A-Z Drug Facts > Thiothixene

Thiothixene

Pronouncation: (THIGH-oh-THIX-een)
Class: Thioxanthene derivative

Trade Names:
Navane
- Capsules 1 mg
- Capsules 2 mg
- Capsules 5 mg
- Capsules 10 mg
- Capsules 20 mg

Pharmacology

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Produces antipsychotic effects apparently because of dopamine receptor blocking in CNS.

Pharmacokinetics

Absorption

Thiothixene absorption is erratic and varies. T _max occurs 2 to 4 h after oral use.

Distribution

Thiothixene is highly lipophilic, is widely distributed in tissues, and is 91% to 99% protein bound.

Metabolism

Thiothixene is extensively metabolized in the liver.

Elimination

About 50% of excretion occurs via the kidneys; the other 50% occurs through enterohepatic circulation. Thiothixene t _½ is 20 to 40 h. Less than 1% is excreted as unchanged drug.

Indications and Usage

Management of schizophrenia.

Contraindications

Comatose or severely depressed states; circulatory collapse; CNS depression from any cause; bone marrow depression; blood dyscrasias.

Dosage and Administration

Mild Conditions
Adults and children 12 yr of age and older

PO Start with 2 mg 3 times daily, an increase to 15 mg/day is often effective if needed.

Severe Conditions
Adults and children 12 yr of age and older

PO Start with 5 mg twice daily. The usual optimal dose is 20 to 30 mg/day. If indicated, an increase to 60 mg/day may be effective. Doses above 60 mg/day rarely increase the beneficial response.

Storage/Stability

Store tablets at controlled room temperature (59° to 86°F).

Drug Interactions

Alcohol, other CNS depressants

May cause additive CNS depressant effects.

Anticholinergics

May reduce therapeutic effects and increase anticholinergic effects of thiothixene; may lead to tardive dyskinesia.

Guanethidine

May inhibit hypotensive effect of guanethidine.

Laboratory Test Interactions

False-positive pregnancy test results may occur but are less likely to occur with serum test. Increases in protein-bound iodine have been reported.

Adverse Reactions

Cardiovascular

Orthostatic hypotension; tachycardia; syncope; lightheadedness; ECG changes.

CNS

Tardive dyskinesia; extrapyramidal symptoms (eg, pseudoparkinsonism, akathisia, dystonias); drowsiness; insomnia; restlessness; agitation; seizures; paradoxical exacerbation of psychotic symptoms.

Dermatologic

Rash; pruritus; urticaria; photosensitivity.

EENT

Pigmentary retinopathy; lenticular pigmentation; blurred vision; nasal congestion.

GI

Dry mouth; anorexia; diarrhea; nausea; vomiting; constipation.

Genitourinary

Impotence, sexual dysfunction; amenorrhea; breast enlargement; lactation; gynecomastia.

Hematologic

Leukopenia; leukocytosis.

Metabolic

Elevations of serum transaminase and alkaline phosphatase.

Respiratory

Laryngospasm; bronchospasm; increased depth of respiration.

Miscellaneous

Hypoglycemia; hyperglycemia; glycosuria; polydipsia; increase in appetite and weight; peripheral edema; elevated prolactin levels; increased sweating or salivation.

Precautions

Pregnancy

Pregnancy category undetermined.

Lactation

Undetermined.

Children

Not recommended in children younger than 12 yr of age.

Elderly

More susceptible to adverse reactions.

Special Risk Patients

Use drug with caution in patients with CV disease or mitral insufficiency, history of glaucoma, EEG abnormalities, seizure disorders, prior brain damage, hepatic or renal function impairment, or those exposed to extreme heat.

CNS effects

Drug may impair mental or physical abilities, especially during first few days of therapy.

Hepatic effects

Jaundice (usually reversible) may occur, usually between second and fourth week of treatment, and is considered a hypersensitivity reaction.

Neuroleptic malignant syndrome (NMS)

NMS has occurred with similar agents and is potentially fatal. Signs and symptoms are hyperpyrexia, muscle rigidity, altered mental status, irregular pulse, irregular BP, tachycardia, and diaphoresis.

Pulmonary effects

Cases of bronchopneumonia, some fatal, have occurred.

Sudden death

Has been reported; predisposing factors may be seizures or previous brain damage. Flare-ups of psychotic behavior may precede death.

Tardive dyskinesia

Potentially irreversible involuntary body and facial movements may occur. Prevalence highest in elderly, especially women.

Overdosage

Symptoms

Twitching muscles, drowsiness, dizziness, CNS depression, rigidity, weakness, torticollis, tremor, salivation, dysphagia, hypotension, disturbed gait, coma.

Patient Information

• Advise patient, family, or caregiver that dose will be adjusted periodically until max benefit has been obtained.
• Advise patient, family, or caregiver not to change the dose or stop taking unless advised by health care provider.
• Instruct patient not to stop taking thiothixene when feeling better.
• Instruct patient, family, or caregiver to immediately report fainting, dizziness, high fever, muscle rigidity, altered mental status, and irregular pulse.
• Advise patient, family, or caregiver to notify health care provider of the following: excessive drowsiness, increased agitation or anxiety, involuntary body or facial movements.
• Advise patient to avoid strenuous activity during periods of high temperature or humidity.
• Instruct patient to avoid alcoholic beverages and other depressants while taking this medication.
• Instruct patient to get up slowly from lying or sitting position and to avoid sudden position changes to prevent postural hypotension. Advise patient to report dizziness with position changes to health care provider. Caution patient that hot tubs and hot showers or baths may worsen dizziness.
• Advise patient to take sips of water, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs.
• Advise patient that drug may cause drowsiness or impaired judgment or thinking skills and to use caution while driving or performing other tasks requiring mental alertness until tolerance is determined.
• Caution patient that medication may cause sensitivity to sunlight and to avoid unnecessary exposure to UV light (sunlight, tanning booths) and to use sunscreen and wear protective clothing when exposed to UV light until tolerance is determined.

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