Trihexyphenidyl + Chlorpromazine + Trifluoperazine Pharmacology
Trihexyphenidyl + Chlorpromazine + Trifluoperazine
Trihexyphenidyl
Trihexyphenidyl produces Mydriasis, increase the heart rate and spasmolytic action on smooth muscles. It decreases sweating and salivation.
Distribution: It crosses the blood brain barrier.
Excretion: It is excreted in urine.
2. Nausea
3. Vomiting
4. Constipation
5. Abdominal cramps
6. Dizziness
7. Headache
8. Nervousness
9. Drowsiness
10. Blurred vision
11. Irritability
12. Tachycardia
13. Urinary retention
14. Mydriasis
15. Increased intraocular pressure
2. Hepatic impairment
3. Cardiac impairment
4. Gastrointestinal obstructive disease
5. Genitourinary obstructive disease
6. Glaucoma
7. Prostatic hyperplasia
8. Slowly withdraw the drug with caution
9. Patient should be cautioned about driving a vehicle operating a machine or involving in any hazardous activities
NEONATES : Contraindicated
Digoxin: Serum levels of digoxin increased when given orally as a slow dissolution tablet.
Haloperidol: Decreased Haloperidol serum concentration may result in worsening of schizophrenic symptoms; also development of tardive dyskinesia.
Levodopa: Efficacy of levodopa may be reduced.
Idiopathic Parkinsonism: initial dose: 1mg / day gradually increase the dose every 3 - 5 days up to 10 - 15 mg /day in 3 - 4 divided doses.
Post encephalitic Parkinsonism: 12 - 15 mg / day in divided doses.
Drug induced Parkinsonism: 5- 15 mg / day in divided doses
Chlorpromazine
Antiemetic action: Chlorpromazine exerts its antiemetic action by blocking the dopamine receptor in the medullary chemoreceptor trigger zone.
Antimigraine action: Chlorpromazine has been used in migraine to control severe nausea and vomiting unresponsive to Antiemetics and to relieve the pain of severe migraine attacks unresponsive to parenteral Dihydroergotamine or Sumatriptan.
Anaesthetic adjuncts: It is used as anaesthetic adjunct since it allays anxiety, smoothen induction and produce antiemetic action.
2.Extrapyramidal reactions
3.Drowsiness
4.Sedation
5.Dizziness
6.Hypotension
7.Dry mouth
8.Constipation
9.Blurred vision
10.Agranulocytosis
11.Photosensitivity
12.Insomnia
13.Urine retention
14.Cholestatic jaundice
15.Aplastic anaemia
16.Pain at injection site.
2.Comatose
3.Bone marrow depression
4.Depression
2.Hepatic impairment
3.Cardiovascular disease
4.Glaucoma
5.Hypocalcaemia
6.Epilepsy
7.Respiratory disorder
8.Prostatic hyperplasia
9.Ceribrovascular disorder
10.Patient on ECT
11.Reaction to Insulin
12.Patient exposed to extreme heat or cold or phosphorus insecticides
13.Slowly withdraw the drug with caution
CHILDREN (below 6 months): Contraindicated
2.Nausea and vomiting
3.Relief of apprehension and restlessness before surgery
4.Acute intermittent Porphyria
5.Intractable hiccups
6.Manic depressive illness
7.Behavioral problems in children
Aluminium salts: Decrease efficacy. Antacids should be given 1 hour before or 2 hours after chlorpromazine administration.
Anticholinergics: Decrease efficacy and increase the anticholinergic side effects of chlorpromazine.
Barbiturates: Decreases efficacy.
Barbiturate anaesthetics: Increase frequency and severity of neuromuscular excitation and hypotension.
Bromocriptine: Efficacy decreased by chlorpromazine.
Charcoal: Prevents absorption of chlorpromazine.
Epinephrine, Norepinephrine: Pressor effect decreased, peripheral vasoconstrictive effect antagonised.
Lithium: Disorientation, unconsciousness and extrapyramidal symptoms.
Meperidine: Excessive sedation and hypotension.
TCAs: Serum concentration increased by chlorpromazine.
Valproic acid: Efficacy potentiated.
Propranolol: Increased plasma levels of both drugs.
MAOIs: Additive orthostatic hypotensive effect.
Lab. Tests: Pregnancy tests: False positive results.
Plasma bound iodine (PBI): Increase in PBI occurs.
Psychoses: 25 mg 3 times a day. Dose can be gradually increased up to 800 mg / day
Maintenance dose: 75 - 300 mg / day in 3 divided doses
Nausea and vomiting: 40 - 100 mg / day in 4 divided doses. Dose can be increased if necessary.
Relief of apprehension and restlessness before surgery: 25 - 50 mg given 2 - 3 hour before surgery. If necessary the drug can be given during surgery dose is 12.5 mg as IM injection.
Acute intermittent Porphyria, Intractable hiccups: 25 - 50 mg every 6 - 8 hourly
Migraine: 12.5 mg as IV and is repeated every 20minutes up to 37.5 mg
Children:
Behavioral problems in children: 0.55 mg/ kg/ dose 4 - 6 times a day. Dose can be increased depending on the severity of patient`s condition
Trifluoperazine
Antiemetic activity: Antiemetic activity is by blocking dopamine receptor (D2 receptor) in the Chemoreceptor trigger zone (CTZ)
Distribution: It is distributed widely in the body in protein bound form.
Metabolism: It is metabolised in the liver.
Excretion: It is excreted mainly through urine. Small amount of drug is excreted through faeces and breast milk.
2. Extrapyramidal reactions
3. Drowsiness
4. Sedation
5. Dizziness
6. Hypotension
7. Dry mouth
8. Constipation
9. Blurred vision
10. Agranulocytosis
11. Photosensitivity
12. Insomnia
13. Weight gain
14. Cholestatic jaundice
2. Comatose
3. Blood dyscrasias
4. Patient taking antidepressants
5. Liver damage
2. Hepatic impairment
3. Cardiovascular disease
4. Pheochromocytoma
5. Hypocalcaemia
6. Epilepsy
7. Cholestatic jaundice
8. Patient exposed to extreme heat or cold or phosphorus insecticides
9. Ceribrovascular disorder
10. Patient on ECT
11. Reaction to Insulin
12. Prostatic hyperplasia
13. Glaucoma
14. Peptic ulcer, slowly withdraw the drug with caution
2. Schizophrenia
3. Antiemetic
4. Anxiety
5. Behavioural disturbances
6. Mania
Almunium Salts: Decrease efficacy. Antacids should be given 1 hour before or 2 hours after chlorpromazine.
Anticholinergics: Decrease efficacy and increase the anticholinergic side effects of chlorpromazine.
Barbiturates: Decreases efficacy.
Barbiturate anaesthetics: Increase frequency and severity of neuromuscular excitation and hypotension.
Bromocriptine: Efficacy decreased by chlorpromazine.
Charcoal: Prevents absorption of chlorpromazine.
Epinephrine, Norepinephrine: Pressor effect decreased, peripheral vasoconstrictive effect antagonised.
Lithium: Disorientation, unconsciousness and extra-pyramidal symptoms.
Meperidine: Excessive sedation and hypotension.
TCAs: Serum concentration increased by chlorpromazine.
Valproic acid: Efficacy potentiated.
Propranolol: Increased plasma levels of both drugs.
MAOIs: Additive orthostatic hypotensive effect.
Lab. Tests: Pregnancy tests: False positive results.
Plasma bound iodine (PBI): Increase in PBI occurs.
Psychoses, Schizophrenia
Out patients: 2 - 4 mg / day in 2 divided doses. Dose can be increased depending on the severity of the disease.
Inpatients: 4 - 10 mg / day in 2 divided doses. Dose can be gradually increased up to 40 mg / day.
Antiemetic, Anxiety: 1 - 2 mg twice daily. Dose can be increased up to 6 mg / day in some case.
Children:
Psychoses, Schizophrenia: 1 - 2 mg / day. Dose can be gradually increased up to 15 mg / day.
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