THIOXANTHENES (Systemic)
Some commonly used brand names are:
In the U.S.?
- Navane 3
- Taractan 1
- Thiothixene HCl Intensol 3
In Canada?
- Fluanxol 2
- Fluanxol Depot 2
- Navane 3
Note: | For quick reference, the following thioxanthenes are numbered tomatch the corresponding brand names. |
Category
- Antipsychotic?Chlorprothixene; Flupenthixol; Thiothixene
Description
This medicine belongs to the family of medicines known as thioxanthenes (thye-oh-ZAN-theens).It is used in the treatment of nervous, mental, and emotional conditions.Improvement in such conditions is thought to result from the effect of themedicine on nerve pathways in specific areas of the brain.
Thioxanthene medicines are available only with your doctor's prescription,in the following dosage forms:
Oral- Chlorprothixene
- Suspension (U.S.)
- Tablets (U.S.)
- Flupenthixol
- Thiothixene
- Capsules (U.S. and Canada)
- Solution (U.S.)
Parenteral- Chlorprothixene
- Flupenthixol
- Thiothixene
Before Using This Medicine
In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For thioxanthenes, thefollowing should be considered:
Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to thioxanthene or to phenothiazine medicines. Also tellyour health care professional if you are allergic to any other substances,such as foods, preservatives, or dyes.
Pregnancy?Studies have not been done in pregnant women. Althoughanimal studies have not shown that thioxanthenes cause birth defects, thestudies have shown that these medicines cause a decrease in fertility andfewer successful pregnancies.
Breast-feeding?It is not known if thioxanthenes pass into thebreast milk. However, similar medicines for nervous, mental, or emotionalconditions do pass into breast milk and may cause drowsiness and increasethe risk of other problems in the nursing baby. Be sure you have discussedthe risks and benefits of this medicine with your doctor.
Children?Certain side effects, such as muscle spasms of theface, neck, and back, tic-like or twitching movements, inability to move theeyes, twisting of the body, or weakness of the arms and legs, are more likelyto occur in children, who are usually more sensitive than adults to the sideeffects of thioxanthenes.
Older adults?Constipation, dizziness or fainting, drowsiness,dryness of mouth, trembling of the hands and fingers, and symptoms of tardivedyskinesia (such as rapid, worm-like movements of the tongue or any otheruncontrolled movements of the mouth, tongue, or jaw, and/or arms and legs)are especially likely to occur in elderly patients, who are usually more sensitivethan younger adults to the effects of thioxanthenes.
Other medicines?Although certain medicines should not be usedtogether at all, in other cases 2 different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takingthioxanthenes, it is especially important that your health care professionalknow if you are taking any of the following:
- Amoxapine (e.g., Asendin) or
- Methyldopa (e.g., Aldomet) or
- Metoclopramide (e.g., Reglan) or
- Metyrosine (e.g., Demser) or
- Other antipsychotics (medicine for mental illness) or
- Pemoline (e.g., Cylert) or
- Pimozide (e.g., Orap) or
- Promethazine (e.g., Phenergan) or
- Rauwolfia alkaloids (alseroxylon [e.g., Rauwiloid], deserpidine [e.g.,Harmonyl], rauwolfia serpentina [e.g., Raudixin], reserpine [e.g., Serpasil])or
- Trimeprazine (e.g., Temaril)?Taking these medicines with thioxanthenesmay increase the chance and severity of certain side effects
- Central nervous system (CNS) depressants (medicine that causes drowsiness)or
- Tricyclic antidepressants (medicine for depression)?Takingthese medicines with thioxanthenes may add to the CNS depressant effects
- Epinephrine (e.g., Adrenalin)?Severe low blood pressure (hypotension)and fast heartbeat may occur if epinephrine is used with thioxanthenes
- Levodopa (e.g., Sinemet)?Thioxanthenes may keep levodopa fromworking properly in the treatment of Parkinson's disease
- Quinidine (e.g., Quinidex)?Unwanted effects on your heart mayoccur
Other medical problems?The presence of other medicalproblems may affect the use of thioxanthenes. Make sure you tell your doctorif you have any other medical problems, especially:
- Alcohol abuse?Drinking alcohol will add to the central nervoussystem (CNS) depressant effects of thioxanthenes
- Blood disease or
- Enlarged prostate or
- Glaucoma or
- Heart or blood vessel disease or
- Lung disease or
- Parkinson's disease or
- Stomach ulcers or
- Urination problems?Thioxanthenes may make the condition worse
- Liver disease?Higher blood levels of thioxanthenes may occur,increasing the chance of side effects
- Reye's syndrome?The risk of liver problems may be increased
- Seizure disorders?The risk of seizures may be increased
Proper Use of This Medicine
This medicinemay be taken with food or a full glass (8 ounces) of water or milk to reducestomach irritation.
For patients taking thiothixene oral solution:
- This medicine must be diluted before you take it. Just before taking,measure the dose with the specially marked dropper. Mix the medicine witha full glass of water, milk, tomato or fruit juice, soup, or carbonated beverage.
Do not take more of this medicine or take it more oftenthan your doctor ordered. This is particularly important when thismedicine is given to children, since they may react very strongly to its effects.
Sometimes this medicine must be taken for several weeksbefore its full effect is reached.
Dosing?The dose of these medicines will be differentfor different patients. Follow your doctor's orders orthe directions on the label. The following information includes onlythe average doses of these medicines. If your dose isdifferent, do not change it unless your doctor tells you to do so.
The number of capsules or tablets or the amount of liquid that you takedepends on the strength of the medicine. Also, the number of doses you takeeach day, the time allowed between doses, and the length of time you takethe medicine depend on the medical problem for which you are taking thioxanthenes.
For chlorprothixene- For treatment of psychosis:
- Oral dosage forms (suspension or tablets):
- Adults and teenagers?25 to 50 milligrams (mg) three or fourtimes a day.
- Children 6 to 12 years of age?10 to 25 mg three or four timesa day.
- Children up to 6 years of age?Use and dose must be determinedby your doctor.
- Injection dosage form:
- Adults and teenagers?25 to 50 mg, injected into a muscle, threeor four times a day.
- Children up to 12 years of age?Use and dose must be determinedby your doctor.
For flupenthixol- For treatment of psychosis:
- Oral dosage form (tablets):
- Adults?To start, 1 milligram (mg) three times a day. Your doctormay increase your dose if needed, depending on your condition.
- Children?Use and dose must be determined by your doctor.
- Long-acting injection dosage form:
- Adults?To start, 20 to 40 milligrams (mg) injected into a muscle.Your doctor will determine whether your dose needs to be changed, dependingon your condition.
- Children?Use and dose must be determined by your doctor.
For thiothixene- For treatment of psychosis:
- Oral dosage forms (capsules and solution):
- Adults and teenagers?To start, 2 milligrams (mg) three timesa day, or 5 mg two times a day. Your doctor may increase your dose if needed.However, the dose is usually not more than 60 mg a day.
- Children up to 12 years of age?Use and dose must be determinedby your doctor.
- Injection dosage form:
- Adults and teenagers?4 milligrams (mg), injected into a muscle,two to four times a day. Your doctor may increase your dose if needed. However,the dose is usually not more than 30 mg a day.
- Children up to 12 years of age?Use and dose must be determinedby your doctor.
Missed dose?If you miss a dose of this medicine, take it assoon as possible. However, if it is within 2 hours of your next dose, skipthe missed dose and go back to your regular dosing schedule. Do not doubledoses.
Storage?To store this medicine:
- Keep out of the reach of children.
- Store away from heat and direct light.
- Do not store the capsule or tablet form of this medicine in the bathroom,near the kitchen sink, or in other damp places. Heat or moisture may causethe medicine to break down.
- Keep the liquid form of this medicine from freezing.
- Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
Yourdoctor should check your progress at regular visits. This will allow the dosageof the medicine to be adjusted when necessary and also will reduce the possibilityof side effects.
Do not stop taking this medicine without first checking with your doctor.Your doctor may want you to gradually reduce the amount you are taking beforestopping completely. This is to prevent side effects and to prevent your conditionfrom becoming worse.
This medicine will add to the effects of alcohol and other CNS depressants(medicines that slow down the nervous system, possibly causing drowsiness).Some examples of CNS depressants are antihistamines or medicine for hay fever,other allergies, or colds; sedatives, tranquilizers, or sleeping medicine;prescription pain medicine or narcotics; barbiturates; medicine for seizures;muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any such depressants whileyou are using this medicine.
Do not take this medicine within an hour of taking antacids or medicinefor diarrhea. Taking them too close together may make this medicine less effective.
Before having any kind of surgery, dental treatment,or emergency treatment, tell the medical doctor or dentist in charge thatyou are using this medicine. Taking thioxanthenes together with medicinesthat are used during surgery or dental or emergency treatments may increasethe CNS depressant effects.
This medicine may cause some people to become drowsy or less alert thanthey are normally, especially during the first few weeks the medicine is beingtaken. Even if you take this medicine only at bedtime, you may feel drowsyor less alert on arising. Make sure you know how youreact to this medicine before you drive, use machines, or do anything elsethat could be dangerous if you are not alert.
Dizziness, lightheadedness, or fainting may occur whileyou are taking this medicine, especially when you get up from a lyingor sitting position. Getting up slowly may help. If the problem continuesor gets worse, check with your doctor.
This medicine may make you sweat less, causing your body temperature toincrease. Use extra care not to become overheated duringexercise or hot weather while you are taking this medicine, since overheatingmay result in heat stroke. Also, hot baths or saunas may make you feel dizzyor faint while you are taking this medicine.
Thioxanthenes may cause your skin to be more sensitive to sunlight thanit is normally. Exposure to sunlight, even for brief periods of time, maycause a skin rash, itching, redness or other discoloration of the skin, ora severe sunburn. When you begin taking this medicine:
- Stay out of direct sunlight, especially between the hours of 10:00a.m. and 3:00 p.m., if possible.
- Wear protective clothing, including a hat. Also, wear sunglasses.
- Apply a sun block product that has a skin protection factor (SPF)of at least 15. Some patients may require a product with a higher SPF number,especially if they have a fair complexion. If you have any questions aboutthis, check with your health care professional.
- Apply a sun block lipstick that has an SPF of at least 15 to protectyour lips.
- Do not use a sunlamp or tanning bed or booth.
If you have a severe reaction from the sun, check withyour doctor.
This medicine may cause dryness of the mouth. For temporary relief, usesugarless gum or candy, melt bits of ice in your mouth, or use a saliva substitute.However, if your mouth continues to feel dry for more than 2 weeks, checkwith your medical doctor or dentist. Continuing dryness of the mouth may increasethe chance of dental disease, including tooth decay, gum disease, and fungusinfections.
If you are taking a liquid form of this medicine, try to avoid spilling it on your skin or clothing. Skin rash and irritationhave been caused by similar medicines.
If you are receiving this medicine by injection:
- The effects of the long-acting injection form of this medicine maylast for up to 3 weeks. The precautions and side effectsinformation for this medicine applies during this period of time.
Side Effects of This Medicine
Along with their needed effects,thioxanthenes can sometimes cause serious side effects. Tardive dyskinesia(a movement disorder) may occur and may not go away after you stop using themedicine. Signs of tardive dyskinesia include fine, worm-like movements ofthe tongue, or other uncontrolled movements of the mouth, tongue, cheeks,jaw, or arms and legs. Other serious but rare side effects may also occur.Some of these side effects, including severe muscle stiffness, fever, unusualtiredness or weakness, fast heartbeat, difficult breathing, increased sweating,loss of bladder control, and seizures, may be the sign of a condition calledneuroleptic malignant syndrome. You and your doctor shoulddiscuss the good this medicine will do as well as the risks of taking it.
Although not all of these side effects may occur, if they do occur theymay need medical attention.
Stop taking this medicineand get emergency help immediately if any of the following side effectsoccur:
Also, check with your doctor as soon as possible if any of the followingside effects occur:
More common
Difficulty in talking or swallowing; inability to move eyes; lip smacking or puckering; loss of balance control; mask-like face; muscle spasms, especially of theneck and back; puffing of cheeks; rapid or worm-like movements of tongue; restlessnessor need to keep moving (severe); shuffling walk; stiffness of arms and legs; tremblingand shaking of fingers and hands; twisting movementsof body; uncontrolled chewing movements; uncontrolled movements of the arms and legs
Rare
Hot, dry skin or lack of sweating; increased blinking or spasms of eyelid; muscle weakness; sore throat and fever; uncontrolled twisting movements of neck, trunk, arms, or legs; unusual bleeding or bruising; unusualfacial expressions or body positions; yellow eyesor skin
Symptoms of overdose
Difficulty in breathing (severe); dizziness(severe); drowsiness (severe); muscle trembling, jerking, stiffness, or uncontrolled movements (severe); small pupils; unusual excitement; unusual tiredness or weakness (severe)
Other side effects may occurthat usually do not need medical attention. These side effects may go awayduring treatment as your body adjusts to the medicine. However, check withyour doctor if any of the following side effects continue or are bothersome:
More common
Constipation; decreased sweating; dizziness, lightheadedness, or fainting; drowsiness (mild); dryness of mouth; increased appetite and weight; increasedsensitivity of skin to sunlight (skin rash, itching, redness or other discolorationof skin, or severe sunburn); stuffy nose
After youstop taking this medicine your body may need time to adjust, especially ifyou took this medicine in high doses or for a long time. If you stop takingit too quickly, the following withdrawal effects may occur and should be reportedto your doctor:
Dizziness; nausea and vomiting; stomach pain; trembling of fingers andhands; uncontrolled, continuing movements of mouth,tongue, or jaw
Although not all of the side effects listedabove have been reported for all thioxanthenes, they have been reported forat least one of them. However, since these medicines are very similar, anyof the above side effects may occur with any of them.
Other side effects not listed above may also occur insome patients. If you notice any other effects, check with your doctor.
Revised: 08/18/1998
