22 Phoenix RisingpboeOlXpbar
ness, and syncope. In the event hypotension occurs, epinephrine 23should not be used as a pressor agent since a paradoxical furtherlowering <strong>of</strong> blood pressure may result. Nonspecific EKG changeshave been observed in som~ patients receiving Navane. Thesechanges are usually reversible and frequently disappear oncontinued Navane therapy. The incidence <strong>of</strong> these changes is lowerthan that observed with some phenothiazines. The clinicalsignificance <strong>of</strong> these changes is not k.nown.eNS effects: Drowsiness. usually mild, may occur although itusually subsides. with continuation <strong>of</strong> Navane therapy. Theincidence <strong>of</strong> sedation appears similarto that <strong>of</strong> the piperazine group<strong>of</strong> phenothiazines. but less than that <strong>of</strong> certain aliphaticphenothiazines. Restlessness, agitation and insomnia have beennoted with Navane (thiothixene). Seizures and paradoxical exacer'bation <strong>of</strong> psychotic symptoms have occurred with Navaneinfrequently.Hyperreflexia has been reported in infants delivered frommothers having received structurally related drugs.In addition. phenothiazine derivatives have been associatedwith cerebral edema and cerebrospinal fluid abnonnalities.Extrapyramidal symptoms, such as pseudo-parkinsonism.akathisia. and dystonia have been reported. Management <strong>of</strong> these:extrapyramidal symptoms depends upon the type and severity.Rapid relief <strong>of</strong> acute symptoms may require the use <strong>of</strong> an injectableantiparkinson agent. More slowly emerging symptoms may bemanaged by reducing the dosage <strong>of</strong> Navane and/or administeringan ontl anti parkinson agent.Persistent Tardive Dyskinesia: As with all antipsychotic agentstardive dyskinesia may appear in some patients on long tenntherapy or may occur after drug therapy has been discontinued. Therisk seems to be greater in elderly patients on high-dose therapy.especially females. The symptoms are persistent and in somepatients appear to be irreversible. The syndrome is characterizedby rhythmical involuntary movements <strong>of</strong> the tongue. face, mouthor jaw (e.g .• protrusion <strong>of</strong> tongue, puffing <strong>of</strong> cheeks. puckering <strong>of</strong>mouth, chewing movements). Sometimes these may be accompaniedby involuTHary movements <strong>of</strong> extremities.There is no known effective treatment for tardive dyskinesia:antiparkinsonism agents usually do not alleviate the symptoms <strong>of</strong>this syndrome. It is suggested that all antipsychotic agents bediscontinued if these symptoms appear.Should it be necessary to reinstitute treatment, or increase thedosage <strong>of</strong> the agent. or switch to adifferent antipsychotic agent. thesyndrome may be masked.It has been reported that fine vennicular movements <strong>of</strong> thetongue may be an early sign <strong>of</strong> the syndrome and if the medicationis stopped at that time, the syndrome may not develop.Hepatic effects: Elevations <strong>of</strong> serum transaminase and alkalinephosphatase, usually transient. have been infrequently observed insome patients, No clinically confirmed l'ases <strong>of</strong> jaundice attributableto Navane have been reported.Hematologic effects: As is true with certain other psychotropicdrugs, leukopenia and leukocytosis. which are usually transient.,can occur occasionally with Navane. Other antipsychotic drugshave been associated with agranulocytosis. eosinophilia. hemolyticanemia. thrombocytopenia and pancytopenia.Allergic reactions: Rash. pruritus, urticaria. photosensitivityand rare cases <strong>of</strong> anaphylaxis have been reported with Navane.Undue exposure to sunlight should be avoided. Although notexperienced with Navane, exfoliative dennatitis and contactdennatitis (in nursing personnel) have been reported with certainphenothiazines.Endocrine disorders: Lactation. moderate breast enlargementand amenorrhea have occurred in a small percentage <strong>of</strong> femalesreceiving Navane, If persistent, this may necessitate a reduction indosage or the discontinuation <strong>of</strong>therapy. Phenothiazines have beenassociated with false positive pregnancy tests, gynecomastia.hypoglycemia. hyperglycemia, and glycosuria.Autonomic effects: Dry mouth. blurred vision, nasal congestion,constipation. increased sweating, increased salivation, andimpotence have occurred infrequently with Navane therapy,Phenothiazines have been associated with miosis. mydriasis. andadynamic ileus.Other\adverse reactions: Hyperpyrexia. anorexia. nausea.vomiting. diarrhea. increase in appetite and weight, weakness orfatigue, polydipsia and peripheral edema.Although not reported with Navane. evidence indicates there is areJationship between phenothiazine therapy and the occurrence <strong>of</strong>a systemic lupus erythematosus· like syndrome.NOTE: Sudden deaths have occasionally been reported 10patients who have received certain phenothiazine derivatives, Insome cases the cause <strong>of</strong> death was apparently cardiac arrest orasphyxia due to failure <strong>of</strong> the cough reflex. In others. the causecould not be determined nor could it be established that death wasdue to phenothiazineadministration.Introducing ...Navane®(thiothixene Hel)IntramuscularFor Injection ~5mg/ml
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