Thioridazine

What is Thioridazine

Thioridazine is a piperidine phenothiazine that is structurally similar to mesoridazine, which is one of its metabolites.

It is used to treat psychotic disorders such as schizophrenia.

Thioridazine can produce a variety of cardiovascular adverse reactions, including dose-related QT prolongation and torsade de pointes (TdP).  

Because of the potential for cardiovascular risks, the manufacturer recommends that therapy with thioridazine be reserved for patients who have failed to respond to adequate courses of treatment with at least 2 other antipsychotics, either because of inadequate efficacy or intolerable side effects.

As with all antipsychotics, the product label includes a boxed warning regarding an increased mortality risk in elderly patients with dementia-related psychosis. Thioridazine was originally approved by the FDA in 1959.

Brand Names

  • Mellaril
  • Mellaril-S

Indications & Dosage

  • behavioral or psychological symptoms of dementia
  • schizophrenia

For the treatment of schizophrenia in patients who fail to respond adequately to treatment with other antipsychotics

Side Effects

  1. agranulocytosis
  2. akathisia
  3. amenorrhea
  4. anaphylactoid reactions
  5. angioedema
  6. anorexia
  7. aplastic anemia
  8. appetite stimulation
  9. asphyxia
  10. atopic dermatitis
  11. blurred vision
  12. bradycardia
  13. breast enlargement
  14. bronchospasm
  15. cardiac arrest
  16. cerebral edema
  17. cholestasis
  18. confusion
  19. constipation
  20. contact dermatitis
  21. corneal opacification
  22. diarrhea
  23. dizziness
  24. drowsiness
  25. dysphagia
  26. dystonic reaction
  27. ejaculation dysfunction
  28. eosinophilia
  29. erythema
  30. exfoliative dermatitis
  31. fever
  32. galactorrhea
  33. glycosuria
  34. gynecomastia
  35. headache
  36. hemolytic anemia
  37. hepatitis
  38. hyperglycemia
  39. hyperhidrosis
  40. hyperprolactinemia
  41. hypersalivation
  42. hypertension
  43. hyperthermia
  44. hypoglycemia
  45. hyponatremia
  46. hypotension
  47. hypothermia
  48. ileus
  49. impotence (erectile dysfunction)
  50. infertility
  51. jaundice
  52. laryngeal edema
  53. lethargy
  54. leukopenia
  55. libido decrease
  56. lupus-like symptoms
  57. mastalgia
  58. menstrual irregularity
  59. miosis
  60. myasthenia
  61. mydriasis
  62. nasal congestion
  63. nausea
  64. neuroleptic malignant syndrome
  65. neutropenia
  66. orthostatic hypotension
  67. pallor
  68. pancytopenia
  69. parotitis
  70. peripheral edema
  71. photosensitivity
  72. polydipsia
  73. polyuria
  74. priapism
  75. pruritus
  76. pseudoparkinsonism
  77. psychosis
  78. purpura
  79. QT prolongation
  80. retinopathy
  81. seborrhea
  82. seizures
  83. SIADH
  84. sinus tachycardia
  85. skin hyperpigmentation
  86. stroke
  87. tardive dyskinesia
  88. thrombocytopenia
  89. torsade de pointes
  90. urinary incontinence
  91. urinary retention
  92. urticaria
  93. ventricular tachycardia
  94. visual impairment
  95. vomiting
  96. water intoxication
  97. weight gain
  98. xerostomia

Monitoring Parameters

  • AIMS assessment
  • CBC
  • ECG
  • ophthalmologic exam
  • serum potassium
  • serum prolactin

Contraindications

  • abrupt discontinuation
  • accidental exposure
  • agranulocytosis
  • alcoholism
  • ambient temperature increase
  • angina
  • anticholinergic medications
  • bone marrow suppression
  • bradycardia
  • breast cancer
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • chemotherapy
  • children
  • closed-angle glaucoma
  • CNS depression
  • coadministration with other CNS depressants
  • coma
  • coronary artery disease
  • dehydration
  • dementia
  • dental work
  • diabetes mellitus
  • driving or operating machinery
  • dysphagia
  • encephalopathy
  • ethanol ingestion
  • females
  • fever
  • geriatric
  • GI obstruction
  • head trauma
  • heart failure
  • hematological disease
  • hepatic disease
  • hyperprolactinemia
  • hypertension
  • hyperthermia
  • hypokalemia
  • hypomagnesemia
  • hypotension
  • hypothermia
  • hypovolemia
  • ileus
  • infants
  • infection
  • infertility
  • intracranial mass
  • jaundice
  • labor
  • leukopenia
  • long QT syndrome
  • malnutrition
  • myocardial infarction
  • neonates
  • neurological disease
  • neutropenia
  • obstetric delivery
  • ocular disease
  • orthostatic hypotension
  • Parkinson’s disease
  • phenothiazine hypersensitivity
  • pregnancy
  • pregnancy testing
  • prostatic hypertrophy
  • pulmonary disease
  • QT prolongation
  • radiographic contrast administration
  • renal failure
  • Reye’s syndrome
  • seizure disorder
  • seizures
  • strenuous exercise
  • stroke
  • suicidal ideation
  • sunlight (UV) exposure
  • surgery
  • tardive dyskinesia
  • thyroid disease
  • tobacco smoking
  • torsade de pointes
  • urinary retention
  • vomiting

Interactions

  • Abarelix
  • Abiraterone
  • Acarbose
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Propoxyphene
  • Acetaminophen; Tramadol
  • Acetohexamide
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  • food
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  • Timolol
  • tobacco
  • Tobramycin
  • Tocilizumab
  • Tolazamide
  • Tolbutamide
  • Tolterodine
  • Topiramate
  • Toremifene
  • Tramadol
  • Tranylcypromine
  • Trazodone
  • Tretinoin, ATRA
  • Triazolam
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimethobenzamide
  • Trimipramine
  • Triprolidine
  • Triptorelin
  • Trospium
  • Valproic Acid, Divalproex Sodium
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Venlafaxine
  • Verteporfin
  • Vigabatrin
  • Vilazodone
  • Voriconazole
  • Vorinostat
  • Zaleplon
  • Ziconotide
  • Ziprasidone
  • Zolpidem
  • Zonisamide
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