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[[Category: Drugs]][[Category: Conventional Antipsychotic]]
[[Category: Drugs]][[Category: Typical Antipsychotic ]]
'''Pericyazine'''(中文:[[哌氰嗪]]) is a typical antipsychotic medication. Periciazine is indicated:
#In adults with schizophrenia or other psychoses, for the treatment of symptoms or prevention of relapse.
#As a short-term adjuntive management of severe anxiety, and violent or dangerously impulseive behavior.
Periciazine is not recommended for children.


==Pronunciation==
[[:Category: Antipsychotic Drug | '''Antipsychotic Drug''']]
===Pericyazine 10mg===
[[File:Pericyazine 10mg.mp3]]


===Pericyazine 2.5mg===
'''Drug class: [[:Category: Typical Antipsychotic  | Typical Antipsychotic]]
[[File:Pericyazine 2.5mg.mp3]]


==Drug Names==
'''Pericyazine (NEULACTIL)''' (中文: [[吩噻嗪類]])
{| class="wikitable"
==Common Strengths of Pericyazine Tablet==
!Generic Name 藥名
Pericyazine are available in the following strengths:
!HA Code 藥物代碼
*Tablets: 2.5 mg, 10 mg
!Classification藥物分類
 
|-
==Drug Trade Names of Pericyazine Tablet==
|Pericyazine Tab 2.5 mg
Neulactil
|PERI01
 
|P1S1S3
==Drug Usage==
|-
Treatment of schizophrenia and other psychotic disorders
|Pericyazine Tab 10 mg
|PERI02
|P1S1S3
|}


==Mechanism of Action==
==Mechanism of Action==
Pericyazine is presumed to act primarily in the subcortical areas, by blocking central alpha-adrenergic receptors and the D1 dopamine receptor.
Pericyazine acts by:
The presumed effectiveness of antipsychotic drugs relied on their ability to block dopamine receptors. This assumption arose from the dopamine hypothesis that maintains that both schizophrenia and bipolar disorder are a result of excessive dopamine activity.
*Blocking dopamine D<sub>1</sub> receptors
*Blocking alpha-1 and alpha-2 adrenergic receptors
 
==Route of Administration==
Oral
 
==Dosages==
For adults with schizophrenia or other severe psychoses:
*Initial dose: 75 mg daily in divided doses
*Increase by 25 mg per day at weekly intervals until optimal effects is achieved
*Maximum dose: Usually not more than 300 mg per day


==Dosage==
==Side Effects==
{| class="wikitable"
{| class="wikitable"
!style="text-align: left"| Indication
!style="text-align: left"| Frequency
!style="text-align: left"| Dose
!Adverse reactions
|-
| rowspan="6" | '''Common
| Drowsiness and dizziness
|-
|-
!style="text-align: left"| Schizophrenia and other psychoses
| Dry mouth: can often be managed by chewing sugar-free gum or sucking on sugar-free sweets
|By ''mouth
ADULT:
*Initially 75 mg daily in divided doses,
*Increased at weekly intervals by 25 mg, according to response.
*Maximum 300 mg per day.
ELDERLY or debilitated patients:
*Initially 15-30 mg daily in divided doses, then
*Increased at weekly intervals by 25 mg, according to response.
*Maximum 300 mg per day
|-
|-
!style="text-align: left"| Short-term adjunctive management of severe anxiety,
| Nausea and vomiting
and violent or dangerously impulse behaviour
|-
|By ''mouth
| Constipation or diarrhea
ADULT:
|-
*15-30 mg daily in 2 divided doses
| Orthostatic hypotension
ELDERLY or debilitated patients:
|-
*5-10 mg 2-3 daily in 2 divided doses
| Photosensitivity: Increased sensitivity to sunlight, requiring protective measures like sunscreen and avoiding sunbeds
|}
 
==Side Effects==
Most serious and/or frequently occurring adverse effects of periciazine include the following:
Possible side effects include:
{| class = "wikitable"
| Behavioral:
|
*Drowsiness is common at the start of treatment, but this effect usually eases off within a few days.
*Impaired psychomotor activity is a frequent side-effect.
|-
|-
|Hepatic:
| rowspan="7" | '''Serious
|
| Neuroleptic Malignant Syndrome (NMS): A rare but potentially life-threatening condition characterized by muscle stiffness, high fever, confusion, fast heartbeat, and sweating. Immediate medical intervention is necessary if these symptoms occutr
*Jaundice occurs in a very small percentage of patients. Treatment should be withheld on the development of jaundice
|-
|-
|Cardiovascular:
| Extrapyramidal symptoms: These include uncontrolled muscle movements, particularly of the face, jaw, neck, and mouth
|
*Postural hypotension commonly occurs, especially in the elderly.
|-
|-
|Haematological:
| Blood disorders: Conditions like leucopenia (low white blood cell count) and agranulocytosis (severe reduction in white blood cells) can increase susceptibility to infections
|
*Agranulocytosis may occur rarely.
*The occurrence of unexplained infections or fever requires immediate haematological investigation.
|-
|-
|Nervous system:
| Venous thromboembolism (VTE): Including deep vein thrombosis and pulmonary embolism, which can be fatal
|
Extrapyramidal effects include:
*Acute dystonia, akathisia
*Parkinsonism shown as tremor, rigidity, akinesia, is more common in the elderly
|-
|-
|Tardive Dyskinesia
| Liver issues: Symptoms such as jaundice (yellowing of the skin or eyes) indicating liver damage
|
*It may appear in patients on long term therapy.
*The risk appears to be greater in elderly patients on high dose therapy, especially females.
*It is characterized by rhythmical involuntary movement of tongue, face, mouth, or jaw (e.g. protrusion of tongue, puffing of cheeks, puckering of mouth, chewing movements).
|-
|-
|Neuroleptic Malignant Syndrome:
| Severe allergic reactions: Signs include rash, itching, fever, difficulty breathing, and swelling of the face, lips, or throat
|
*A potentially fatal syndrome.
*It is characterized by muscular rigidity, fever, hyperthermia, and autonomic instability (e.g. tachycardia, labile blood pressure, profuse sweating, dyspnoea)
|-
|-
|Skin:
| QT prolongation leading to dangerous heart arrhythmias
|
*Owing to contact skin hypersensitivity should avoid direct contact with the drug,
*Because of the risk of photosensitization, patients should be advised to avoid exposure to direct sunlight and that retinal changes may occur.
|}
|}


==Pharmacokinetics==
==Pharmacokinetics==
{|class="wikitable"
*Metabolism: Pericyazine undergoes extensive hepatic metabolism.  
!style="text-align: left"| Oral bioavailability
*Elimination: The drug and its metabolites are primarily excreted in the urine, with some elimination occurring through feaces
|Haloperidol is readily absorbed after oral doses.
*Elimination half-life: Approximately 12 hours
|-
 
!style="text-align: left"| Onset of action
The onset of action for pericyazine typically occurs within 1-2 hours after oral administration. This relatively quick onset is due to its rapid absorption from the gastrointestinal tract.
|Peak plasma concentrations achieve about 2 hours after ingestion.
|-
!style="text-align: left"| Metabolism
|It is extensively metabolized in the liver
|-
!style="text-align: left"| Elimination half-life
|
It is excreted in the urine and faeces.


The elimination half-life is approximately 12 hours.
The duration of pericyazine's effects is approximately 12 hours.


There is high inter-patient variability
==Drug Precautions==
|}
'''Pregnancy


==Drug Management==
Use only if clearly needed; potential risk to the fetus, especially in the third trimester
===Monitoring===
*Full blood count, serum potassium, and liver function test is required at the start of therapy, and then annually thereafter.
*Fasting blood glucose should be monitored at start of therapy, at 4-6 months, and then yearly
*Blood pressure and BMI
*Patients on long-term treatment should receive regular eye examinations.
*Careful monitoring is required in the elderly who are particularly susceptible to postural hypotension, sedation, and extrapyramidal effects, chronic constipation, and possible prostatic hypertrophy.


===Drug interaction===
'''Breastfeeding
The metabolism of pericyazine is mediated by the cytochrome P450 system, particularly the isoenzymes CYP3A4 and CYP2D6. Therefore, there is the potential for interactions between pericyazine and other drugs that induce, inhibit, or act as a substrate for these isoenzymes, resulting in altered plasma pericyazine concentrations.


{| class="wikitable"
Not recommended; potential risk to the infant
!Drugs given with pericyazine
!Potential Effect
|-
|style="text-align: left"|
*CNS-depressant drugs including alcohol, hypnotics, anxiolytics, sedative H1 antihistamines, central antihypertensives, baclofen, thalidomide and opioids.
|
Potentiates the sedative effect.
Impaired vigilance may make it dangerous to drive or use machines.
|-
|style="text-align: left"|
*Lithium
|Might increase the risk of lithium poisoning or neuroleptic malignant syndrome. Regular monitoring of serum lithium should be performed.
|-
|style="text-align: left"|
*Tricyclic antidepressants such as amitriptyline, a CYP2D6 substrate, and pericyazine is potent inhibitor of CYP2D6.
|Metabolism and elimination of tricyclics significantly decreased, increased toxicity such as anticholinergic and cardiovascular side effects.
|-
|style="text-align: left"|
*Levodopa
|In theory, antipsychotics with dopamine-blocking activity and dopaminergic drugs such as those used to treat parkinsonism may be mutually antagonistic.
|-
|style="text-align: left"|
*Drugs that prolong the QT interval e.g. amiodarone, sotalol, quinidine
*Drugs which induce bradycardia e.g. diltiazem, verapamil
*Drugs which can cause hypokalaemia such as diuretics e.g. frusemide
|
*An increased risk of ventricular arrhythmias – avoid concomitant use.
|}


===Caution===
'''Children and Elderly
*In those with renal dysfunction, epilepsy, Parkinson’s disease, hypothyroidism, cardiac failure and myasthenia gravis.
*Children: Not recommended for children under 1 year old; use with caution in older children
*In patients with impaired liver
*Elderly: Start at lower doses and titrate slowly due to increased sensitivity to side effecrs
*In patients with cardiovascular disorders, bradycardia, hypokalaemia or prolongation of QT, because of a risk of worsening of long QT-syndrome, which may also elevate the risk of tachycardia and sudden death.
*Concomitant use with QT prolonging drugs should be avoided
*In epileptics due to a possible lowering of the seizure threshold. The occurrence of convulsive seizures necessitates the discontinuation of treatment.


===Contra-indications===
'''Monitoring Requirements
Use of pericyazine should be avoided in individuals with:
*Blood pressure
*CNS depression
*Complete blood count
*Comatose states
*Liver function tests
*Risk of angle-closure glaucoma
*ECG in patients at risk of QT prolongation
*Parkinson’s disease
*Phaeochromocytoma
*Prostatic hypertrophy


===Hepatic impairment===
'''Drug Interactions
*Pericyazine is hepatotoxic; can precipitate coma.
*Increased CNS depression with alcohol, barbiturates, opioids
*Increased risk of arrhythmias with drugs that prolong QT interval
*Decreased effectiveness of levodopa
*Increased risk of extrapyramidal symptoms with metoclopramide


===Renal impairment===
==FAQ==
*Avoid in renal impairment.
'''How Should I Take the Tablet?


===Pregnancy===
Take orally, usually twice daily in the morning and evening
Should be avoided in pregnancy.


===Breast-feeding===
'''What Should I Avoid While Taking?
Use during breast feeding is not recommended.


===Driving and skilled tasks===
Avoid alcohol, driving, or operating machinery until you know how it affects you. Avoid excessive sun exposure
Drivers and machine operators should be told about the risk of drowsiness with this medication especially at the start of treatment. Affected patients should not drive or operate machinery.


== FAQ ==
'''What Happens if I Miss a Dose?
===How should I take the tablet?===
You will be prescribed the lowest dose needed to control your symptoms. Take with food. Food reduces irritation.
===What should I avoid while taking?===
Avoid drinking alcohol while taking pericyazine because it may enhance the side effects of sedation.


Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.
Take as soon as you remember. If it is close to the next dose, skip the missed dose. Do not double up.
=== What happen if I overdose? ===
Contact your primary care doctor.
If emergency situation, call 999
=== What happen if I miss a dose? ===
Take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Latest revision as of 21:06, 31 July 2024


Antipsychotic Drug

Drug class: Typical Antipsychotic

Pericyazine (NEULACTIL) (中文: 吩噻嗪類)

Common Strengths of Pericyazine Tablet[edit]

Pericyazine are available in the following strengths:

  • Tablets: 2.5 mg, 10 mg

Drug Trade Names of Pericyazine Tablet[edit]

Neulactil

Drug Usage[edit]

Treatment of schizophrenia and other psychotic disorders

Mechanism of Action[edit]

Pericyazine acts by:

  • Blocking dopamine D1 receptors
  • Blocking alpha-1 and alpha-2 adrenergic receptors

Route of Administration[edit]

Oral

Dosages[edit]

For adults with schizophrenia or other severe psychoses:

  • Initial dose: 75 mg daily in divided doses
  • Increase by 25 mg per day at weekly intervals until optimal effects is achieved
  • Maximum dose: Usually not more than 300 mg per day

Side Effects[edit]

Frequency Adverse reactions
Common Drowsiness and dizziness
Dry mouth: can often be managed by chewing sugar-free gum or sucking on sugar-free sweets
Nausea and vomiting
Constipation or diarrhea
Orthostatic hypotension
Photosensitivity: Increased sensitivity to sunlight, requiring protective measures like sunscreen and avoiding sunbeds
Serious Neuroleptic Malignant Syndrome (NMS): A rare but potentially life-threatening condition characterized by muscle stiffness, high fever, confusion, fast heartbeat, and sweating. Immediate medical intervention is necessary if these symptoms occutr
Extrapyramidal symptoms: These include uncontrolled muscle movements, particularly of the face, jaw, neck, and mouth
Blood disorders: Conditions like leucopenia (low white blood cell count) and agranulocytosis (severe reduction in white blood cells) can increase susceptibility to infections
Venous thromboembolism (VTE): Including deep vein thrombosis and pulmonary embolism, which can be fatal
Liver issues: Symptoms such as jaundice (yellowing of the skin or eyes) indicating liver damage
Severe allergic reactions: Signs include rash, itching, fever, difficulty breathing, and swelling of the face, lips, or throat
QT prolongation leading to dangerous heart arrhythmias

Pharmacokinetics[edit]

  • Metabolism: Pericyazine undergoes extensive hepatic metabolism.
  • Elimination: The drug and its metabolites are primarily excreted in the urine, with some elimination occurring through feaces
  • Elimination half-life: Approximately 12 hours

The onset of action for pericyazine typically occurs within 1-2 hours after oral administration. This relatively quick onset is due to its rapid absorption from the gastrointestinal tract.

The duration of pericyazine's effects is approximately 12 hours.

Drug Precautions[edit]

Pregnancy

Use only if clearly needed; potential risk to the fetus, especially in the third trimester

Breastfeeding

Not recommended; potential risk to the infant

Children and Elderly

  • Children: Not recommended for children under 1 year old; use with caution in older children
  • Elderly: Start at lower doses and titrate slowly due to increased sensitivity to side effecrs

Monitoring Requirements

  • Blood pressure
  • Complete blood count
  • Liver function tests
  • ECG in patients at risk of QT prolongation

Drug Interactions

  • Increased CNS depression with alcohol, barbiturates, opioids
  • Increased risk of arrhythmias with drugs that prolong QT interval
  • Decreased effectiveness of levodopa
  • Increased risk of extrapyramidal symptoms with metoclopramide

FAQ[edit]

How Should I Take the Tablet?

Take orally, usually twice daily in the morning and evening

What Should I Avoid While Taking?

Avoid alcohol, driving, or operating machinery until you know how it affects you. Avoid excessive sun exposure

What Happens if I Miss a Dose?

Take as soon as you remember. If it is close to the next dose, skip the missed dose. Do not double up.

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