molindone

Contraindicated in:

Hypersensitivity;
Cross-sensitivity with other antipsychotics may exist;
Severe CNS depression;
Lactation: Lactation.

Use Cautiously in:

Diabetes mellitus;
Respiratory disease;
Prostatic hyperplasia;
CNS tumors;
Seizure disorders;
Intestinal obstruction;
Patients at risk for falls;
OB: Safety not established in pregnancy;
Pedi: Children <12 yr (safety and effectiveness not established);
Geri: Lower initial doses recommended in older adults; ↑ risk of mortality in older adults treated for dementia-related psychosis.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, tachycardia

Derm: photosensitivity, rash

EENT: blurred vision, dry eyes, nasal congestion

Endo: galactorrhea, irregular menses

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

GU: ↑libido

Hemat: AGRANULOCYTOSIS, leukopenia, neutropenia

Neuro: sedation, depression, dizziness, euphoria, extrapyramidal reactions, headache, insomnia, NEUROLEPTIC MALIGNANT SYNDROME, tardive dyskinesia

Interactions ⬆ ⬇

Drug-drug:

Additive CNS depression with other CNS depressants, including alcohol, antihistamines, antidepressants, MAO inhibitors, opioid analgesics, and sedative/hypnotics.
Additive anticholinergic properties with agents having anticholinergic effects, including phenothiazines, haloperidol, antihistamines, MAO inhibitors, or disopyramide.
Encephalopathy may occur with lithium.
Molindone may mask early signs of lithium toxicity.
May negate the beneficial effects of levodopa.

Drug-Natural Products:

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

Availability ⬆ ⬇

Tablets: 5 mg; 10 mg; 25 mg

Route/Dosage ⬆ ⬇

PO (Adults and Children ≥12 yr): 50–75 mg/day in 3–4 divided doses initially; may ↑ to 100 mg/day after 3–4 days. Usual maintenance dose is 5–25 mg 3–4 times daily. Doses up to 225 mg/day (in 3–4 divided doses) have been used in severe psychoses.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Blocks the effects of dopamine in the reticular activating and limbic systems in the brain.

Therapeutic effects:

Diminished psychoses associated with schizophrenic behavior.

Classifications ⬆ ⬇

Therapeutic Classification: antipsychotics

Pharmacokinetics ⬆ ⬇

Absorption: Rapidly absorbed following oral administration.

Distribution: Appears to be widely distributed.

Metabolism/Excretion: Mainly (>90%) metabolized by the liver. Small (<3%) amounts excreted unchanged by the kidneys.

Half-Life: 1.5 hr.

Time/Action Profile ⬆ ⬇

(peak = blood levels; duration = antipsychotic effects)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	1.5 hr	24–36 hr

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed and not to take more or less than prescribed. Take missed doses as soon as remembered but not within 2 hr of next dose; do not double up on missed doses. Consult health care professional prior to discontinuing molindone; gradual withdrawal may be necessary.
Inform patient of possibility of extrapyramidal symptoms and tardive dyskinesia. Caution patient to report these symptoms immediately to health care professional.
Instruct patient not to take molindone within 2 hr of antacids or medications for treating diarrhea.
Advise patient to make position changes slowly to minimize orthostatic hypotension. Exercise, hot weather, or hot baths may increase hypotensive effects.
Medication may cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.
Advise patient to use frequent mouth rinses, good oral hygiene, and sugarless gum or candy to minimize dry mouth. Notify health care professional if dry mouth persists for more than 2 wk.
Advise patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
Inform patient of possibility for weight gain and elevated cholesterol. Refer as appropriate for nutritional, weight, and/or medical management.
Instruct patient not to take OTC medications, especially cold or cough preparations, without consulting health care professional.
Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
Instruct patient to notify health care professional promptly if fever, signs of infection, tremors, involuntary muscle twitching, or visual disturbances occur.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy.
Emphasize the importance of routine follow-up exams to monitor response to medication and detect side effects.

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Indications ⬇

Contraind./Precautions ⬆ ⬇