thiothixene

Contraindicated in:

Hypersensitivity to thiothixene or other phenothiazines (cross-sensitivity may occur);
Circulatory collapse;
Blood dyscrasias;
CNS depression;
Lactation: Lactation.

Use Cautiously in:

Diabetes mellitus;
Respiratory disease;
Prostatic hypertrophy;
CNS tumors;
Epilepsy;
Intestinal obstruction;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Pedi: Safety and effectiveness not established in children;
Geri: Appears on Beers list. risk of stroke, cognitive decline, and mortality in older adults with dementia. Avoid use in older adults, except for schizophrenia.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, nonspecific ECG changes, tachycardia

Derm: photosensitivity, pigment changes, rash

EENT: blurred vision, dry eyes, lens opacities

Endo: amenorrhea, breast enlargement, galactorrhea

GI: constipation, dry mouth, anorexia, ileus, nausea

GU: urinary retention

Hemat: AGRANULOCYTOSIS, leukocytosis, leukopenia, neutropenia

Neuro: sedation, extrapyramidal reactions, NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, tardive dyskinesia

Misc: allergic reactions, hyperpyrexia

Interactions ⬆ ⬇

Drug-drug:

Additive hypotension with antihypertensives, acute ingestion of alcohol, and nitrates.
Additive hypotension may occur if epinephrine is given to treat hypotension.
Additive CNS depression with other CNS depressants, including alcohol, antihistamines, antidepressants, opioid analgesics, and sedative/hypnotics.
Additive anticholinergic effects with other drugs having anticholinergic properties, including antihistamines, antidepressants, quinidine, or disopyramide.
May ↓ the effectiveness of levodopa.
↑risk of cardiac effects with quinidine.

Drug-Natural Products:

Concomitant use of kava-kava, valerian, skullcap, chamomile, or hops can ↑ CNS depression.

Route/Dosage ⬆ ⬇

PO (Adults ): Mild conditions: 2 mg 3 times daily (up to 15 mg/day if necessary; Severe conditions: 5 mg twice daily (up to 20–30 mg/day; not to exceed 60 mg/day).

Availability ⬆ ⬇

(Generic available)

Capsules: 1 mg; 2 mg; 5 mg; 10 mg

Assessment ⬆ ⬇

Monitor patient’s mental status (orientation, mood, behavior) prior to and periodically during therapy.
Assess weight and BMI initially and throughout therapy.
Assess positive (hallucinations, delusions, agitation) and negative (social withdrawal) symptoms of schizophrenia.
Observe patient carefully when administering medication to ensure that medication is actually taken and not hoarded or cheeked.
Assess patient for level of sedation following administration.
Monitor patient for onset of akathisia (restlessness or desire to keep moving) and extrapyramidal side effects (parkinsonian: difficulty speaking or swallowing, loss of balance control, pill rolling of hands, mask-like face, shuffling gait, rigidity, tremors; and dystonic: muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs) every 2 mo during therapy and 8–12 wk after therapy has been discontinued. Parkinsonian effects are more common in geriatric patients, and dystonias are more common in younger patients. Notify health care professional if these symptoms occur, because reduction in dosage or discontinuation of medication may be necessary. Trihexyphenidyl, diphenhydramine, or benztropine may be used to control these symptoms. Benzodiazepines may alleviate akathisia.
Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue, excessive eye blinking). Notify health care professional immediately if these symptoms occur, as these side effects may be irreversible.
Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, convulsions, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Notify health care professional immediately if these symptoms occur.
•Monitor for symptoms related to hyperprolactinemia (menstrual abnormalities, galactorrhea, sexual dysfunction).

Lab Test Considerations:

Thiothixene ↑ serum prolactin levels and ↓ serum uric acid levels. May cause false-positive or false-negative pregnancy tests.
- Monitor CBC and differential prior to and periodically during therapy. Risk of leukopenia is highest between wk 4 and 10 of therapy.
- Monitor liver function studies prior to and periodically during therapy. Risk of hepatotoxicity is greatest 2–4 wk after beginning therapy.
Obtain fasting blood glucose and cholesterol levels initially and during therapy.

Implementation ⬆ ⬇

PO: Administer capsules with food or milk to decrease gastric irritation.

Patient/Family Teaching ⬆ ⬇

Instruct patient on need to take medication as directed. Take missed doses as soon as remembered unless 2 hr before next dose. Do not double doses. Patients on long-term high-dose therapy may need dose tapered to avoid withdrawal symptoms (dyskinesia, tremors, dizziness, nausea, and vomiting).
Drowsiness may occur. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Inform patient of possibility of extrapyramidal symptoms and tardive dyskinesia. Caution patient to report these symptoms immediately to health care professional.
Instruct patient to use frequent mouth rinses, good oral hygiene, and sugarless gum or candy to minimize dry mouth. Consult health care professional if dry mouth continues for >2 wk.
Advise patient that increasing bulk and fluids in the diet and exercising may help minimize the constipating effects of this medication.
Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications.
Caution patient to avoid concurrent use of alcohol and other CNS depressants during therapy.
Caution patient to avoid exercising in hot weather and taking very hot baths, because this drug impairs temperature regulation.
Instruct patient to notify health care professional promptly if sore throat, fever, skin rashes or discoloration, weakness, tremors, visual disturbances, menstrual abnormalities, galactorrhea or sexual dysfunction are noted.
Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
Rep: Advise patient to use effective contraception during therapy and to notify health care professional immediately if pregnancy is suspected and to avoid breastfeeding during therapy. May cause neonatal extrapyramidal and/or withdrawal symptoms (agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, feeding disorder) following delivery if taken during third trimester.
Emphasize the importance of continued medical follow-up for psychotherapy, eye exams, and laboratory tests, and to monitor response to medication and detect side effects.

ROUTE	ONSET	PEAK	DURATION
PO	days–wks	unknown	unknown

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇