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Revista de Neurologia Feb 2013Oculogyric crises are considered to be a form of focal dystonia and can be observed as reactions to pharmaceuticals. The signs and symptoms may be confused with... (Review)
Review
INTRODUCTION
Oculogyric crises are considered to be a form of focal dystonia and can be observed as reactions to pharmaceuticals. The signs and symptoms may be confused with epileptic crises.
AIMS
To describe the clinical features and progress of patients with pharmaceutical-related oculogyric crises and to carry out a review of the topic.
CASE REPORTS
We conducted a retrospective, descriptive study of four patients evaluated in the neurology service due to oculogyric crises. The patients had been diagnosed with an associated conduct disorder requiring treatment with antipsychotic drugs. The episodes of oculogyric crises did not correlate with the findings in the electroencephalogram. They responded well to the reduction in dosage or to withdrawal of the apparent causing agent.
CONCLUSIONS
The clinical picture does not present only in patients treated with antipsychotics but is also linked with other pharmaceuticals that are frequently used in daily paediatric practice. When oculogyric crises are the reason for visiting, differential diagnoses must be taken into account in order to avoid unnecessary studies and to carry out an appropriate therapeutic management.
Topics: Adolescent; Anticonvulsants; Antipsychotic Agents; Aripiprazole; Child; Child Behavior Disorders; Child, Preschool; Dopamine; Dopamine Antagonists; Down Syndrome; Dyskinesia, Drug-Induced; Dystonic Disorders; Electroencephalography; Epilepsy; Female; Fragile X Syndrome; Humans; Intellectual Disability; Isoxazoles; Male; Methotrimeprazine; Ocular Motility Disorders; Paliperidone Palmitate; Piperazines; Pyrimidines; Quinolones; Risperidone; Substance Withdrawal Syndrome; Translocation, Genetic; Valproic Acid
PubMed: 23359076
DOI: No ID Found -
Journal of Clinical Pharmacology Nov 1988Since methotrimeprazine proved to be both an effective tranquilizer and analgesic, its effect in a tranquilizing dose of 0.15 mg/kg on the arterial blood gases was...
Since methotrimeprazine proved to be both an effective tranquilizer and analgesic, its effect in a tranquilizing dose of 0.15 mg/kg on the arterial blood gases was determined in human volunteers. Because of the known potentiating effect of some phenothiazines on the narcotic-analgesic induced respiratory depression and analgesia, the effect of methotrimeprazine on the meperidine-induced respiratory depression was also studied. Before, and at five minute intervals after the administration of the test drugs, PaO2, PaCO2 and pH were determined by a Radiometer Copenhagen Blood Gas Analyzer (Radiometer Copenhagen, 72 Endruvej, Denmark) through a Riley-needle. Continuous ECG lead II tracings were taken during the experiment. No significant decrease in PaO2 or increase in PaCO2 (P less than 0.01) was observed in 6 healthy volunteers (mean age = 25 yrs) after 0.15 mg/kg i.v. methotrimeprazine. In 19 volunteers (mean age = 32 yrs), the intravenous infusion of 1.5 mg/kg meperidine caused significant decrease in PaO2 and increase in PaCO2 five minutes after its administration. The combined administration of both drugs to 6 volunteers (mean age = 23 yr) caused initially the same decrease in PaO2 as after meperidine alone with subsequent increase in PaO2 over normal levels, however, the PaCO2 significantly increased both as compared to baseline values and as compared with meperidine alone. The pH reductions after the combination of both drugs were greater than after meperidine alone, which in combination with the PaCO2 values confirms the potentiation of meperidine-induced respiratory depression by methotrimeprazine. The results indicate the methotrimeprazine alone causes no significant respiratory depression, but it potentiates the respiratory depression caused by meperidine.
Topics: Adult; Blood Gas Analysis; Drug Interactions; Female; Humans; Hydrogen-Ion Concentration; Male; Meperidine; Methotrimeprazine; Time Factors
PubMed: 3243915
DOI: 10.1002/j.1552-4604.1988.tb03125.x -
British Journal of Pharmacology and... Dec 1963The dose/response curves for the protective effects of the new antihistamine compounds trimeprazine, 10-(3-diethylamino-2-methylpropyl)phenothiazine 1,1-dioxide...
The dose/response curves for the protective effects of the new antihistamine compounds trimeprazine, 10-(3-diethylamino-2-methylpropyl)phenothiazine 1,1-dioxide hydrochloride (oxomemazine hydrochloride), cyproheptadine, homochlorcyclizine and methotrimeprazine against the anaphylactic microshock of the guinea-pig were similar to that of promethazine. The first three compounds, however, protected at lower doses than promethazine (5 to 10 mug/kg). The protective effect of cyproheptadine lasted longer than 24 hr.
Topics: Anaphylaxis; Animals; Anti-Allergic Agents; Antipsychotic Agents; Cyclic S-Oxides; Cyproheptadine; Guinea Pigs; Histamine H1 Antagonists; Methotrimeprazine; Pharmacology; Phenothiazines; Promethazine; Research; Trimeprazine
PubMed: 14110740
DOI: 10.1111/j.1476-5381.1963.tb02008.x -
Journal of Pain and Symptom Management Oct 1994The role of neuroleptic drugs as adjuvant analgesics has been a subject of longstanding controversy. Despite frequent claims of efficacy, evidence from controlled trials... (Review)
Review
The role of neuroleptic drugs as adjuvant analgesics has been a subject of longstanding controversy. Despite frequent claims of efficacy, evidence from controlled trials supports neither claims of intrinsic analgesic properties nor the routine use of the neuroleptics as a means to reliably induce clinically useful analgesia. Methotrimeprazine is unique in that there is evidence for reliable dose-related analgesia that is comparable to opioid-mediated analgesia, although routine use is not recommended. Despite probable interaction with opioid receptors, there is insufficient evidence to support a role for the butyrophenone category of neuroleptics as adjuvant analgesics. Limited trials of the neuroleptics may be considered for pain that has been unresponsive to more conventional pharmacologic approaches, especially when associated with headache, nerve injury, or psychological distress. The neuroleptics have an important role in the symptomatic management of agitation, delirium, and nausea, particularly in patients with cancer.
Topics: Analgesics; Antipsychotic Agents; Butyrophenones; Clinical Trials as Topic; Humans; Methotrimeprazine; Phenothiazines
PubMed: 7822884
DOI: 10.1016/0885-3924(94)90201-1 -
Psychiatria Danubina 2022To assess potential benefits of quetiapine for persistent sleep disturbances in patients with posttraumatic stress disorder (PTSD) on stable combined SSRI and...
Quetiapine Add-On Therapy May Improve Persistent Sleep Disturbances in Patients with PTSD on Stabile Combined SSRI and Benzodiazepine Combination: A One-Group Pretest-Posttest Study.
BACKGROUND
To assess potential benefits of quetiapine for persistent sleep disturbances in patients with posttraumatic stress disorder (PTSD) on stable combined SSRI and benzodiazepine therapy, who previously failed to respond to various benzodiazepine and non-benzodiazepine hypnotic adjuvant treatment as well as to first-generation antipsychotic add-on treatment.
SUBJECTS AND METHODS
Fifty-two male PTSD outpatients on stable combination treatment with SSRI and benzodiazepines, with persistent sleep disturbances not responding to prescription of zolpidem, flurazepam, nitrazepam, promazine, and levopromazine, were assessed for sleep disturbances improvements after prescription of quetiapine in the evening. Each patient met both ICD-10 and DSM-IV criteria for PTSD. Psychiatric comorbidity and premorbidity were excluded using the Mini-International Neuropsychiatric Interview (MINI). Improvement on the CAPS recurrent distressing dream item, reduction in the amount of time needed to fall asleep, prolongation of sleep duration, and reduction in average number of arousals per night in the last 7 days before the assessment period were used as efficacy measures.
RESULTS
All sleep-related parameters improved significantly at the end of a five-week follow-up: sleep duration increased by one hour (p<0.001), sleep latency decreased by 52.5 minutes (p<0.001), median number of arousals per night decreased from two to one (p<0.001), CAPS recurrent distressing dream item median decreased from five to four (p<0.001), and the number of patients dissatisfied with their sleep quality and quantity decreased from 45 to two (p<0.001).
CONCLUSION
Quetiapine prescribed in the evening may be successful therapy for persistent sleep disturbances in patients with PTSD and generally good response to an SSRI and benzodiazepine combination, who previously failed to respond to some of the usual hypnotic medication or addition of first-generation antipsychotics: zolpidem, flurazepam, nitrazepam, promazine, and levopromazine.
Topics: Antipsychotic Agents; Benzodiazepines; Flurazepam; Humans; Hypnotics and Sedatives; Male; Methotrimeprazine; Nitrazepam; Promazine; Quetiapine Fumarate; Sleep; Sleep Wake Disorders; Stress Disorders, Post-Traumatic; Zolpidem
PubMed: 35772134
DOI: 10.24869/psyd.2022.245 -
Proceedings of the Royal Society of... Nov 1965The evidence for believing that mixtures of aspirin, phenacetin, and caffeine provide advantages over the individual components of these mixtures is reviewed, and doubt... (Clinical Trial)
Clinical Trial Comparative Study
The evidence for believing that mixtures of aspirin, phenacetin, and caffeine provide advantages over the individual components of these mixtures is reviewed, and doubt expressed as to the rationale for the use of these mixtures in ordinary medical practice. The syndrome of ;analgesic nephropathy' is also reviewed, and on the basis of experiments in healthy volunteers it is suggested that individual ingredients of analgesic mixtures be scrutinized more carefully in an attempt to track down the agents responsible for toxic effects.The use of phenothiazine compounds, alone or in mixture with narcotics, is reviewed, and the opinion expressed that methotrimeprazine has special analgesic attributes.The narcotic antagonists represent an extremely interesting group of drugs which possess analgesic activity as well as the ability to antagonize certain effects of morphine and other narcotic agents. The patterns of respiratory effect, psychotomimesis, and abstinence phenomena seen with these antagonists illustrate the possibility of dissociating certain effects usually assumed to be linked inseparably in drugs possessing the analgesic power of morphine.
Topics: Analgesics; Aspirin; Caffeine; Clinical Trials as Topic; Cyclazocine; Drug Synergism; Humans; Meperidine; Methotrimeprazine; Morphine; Nalorphine; Narcotic Antagonists; Pentazocine; Phenacetin; Placebos; Tranquilizing Agents; Triflupromazine
PubMed: 5322679
DOI: No ID Found -
Biological & Pharmaceutical Bulletin 2021The clinical applications of antipsychotics for symptoms unrelated to schizophrenia, such as behavioral and psychological symptoms, in patients with Alzheimer's disease,...
The clinical applications of antipsychotics for symptoms unrelated to schizophrenia, such as behavioral and psychological symptoms, in patients with Alzheimer's disease, and the likelihood of doctors prescribing antipsychotics for elderly people are increasing. In elderly people, drug-induced and aging-associated urinary disorders are likely to occur. The most significant factor causing drug-induced urinary disorders is a decrease in urinary bladder smooth muscle (UBSM) contraction induced by the anticholinergic action of therapeutics. However, the anticholinergic action-associated inhibitory effects of antipsychotics on UBSM contraction have not been sufficiently assessed. In this study, we examined 26 clinically available antipsychotics to determine the extent to which they inhibit acetylcholine (ACh)-induced contraction in rat UBSM to predict the drugs that should not be used by elderly people to avoid urinary disorders. Of the 26 antipsychotics, six (chlorpromazine, levomepromazine (phenothiazines), zotepine (a thiepine), olanzapine, quetiapine, clozapine (multi-acting receptor targeted antipsychotics (MARTAs))) competitively inhibited ACh-induced contractions at concentrations corresponding to clinically significant doses. Further, 11 antipsychotics (perphenazine, fluphenazine, prochlorperazine (phenothiazines), haloperidol, bromperidol, timiperone, spiperone (butyrophenones), pimozide (a diphenylbutylpiperidine), perospirone, blonanserin (serotonin-dopamine antagonists; SDAs), and asenapine (a MARTA)) significantly suppressed ACh-induced contraction; however, suppression occurred at concentrations substantially exceeding clinically achievable blood levels. The remaining nine antipsychotics (pipamperone (a butyrophenone), sulpiride, sultopride, tiapride, nemonapride (benzamides), risperidone, paliperidone (SDAs), aripiprazole, and brexpiprazole (dopamine partial agonists)) did not inhibit ACh-induced contractions at concentrations up to 10 M. These findings suggest that chlorpromazine, levomepromazine, zotepine, olanzapine, quetiapine, and clozapine should be avoided by elderly people with urinary disorders.
Topics: Acetylcholine; Aging; Animals; Antipsychotic Agents; Chlorpromazine; Cholinergic Antagonists; Clozapine; Dibenzothiepins; Male; Mental Disorders; Methotrimeprazine; Muscle Contraction; Muscle, Smooth; Olanzapine; Quetiapine Fumarate; Rats, Wistar; Urinary Bladder; Urologic Diseases; Rats
PubMed: 34334499
DOI: 10.1248/bpb.b21-00363 -
Journal of Pharmacological Sciences Jun 2019Antipsychotics are often the first-line treatment for behavioral and psychological symptoms of dementia. However, the potential anticholinergic effects of antipsychotics...
Antipsychotics are often the first-line treatment for behavioral and psychological symptoms of dementia. However, the potential anticholinergic effects of antipsychotics could counteract the therapeutic effects of cholinesterase inhibitors used to treat dementia. We investigated the inhibitory effects of 26 antipsychotics on [N-Methyl-H]scopolamine specific binding in mouse cerebral cortex. At 10 M, chlorpromazine, levomepromazine, prochlorperazine, timiperone, zotepine, pimozide, blonanserin, olanzapine, quetiapine, and clozapine inhibited [N-Methyl-H]scopolamine binding by > 45%. Furthermore, the pK values of chlorpromazine, levomepromazine, zotepine, olanzapine, and clozapine overlapped with their clinically achievable blood concentrations. Therefore, the anticholinergic properties of these antipsychotics could attenuate the effects of cholinesterase inhibitors.
Topics: Animals; Antipsychotic Agents; Cerebral Cortex; Chlorpromazine; Cholinergic Antagonists; Cholinesterase Inhibitors; Depression, Chemical; Drug Interactions; Male; Methotrimeprazine; Mice, Inbred Strains; Prochlorperazine; Protein Binding; Receptors, Muscarinic; Scopolamine
PubMed: 31178327
DOI: 10.1016/j.jphs.2019.05.006 -
Journal of Psychiatry & Neuroscience :... Jul 2006We compared the effect of levomepromazine (LMP) with chlorpromazine (CPZ) in treatment-resistant schizophrenia (TRS). (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
We compared the effect of levomepromazine (LMP) with chlorpromazine (CPZ) in treatment-resistant schizophrenia (TRS).
METHODS
We carried out a double-blind, parallel group study (n = 19/arm) with balanced randomization in blocks of 4 and stratification by sex. Subjects entered a 30-week trial, of which phases I-III were open: phase I (wk 0-6) baseline; phase II (wk 7-9) stepwise transition to haloperidol (HAL), 30 mg/d, plus benztropine (BT), 4 mg/d; phase III (wk 10-15) HAL, 40-60 mg/d, plus BT, 4-6 mg/d; phase IV (wk 16-20) stepwise transition to LMP or CPZ (500 mg/d) following randomization; phase V (wk 21-28) stepwise increase of LMP or CPZ (600-1000 mg/d, dose reduction permitted) to establish optimum dose; and phase VI (wk 29-30) optimized dose maintained. Criteria for TRS were based on those established by Kane et al in 1988. The criterion for a response to treatment was a reduction of 25% or more in total Brief Psychiatric Rating Scale score.
RESULTS
Both LMP (p = 0.007) and CPZ (p = 0.030) improved TRS relative to baseline. Although there was no significant difference between the 2 groups in treatment response at study end point, hierarchical linear modelling of longitudinal outcome revealed a significant (p = 0.006) advantage of LMP over CPZ for the BPRS total score. Ten of 19 participants on LMP and 8 of 19 on CPZ met the criterion for treatment response, and 9 of the 18 responders did so on 200-700 mg/d phenothiazine. The mean dose of responders was 710 (standard deviation [SD] 265) mg/d (LMP) and 722 (SD 272) mg/d (CPZ). Akathisia was associated with a nonresponse to phenothiazines (p = 0.010). BPRS scores increased significantly on HAL (p = 0.006). Two of 19 participants on LMP and 5 of 19 on CPZ withdrew early from the study.
CONCLUSION
LMP and CPZ may be useful in the management of TRS. A modest advantage of LMP compared with CPZ was seen in longitudinal analysis. High doses of neuroleptics may contribute to TRS; reduction of neuroleptics to modest or moderate doses should be considered before categorizing a patient as treatment resistant.
Topics: Adult; Antipsychotic Agents; Chlorpromazine; Double-Blind Method; Drug Resistance; Female; Humans; Male; Methotrimeprazine; Middle Aged; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology
PubMed: 16862245
DOI: No ID Found -
Journal of Pain and Symptom Management Feb 1990Continuous subcutaneous infusions offer a safe, simple, effective alternative to intravenous or intramuscular injections when oral medications cannot be used. They are...
Continuous subcutaneous infusions offer a safe, simple, effective alternative to intravenous or intramuscular injections when oral medications cannot be used. They are extremely useful for cancer patients suffering from pain, vomiting, seizures, and other symptoms. Hydromorphone or morphine may be combined with metoclopramide, methotrimeprazine, or haloperidol (in D5W only), in the same pump to control both pain and nausea. Seizures can be controlled by subcutaneous infusion of phenobarbital or midazolam. If proper doses are prescribed and skin irritation is watched for, they can be used safely in the patient's home.
Topics: Analgesics; Analgesics, Opioid; Humans; Infusions, Parenteral; Nausea; Neoplasms; Pain, Intractable; Vomiting
PubMed: 1969887
DOI: 10.1016/s0885-3924(05)80007-7