Thiothixene

Pronunciation

Class: Thioxanthenes
VA Class: CN709
Chemical Name: N,N-dimethyl-9-[3-(4-methyl-1-piperazinyl)-propylidene]thioxanthene-2-sulfonamide
Molecular Formula: C23H29N3O2S2
CAS Number: 5591-45-7
Brands: Navane

Warning(s)

  • Increased Mortality in Geriatric Patients with Dementia-related Psychosis
  • Geriatric patients with dementia-related psychosis treated with antipsychotic agents are at an increased risk of death.101 102 103 104 105 106

  • Analyses of 17 placebo-controlled trials in geriatric patients mainly receiving atypical antipsychotic agents revealed an approximate 1.6- to 1.7-fold increase in mortality compared with that in patients receiving placebo.101 102 106

  • Most fatalities appeared to result from cardiovascular-related events (e.g., heart failure, sudden death) or infections (mostly pneumonia).101 102 106

  • Observational studies suggest that conventional or first-generation antipsychotic agents also may increase mortality in such patients.101 102 104 105

  • Antipsychotic agents, including thiothixene, are not approved for the treatment of dementia-related psychosis.100 101 102

Introduction

Thioxanthene-derivative, conventional (prototypical, first-generation) antipsychotic agent; structurally and pharmacologically related to chlorprothixene (no longer commercially available in the US) and trifluoperazine.100 101 b c e g u

Uses for Thiothixene

Psychotic Disorders

Symptomatic management of psychotic disorders (i.e., schizophrenia).100 101 b c u

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Has been used in the management of refractory or treatment-resistant schizophrenia.c

Mental Retardation

Efficacy not established for the management of behavioral complications in patients with mental retardation.101 b c u

Thiothixene Dosage and Administration

General

  • Adjust dosage carefully according to individual requirements and response; use the lowest possible effective dosage.101 b c u

  • Periodically evaluate patients receiving long-term therapy to determine whether maintenance dosage can be decreased or drug therapy discontinued.101 b u w (See Tardive Dyskinesia under Cautions.)

  • For symptomatic relief of psychotic disorders, initial therapeutic response to antipsychotic therapy usually occurs within 2–4 weeks and optimum therapeutic response occurs within 6 months or longer.100 w

Administration

Oral Administration

Thiothixene is administered orally once daily or in divided doses 2 or 3 times daily.101 b c k t u Thiothixene hydrochloride has been given orally and parenterally, but no longer is commercially available in the US.101 c h v

Dosage

Pediatric Patients

Psychotic Disorders
Oral

Children ≥12 years of age: Initially, 2 mg 3 times daily for mild to moderate psychotic disorders; may gradually increase dosage, if necessary, up to 15 mg daily.101 b c u

For more severe psychotic disorders in children ≥12 years of age: Initially, 5 mg twice daily; may then increase dosage until satisfactory response obtained.101 b c u

Optimal maintenance dosage usually 20–30 mg daily; may be increased up to 60 mg daily, if necessary; once-daily administration may be adequate.101 b c k u

Daily dosages >60 mg rarely provide additional therapeutic effect.101 b c u

Adults

Psychotic Disorders
Oral

For mild to moderate psychotic disorders: Initially, 2 mg 3 times daily; may gradually increase dosage, if necessary, up to 15 mg daily.101 b c u

For more severe psychotic disorders: Initially, 5 mg twice daily; may then increase dosage until satisfactory response obtained.101 b c u

Optimal maintenance dosage usually 20–30 mg daily; may be increased up to 60 mg daily, if necessary; once-daily administration may be adequate.101 b c k u

Daily dosages >60 mg rarely provide additional therapeutic effect.101 b c u

Prescribing Limits

Pediatric Patients

Psychotic Disorders
Oral

Children ≥12 years of age: Maximum 60 mg daily.101 b c u

Adults

Psychotic Disorders
Oral

Maximum 60 mg daily.101 b c u

Special Populations

Geriatric Patients

No specific dosage recommendations for geriatric patients, but generally select dosage at the lower end of recommended range; increase dosage more gradually and monitor closely.100 101 b h u w (See Geriatric Use under Cautions and see Special Populations under Pharmacokinetics.)

Cautions for Thiothixene

Contraindications

  • Circulatory collapse.101 b c u

  • Comatose states or CNS depression from any cause.101 b c u (See Specific Drugs and Laboratory Tests under Interactions.)

  • Blood dyscrasias.101 b c u

  • Known hypersensitivity to thiothixene.101 b c u Not known if cross-sensitivity exists between thioxanthenes and phenothiazines; consider possibility that cross-sensitivity may occur.101 b c u

Warnings/Precautions

Warnings

Shares the toxic potentials of other antipsychotic agents (e.g., phenothiazines); observe the usual precautions associated with therapy with these agents.101 b c u

Increased Mortality in Geriatric Patients with Dementia-related Psychosis

Increased risk of death with use of either conventional (first-generation) or atypical (second-generation) antipsychotics in geriatric patients with dementia-related psychosis.101 102 103 104 105 106

Antipsychotic agents, including thiothixene, are not approved for the treatment of dementia-related psychosis.100 101 102 (See Increased Mortality in Geriatric Patients with Dementia-related Psychosis in Boxed Warning.)

Tardive Dyskinesia

Tardive dyskinesia, a syndrome of potentially irreversible, involuntary, dyskinetic movements, reported with use of antipsychotic agents, including thiothixene.100 101 b u w

Reserve long-term antipsychotic treatment for patients with chronic illness known to respond to antipsychotic agents, and for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate.101 In patients requiring chronic treatment, use smallest dosage and shortest duration of treatment producing a satisfactory clinical response; periodically reassess need for continued therapy.101

APA recommends assessing patients receiving conventional antipsychotic agents for abnormal involuntary movements every 6 months; for patients at increased risk for tardive dyskinesia, assess every 3 months.100 Consider discontinuance of thiothixene if signs and symptoms of tardive dyskinesia appear.101 However, some patients may require treatment despite presence of the syndrome.101

Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome (NMS), a potentially fatal syndrome characterized by hyperpyrexia, muscle rigidity, altered mental status, and autonomic instability, reported with antipsychotic agents, including thiothixene.101 b c u w

Immediately discontinue therapy and initiate supportive and symptomatic treatment if NMS occurs.101 Careful monitoring recommended if therapy is reinstituted following recovery; the risk that NMS can recur must be considered.101

CNS Depression

May impair mental and/or physical abilities, especially during the first few days of therapy; use caution with activities requiring alertness (e.g., operating vehicles or machinery).101 b u

Response to CNS depressants and alcohol may be potentiated.101 b u (See Specific Drugs and Laboratory Tests under Interactions.)

Sensitivity Reactions

Hypersensitivity and Cross-sensitivity

Possible sensitivity reactions reported with thiothixene (e.g., rash, pruritus, urticaria, anaphylactoid reactions) and related drugs (e.g., agranulocytosis, pancytopenia, thrombocytopenic purpura, jaundice, biliary stasis).101 b c u w

Not known if cross-sensitivity exists between thioxanthenes and phenothiazines; consider possibility that cross-sensitivity may occur.101 b u

Photosensitivity

Photosensitivity may occur; avoid excessive exposure to sunlight during therapy.101 b u w

General Precautions

Seizures

Possible risk of seizures; may lower seizure threshold.101 b c u Use with extreme caution in patients with a history of seizures or during alcohol withdrawal.101 b c u (See Specific Drugs and Laboratory Tests under Interactions.)

Cardiovascular Effects

Possible hypotension, tachycardia, nonspecific ECG changes, dizziness, and/or syncope; use with caution in patients with cardiovascular disease.101 b c u

If severe hypotension occurs, administer norepinephrine or phenylephrine; epinephrine or dopamine should not be used.101 b c u w (See Specific Drugs and Laboratory Tests under Interactions.)

Anticholinergic Effects

Possible anticholinergic effects (e.g., dry mouth, blurred vision, constipation, increased perspiration, urinary retention, impotence).101 b c u

Use with caution in patients with glaucoma or prostatic hypertrophy.c (See Specific Drugs and Laboratory Tests under Interactions.)

Ocular Effects

Pigmentary retinopathy and lenticular pigmentation reported with prolonged therapy with antipsychotic agents, including thiothixene.101 b c u Observe carefully.101 b c u

Prolactin Secretion

Elevated prolactin concentrations reported; elevation persists during chronic administration.101 b c u w

Clinical significance unknown; consider that approximately one-third of human breast cancers are prolactin dependent when prescribing thiothixene in patients with previously detected breast cancer.101 b c u w

Galactorrhea, amenorrhea, gynecomastia, and impotence reported.101 b c u w

Hematologic Effects

Leukopenia and neutropenia temporally related to antipsychotic agents reported during clinical trial and/or postmarketing experience.101 Agranulocytosis also reported with other antipsychotic agents.101

Possible risk factors for leukopenia and neutropenia include preexisting low WBC count and a history of drug-induced leukopenia or neutropenia.101 Monitor CBC frequently during the first few months of therapy in patients with such risk factors.101 Consider discontinuing thiothixene at the first sign of a clinically important decline in WBC count in the absence of other causative factors.101

Carefully monitor patients with clinically important neutropenia for signs and symptoms of infection (e.g., fever) and treat promptly if they occur.101 Discontinue thiothixene if severe neutropenia (ANC <1000/mm3) occurs; monitor WBC until recovery occurs.101

Regulation of Body Temperature

Use with caution in patients exposed to extreme heat or cold.101 b c u w

Other Precautions

Antiemetic effects may mask signs of overdosage of other drugs (e.g., antineoplastic agents) or obscure cause of vomiting in various disorders (e.g., intestinal obstruction, Reye’s syndrome, brain tumor).101 b c u w

Specific Populations

Pregnancy

Category C.e

Risk for extrapyramidal and/or withdrawal symptoms (e.g., agitation, hypertonia, hypotonia, tardive dyskinetic-like symptoms, tremor, somnolence, respiratory distress, feeding disorder) in neonates exposed to antipsychotic agents during the third trimester; monitor neonates exhibiting such symptoms.101 107 108 109 Symptoms were self-limiting in some neonates but varied in severity; some infants required intensive support and prolonged hospitalization.101 107 108 109

Use during pregnancy only if potential benefit justifies potential risk to the fetus.101

Lactation

Not known but considered likely to distribute into human milk; possible effects on nursing infant unknown.e h n o r s Caution if used in nursing women; carefully assess potential benefits and risks.e n o

Pediatric Use

Safety not established in children <12 years of age.101 b c u

Geriatric Use

Geriatric patients appear to be particularly sensitive to adverse CNS (e.g., tardive dyskinesia, parkinsonian manifestations, akathisia, sedation), anticholinergic, and cardiovascular (e.g., orthostatic hypotension) effects of antipsychotic agents.100 101 b h i u w

Use with caution.h (See Geriatric Patients under Dosage and Administration and see Special Populations under Pharmacokinetics.)

Geriatric patients with dementia-related psychosis treated with either conventional or atypical antipsychotic agents are at an increased risk of death.101 102 103 104 105 106 (See Increased Mortality in Geriatric Patients with Dementia-related Psychosis in Boxed Warning.)

Common Adverse Effects

Drowsiness or sedation, extrapyramidal reactions (e.g., Parkinson-like symptoms, dystonia, akathisia, tardive dyskinesia), anticholinergic effects (e.g., dry mouth, blurred vision), hypotension.101 b c u

Interactions for Thiothixene

Drugs Affecting Hepatic Microsomal Enzymes

Potential pharmacokinetic interaction (increased or decreased plasma thiothixene concentrations) with concomitant use of CYP enzyme inhibitors or inducers.101 b h j l u (See Specific Drugs and Laboratory Tests under Interactions.)

Specific Drugs and Laboratory Tests

Drug or Test

Interaction

Comments

Alcohol

Potential additive CNS effects and hypotension101 b u w

Use with caution101 b h u w

Anticholinergic drugs (e.g., atropine)

Possible potentiation of anticholinergic effects101 b c u

Use with caution101 b u

Anticonvulsants (e.g., carbamazepine, phenobarbital, phenytoin)

Anticonvulsants may decrease plasma thiothixene concentrations101 h j l

Thiothixene may lower seizure threshold101 b c u

Barbiturates: Thiothixene potentiates the anticonvulsant activity of barbiturates101 b c u

Observe for signs and symptoms of reduced thiothixene effectiveness101

Dosage adjustments of anticonvulsants may be necessary i

Barbiturates: Do not reduce anticonvulsant dosage during concurrent use101 b c u

Antidepressants, tricyclic (TCAs)

Possible increased plasma concentrations of thiothixenej l

β-Blockers (e.g., propranolol)

Possible decreased thiothixene clearancej l

Cimetidine

Possible decreased thiothixene clearanceh j l

CNS depressants (e.g., antihistamines, barbiturates, general anesthetics, opiate analgesics, sedative/hypnotics)

Possible additive CNS effects and hypotension101 b u

Use with caution to avoid excessive sedation or CNS depression; carefully adjust dosages of both agents as necessary101 b h u

Epinephrine or dopamine

Possible further lowering of BP101 b c u w

Do not use epinephrine or dopamine for thiothixene-induced hypotension101 b c u w (see Cardiovascular Effects under Cautions)

Hypotensive agents

Possible additive hypotensive effect101 c

Observe closely for signs of excessive hypotension101 c

Isoniazid

Possible decreased thiothixene clearancel

Lithium

An acute encephalopathic syndrome reported occasionally, especially when high serum lithium concentrations present h w

Observe patients receiving combined therapy for evidence of adverse neurologic effects; promptly discontinue if such signs or symptoms appearw

Paroxetine

Pharmacokinetic interaction unlikelym

Smoking

Possible decreased plasma thiothixene concentrations h j l

Tests for pregnancy

False-positive results reported in some patients receiving phenothiazines; less likely to occur when serum test is used101 b u

Thiothixene Pharmacokinetics

Absorption

Bioavailability

Rapidly and well absorbed from GI tract following oral administration.c i k Peak plasma concentrations usually occur within 1–3 hours.i k t

Onset

Antipsychotic effects usually are apparent within 2–4 weeks after initiation of oral therapy and optimum therapeutic response usually occurs within 6 months or longer.100 c w

Plasma Concentrations

Optimal therapeutic plasma concentrations not well defined, but clinical improvement associated with peak plasma concentrations of 2–15 mcg/L.t y

Distribution

Extent

Widely distributed into body tissues.c i

Crosses placenta in animals; considered likely to cross placenta in humans.p x Not known if distributed into human milk but distribution into breast milk considered likely.e h o r

Plasma Protein Binding

>99%.i

Elimination

Metabolism

Principally metabolized in the liver; undergoes extensive oxidative first-pass metabolism to form thiothixene sulfoxide and N-desmethylthiothixene.c h i j

Elimination Route

Excreted mainly in feces via biliary elimination as unchanged drug and as demethyl, sulfoxide, demethylated sulfoxide, and hydroxylated metabolites.c i

Unlikely to be removed by hemodialysis and peritoneal dialysis.101 b u w

Half-life

34–35 hours.100 i k m t

Special Populations

Clearance is reduced in females and in patients >50 years of age.h

Stability

Storage

Oral

Capsules

Tight, light-resistant containers at 20–25°C; protect from light and moisture.b c u

Actions

  • Produces pharmacologic effects similar to those of other conventional antipsychotic agents (e.g., phenothiazines, butyrophenones, chlorprothixene).101 b c u w

  • Precise mechanism(s) of antipsychotic action not determined, but may be principally related to antidopaminergic effects.w Acts principally at subcortical levels on the reticular formation, hypothalamus, and limbic system.c w

  • Exhibits weak anticholinergic, antihistaminic, α-adrenergic, and sedative effects and strong extrapyramidal effects; appears to possess antiemetic activity.101 b c h u

Advice to Patients

  • Importance of advising patients and caregivers that geriatric patients with dementia-related psychosis treated with antipsychotic agents are at an increased risk of death.101 102 103 104 105 Importance of informing patients and caregivers that thiothixene is not approved for treating geriatric patients with dementia-related psychosis.100 101 102

  • Importance of informing patients and caregivers about the risk of NMS, which can cause high fever, stiff muscles, sweating, fast or irregular heart beat, change in BP, confusion, and kidney damage.101

  • Potential for drug to impair mental alertness or physical coordination; use caution when driving or operating machinery until effects on individual are known.101 b c h u

  • Importance of informing patients in whom chronic thiothixene use is contemplated of risk of tardive dyskinesia, taking into account clinical circumstances and competency of patient to understand information provided.101 b u

  • Importance of clinicians informing patients of risk of extrapyramidal reactions and providing reassurance that these reactions usually can be controlled by administration of antiparkinsonian drugs (e.g., benztropine) and by subsequent dosage reduction.101 b c u w

  • Risk of leukopenia/neutropenia.101 Importance of advising patients with a preexisting low WBC count or history of drug-induced leukopenia/neutropenia that their CBC count should be monitored during thiothixene therapy.101

  • Advise patients to avoid excessive sunlight.101 b u w

  • Importance of avoiding exposure to temperature extremes.101 b c w

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses (e.g., cardiovascular disease, seizures).101 b u

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.101 Importance of clinicians informing patients about the benefits and risks of taking antipsychotics during pregnancy (see Pregnancy under Cautions).101 109 Importance of advising patients not to stop taking thiothixene if they become pregnant without consulting their clinician; abruptly stopping antipsychotic agents may cause complications.109

  • Importance of informing patients of other important precautionary information.101 b u (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Thiothixene

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

1 mg*

Navane

Pfizer

Thiothixene Capsules

2 mg*

Navane

Pfizer

Thiothixene Capsules

5 mg*

Navane

Pfizer

Thiothixene Capsules

10 mg*

Navane

Pfizer

Thiothixene Capsules

20 mg

Navane

Pfizer

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Navane 10MG Capsules (PFIZER U.S.): 90/$207.09 or 270/$616.88

Navane 2MG Capsules (PFIZER U.S.): 90/$101.36 or 270/$291.02

Navane 20MG Capsules (PFIZER U.S.): 90/$289.94 or 270/$850.17

Navane 5MG Capsules (PFIZER U.S.): 90/$139.99 or 270/$409.96

Thiothixene 1MG Capsules (SANDOZ): 90/$22.99 or 270/$49.97

Thiothixene 2MG Capsules (MYLAN): 90/$29.69 or 270/$79.16

Thiothixene 5MG Capsules (MYLAN): 90/$37.99 or 270/$93.97

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions April 20, 2012. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

100. American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia, second edition. From the APA website.

101. Pfizer Inc. Navane (thiothixene) capsules prescribing information. New York, NY; 2011 Jan.

102. US Food and Drug Administration. FDA Alert: Information for healthcare professionals: conventional antipsychotics. Rockville, MD; 2008 Jun 16. From the FDA website.

103. US Food and Drug Administration. FDA News: FDA requests boxed warnings on older class of antipsychotic drugs. Rockville, MD; 2008 Jun 16. From the FDA website.

104. Schneeweiss S, Setoguchi S, Brookhart A et al. Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients. CMAJ. 2007; 176:627-32. [PubMed 17325327]

105. Gill SS, Bronskill SE, Normand SL et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med. 2007; 146:775-86. [PubMed 17548409]

106. US Food and Drug Administration. Public health advisory: deaths with antipsychotics in elderly patients with behavioral disturbances. Rockville, MD; 2005 Apr 11. From the FDA website.

107. Sexson WR, Barak Y. Withdrawal emergent syndrome in an infant associated with maternal haloperidol therapy. J Perinatol. 1989; 9:170-2. [PubMed 2738729]

108. Coppola D, Russo LJ, Kwarta RF Jr. et al. Evaluating the postmarketing experience of risperidone use during pregnancy: pregnancy and neonatal outcomes. Drug Saf. 2007; 30:247-64. [PubMed 17343431]

109. US Food and Drug Administration. FDA drug safety communication: Antipsychotic drug labels updated in use during pregnancy and risk of abnormal muscle movements and withdrawal symptoms in newborns. Rockville, MD; 2011 Feb 22. From the FDA website.

b. Sandoz Inc. Thiothixene capsules prescribing information. Princeton, NJ. 2007 Feb.

c. AHFS drug information 2008. McEvoy GK, ed. Thiothixene. Bethesda, MD: American Society of Health-System Pharmacists; 2008:2516-7.

d. Banerjee S. The use of antipsychotic medication for people with dementia: time for action. A report for the Minister of State for Care Services. United Kingdom Department of Health. From the website.

e. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 7th ed. Baltimore, MD: Williams & Wilkins; 2005:1577-8.

f. American Academy of Pediatrics. Use of psychoactive medication during pregnancy and possible effects on the fetus and newborn. Pediatrics. 2000; 105:880-87. [PubMed 10742343]

g. The United States Pharmacopeial Convention, Inc. USAN and the USP Dictionary drug names. Rockville, MD: United States Pharmacopeial Convention, Inc; 2007:853.

h. AMA Division of Drugs. AMA drug evaluations. Chicago: American Medical Association; 1994:2:1-2:29.

i. Balant-Gorgia AE, Balant L. Antipsychotic drugs: clinical pharmacokinetics of potential candidates for plasma concentration monitoring. Clin Pharmacokinet. 1987: 13:65-90.

j. Ereshefsky L, Saklad SR, Watanabe MD, et al. Thiothixene pharmacokinetic interactions: a study of hepatic enzyme inducers, clearance inhibitors, and demographic variables. J Clin Psychopharmacol. 1991; 11:296-301. [PubMed 1765572]

k. Hobbs DC, Welch WM, Short MJ, et al. Pharmacokinetics of thiothixene in man. Clin Pharmacol Ther. 1974; 16:473-8. [PubMed 4415039]

l. Ereshefsky L, Jann MW, Saklad SR, et al. Bioavailability of psychotropic drugs: historical perspective and pharmacokinetic overview. J Clin Psychiatry. 1986; 47 (Suppl):6-15. [PubMed 3528134]

m. Guthrie SK, Hariharan M, Kumar AA, et al. The effect of paroxetine on thiothixene pharmacokinetics. J Clin Pharm Ther. 1997; 22:221-6. [PubMed 9447478]

n. Webb RT, Howard L, Abel KM. Antipsychotic drugs for non-affective psychosis during pregnancy and postpartum. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004411. DOI: 10.1002/14651858.CD004411.pub2.

o. Cohen LS, Heller VL, Rosenbaum JF. Treatment guidelines for psychotropic drug use in pregnancy. Psychosomatics. 1989; 30:25-33. [PubMed 2643809]

p. Altshuler LL, Cohen L, Szuba MP, et al. Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines. Am J Psychiatry. 1996; 153:592-606. [PubMed 8615404]

q. Mortola JF. The use of psychotropic agents in pregnancy and lactation. Psychiatr Clin North Am. 1989; 12:69-87. [PubMed 2652114]

r. Goldberg H, Nissim R. Psychotropic drugs in pregnancy and lactation. Int J Psychiatry Med. 1994; 24:129-49. [PubMed 7960421]

s. Calabrese JR, Gulledge AD. Psychotropics during pregnancy and lactation: a review. Psychosomatics. 1985; 26:413-26. [PubMed 2859631]

t. Milton GV, Jann MW. Emergency treatment of psychotic symptoms: pharmacokinetic considerations for antipsychotic drugs. Clin Pharmacokinet. 1995; 28:494-504. [PubMed 7656507]

u. Mylan Pharmaceuticals Inc. Thiothixene capsules prescribing information. Morgantown, WV; 2003 Oct.

v. Roerig, Division of Pfizer Inc. Navane (thiothixene hydrochloride) intramuscular for injection prescribing information. New York, NY. 2008 Jan.

w. AHFS drug information 2008. McEvoy GK, ed. Phenothiazines general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2008: 2497-508.

x. Schmidt MH, Lee T. Investigation of striatal dopamine D2 receptor acquisition following prenatal neuroleptic exposure. Psychiatry Res. 1991; 36:319-28. [PubMed 1676523]

y. Mavroidis ML, Kanter DR, Hirschowitz J et al. Clinical relevance of thiothixene plasma levels.J Clin Psychopharmacol. 1984; 4:155-7. [PubMed 6736276]

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