki/Thioridazine * http://www.pharma.us.novartis.com/pr...f/Mellaril.pdf * http://www.webmd.com/drugs/mono-5287...=Mellaril+Oral * http://en.wikipedia.org/wiki/Schizophrenia * http://www.rxlist.com/cgi/generic/thioridazine_ids.htmMELLERIL
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