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Thiothixene is an antipsychotic agent of the thioxanthene series navane norvasc. It possessescertain chemical and pharmacologic similarities to the piperazine phenothiazinesand differences from the aliphatic group of phenothiazines navane norvasc. Thiothixene's modeof action has not been clearly established navane norvasc.

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Indications
An antipsychotic agent useful in the management of schizophrenia and other psychoticdisorders navane norvasc.

As with other antipsychotic agents, some patients resistant to previous medicationhave responded favorably to thiothixene navane norvasc. It may also be of value in the managementof withdrawn, apathetic schizophrenic patients navane norvasc.

Thiothixene is not recommended for the treatment of nonpsychotic mental andemotional disorders navane norvasc.

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Contraindications
Children:
Safety for use in children under 12 years of age has not yet been established navane norvasc.

Circulatory collapse, comatose states, CNS depression due to any cause andblood dyscrasias navane norvasc.

Known hypersensitivity to the drug navane norvasc. It is not known whether a cross sensitivitybetween the thioxanthenes and the phenothiazines exists, but this possibilityshould be considered navane norvasc.

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Warnings
Occupational Hazards:
As is true with many CNS drugs, thiothixene may impair the mental and/or physicalabilities required for the performance of potentially hazardous tasks such asdriving a car or operating machinery, especially during the first few days oftherapy navane norvasc. Therefore, the patient should be cautioned accordingly navane norvasc.

As in the case of other CNS-acting drugs, patients should be cautioned aboutthe possible additive effects (which may include hypotension) with CNS depressantsand with alcohol navane norvasc. Potentiation of CNS depressants (sedatives, tranquilizers,narcotic analgesics, antihistamines, anesthetics, alcohol), atropine and organophosphorusinsecticides, and reversal of epinephrine effect, have been observed with relateddrugs navane norvasc.

Pregnancy:
Safe use in pregnancy has not been established navane norvasc. It should, therefore, not beused in women of child-bearing potential unless, in the opinion of the physician,the expected benefits of the drug outweigh the potential hazard to the fetus navane norvasc.

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Precautions
In consideration of the known capability of thiothixene and certain other antipsycoticdrugs to precipitate convulsions, extreme caution should be used in patientswith a history of convulsive disorders or those in a state of alcohol withdrawal,since it may lower the convulsive threshold navane norvasc. Although the drug potentiates theactions of the barbiturates, the dosage of the anticonvulsant therapy shouldnot be reduced when it is administered concurrently navane norvasc.

Production or aggravation of ECG changes has occurred with thiothixene andtherefore caution should be observed when there is increased risk to the patient(see Adverse Effects) navane norvasc.

Though exhibiting rather weak anticholinergic properties, thiothixene shouldbe used with caution in patients who are known or are suspected to have glaucoma,and in those who might be exposed to extreme heat or who are receiving atropineor related drugs navane norvasc. Undue exposure to sunlight should be avoided navane norvasc. Photosensitivereactions have been reported in patients navane norvasc.

Careful observation should be made for pigmentary retinopathy, and lenticularpigmentation (fine lenticular pigmentation has been noted in a small numberof patients treated with thiothixene for prolonged periods) navane norvasc. Blood dyscrasias(agranulocytosis, pancytopenia, thrombocytopenic purpura), and liver damage(jaundice, biliary stasis), have been reported with related drugs navane norvasc.

Caution as well as careful adjustment of the dosages is indicated when thiothixeneis used in conjunction with other CNS depressants navane norvasc.

An antiemetic effect observed in animal studies may also occur in man; therefore,it is possible that thiothixene may mask signs of overdosage of toxic drugsand it may obscure conditions such as intestinal obstruction and brain tumor navane norvasc.

To lessen the likelihood of adverse reactions related to drug accumulation,patients on long-term therapy, particularly on high doses, should be evaluatedperiodically to decide whether the maintenance dosage could be lowered or drugtherapy discontinued navane norvasc. Periodic blood counts and liver function tests shouldbe performed navane norvasc. Sudden onset of severe CNS or vasomotor symptoms should be keptin mind navane norvasc.

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Adverse Effects
Since thiothixene has pharmacologic properties similar to those of the phenothiazines,all the known adverse reactions of that class of drugs should be borne in mindwhen it is used navane norvasc.

Behavioral:
The most common side effects are initial and transient drowsiness, restlessnessand agitation and insomnia navane norvasc. (The incidence of sedation appears to be similarto that of the piperazine group of phenothiazines, but less than that of certainaliphatic phenothiazines.)

Other adverse reactions reported less frequently are weakness or fatigue, excitement,depression and headache navane norvasc.

Psychic and motor hyperactivity may be desirable, except in an already agitatedand excited patient navane norvasc. Activation of psychotic symptomatology has been observed,but it usually responds to reduction of dosage or temporary discontinuationof the drug navane norvasc. Toxic confusional states may occur on rare occasions navane norvasc.

Neurological:
The incidence and nature of extrapyramidal symptoms, including akathisia, pseudo-parkinsonismand dystonic reactions, are similar to those encountered with the piperazinephenothiazines, but thiothixene is more likely to produce akathisia navane norvasc. They areusually controlled by reduction of dosage and/or administration of antiparkinsondrugs depending on the type and severity of symptoms navane norvasc. Cerebral seizures havebeen reported (see Precautions) navane norvasc. Phenothiazine derivatives have been associatedwith cerebral edema and cerebrospinal fluid abnormalities navane norvasc.

Hyperreflexia has been reported in infants delivered from mothers having receivedstructurally related drugs navane norvasc.

Tardive Dyskinesias:
As with all antipsychotic agents, tardive dyskinesia may appear in some patientson long-term therapy or may appear after drug therapy has been discontinued navane norvasc. The risk appears to be greater in elderly patients on high dose therapy, especiallyfemales navane norvasc. The symptoms are persistent and in some patients appear to be irreversible navane norvasc. The syndrome is characterized by rhythmical involuntary movements of the tongue,face, mouth or jaw (e.g navane norvasc. protrusion of tongue, puffing of cheeks, puckeringof mouth, chewing movements) navane norvasc. Sometimes these may be accompanied by involuntarymovements of extremities navane norvasc.

There is no known effective treatment for tardive dyskinesia; antiparkinsonianagents usually do not alleviate the symptoms of this syndrome navane norvasc. All antipsychoticagents should be discontinued if these symptoms appear navane norvasc. Should it be necessaryto reinstitute treatment, or increase the dosage of the agent, or switch toa different antipsychotic agent, the syndrome may be masked navane norvasc. The physician maybe able to reduce the risk of this syndrome by minimizing the unnecessary useof neuroleptics and reducing the dose or discontinuing the drug, if possible,when manifestations of this syndrome are recognized, particularly in patientsover the age of 50 navane norvasc. Fine vermicular movements of the tongue may be an earlysign of the syndrome navane norvasc. If the medication is stopped at that time, the syndromemay not develop navane norvasc.

Autonomic:
Dry mouth, blurred vision, nasal congestion, constipation, increased salivationand sweating, and impotence have occurred infrequently navane norvasc. Phenothiazines havebeen associated with miosis, mydriasis and adynamic ileus navane norvasc.

Cardiovascular:
Tachycardia, hypotension, lightheadedness, and syncope navane norvasc. (In the event hypotensionoccurs, epinephrine should not be used as a pressor agent since a paradoxicalfurther lowering of blood pressure may result.) Nonspecific ECG changes havebeen observed in some patients receiving thiothixene navane norvasc. These changes are usuallyreversible and frequently disappear on continued therapy navane norvasc. The clinical significanceof these changes is not known navane norvasc. Cardiac arrhythmias, including AV block, paroxysmaltachycardia and ventricular fibrillation have been observed with some phenothiazines navane norvasc.

Note:
Sudden deaths have occasionally been reported in patients who have receivedcertain phenothiazine derivatives navane norvasc. In some cases the cause of death was apparentlycardiac arrest or asphyxia due to failure of the cough reflex navane norvasc. In others, thecause could not be determined nor could it be established that death was dueto phenothiazine administration navane norvasc.

Endocrine:
Lactation, moderate breast enlargement and amenorrhea have occurred in a smallpercentage of females receiving thiothixene navane norvasc. If persistent, this may necessitatea reduction in dosage or the discontinuation of therapy navane norvasc. Phenothiazines havebeen associated with false positive pregnancy tests, gynecomastia, hypoglycemia,hyperglycemia, and glycosuria navane norvasc.

Allergic:
Rash, pruritus, urticaria, and rare cases of anaphylaxis have been reported navane norvasc. Undue exposure to sunlight should be avoided navane norvasc. Although not experienced withthiothixene, exfoliative dermatitis, contact dermatitis (in nursing personnel),have been reported with certain phenothiazines navane norvasc.

Hematologic:
As is true with certain other antipsychotic drugs, leukopenia and leukocytosis,which are usually transient, can occur occasionally navane norvasc. Other antipsychotic drugshave been associated with agranulocytosis, eosinophilia, hemolytic anemia, thrombocytopeniaand pancytopenia navane norvasc.

Hepatic:
Elevations of serum transaminase and alkaline phosphatase, usually transient,have been infrequently observed in some patients navane norvasc. No clinically confirmed casesof jaundice attributable to the drug have been reported navane norvasc.

Ophthalmological:
Fine lenticular pigmentation after prolonged therapy navane norvasc.

Miscellaneous:
Hyperpyrexia, anorexia, nausea, vomiting, diarrhea, increase in appetite andweight, weakness or fatigue, polydipsia and peripheral edema navane norvasc. Although not reportedwith thiothixene, evidence indicates there is a relationship between phenothiazinetherapy and the occurrence of a systemic lupus erythematosus-like syndrome navane norvasc.

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