THERAPEUTICS

Brands

• Serentil
• Lidanil see index for additional brand names

Generic?

• Yes

Class

• Conventional antipsychotic (neuroleptic, phenothiazine, dopamine 2 antagonist)

Commonly Prescribed For

• (bold for FDA approved)
• Management of schizophrenic patients who fail to respond adequately to treatment with other antipsychotic drugs

How The Drug Works

• Blocks dopamine 2 receptors, reducing positive symptoms of psychosis

How Long Until It Works

• Psychotic symptoms can improve within 1 week, but it may take several weeks for full effect on behavior

If It Works

• Is a second-line treatment option
• Should evaluate for switching to an antipsychotic with a better risk/benefit ratio

If It Doesn’t Work

• Consider trying one of the first-line atypical antipsychotics (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, amisulpride)
• Consider trying another conventional antipsychotic
• If 2 or more antipsychotic monotherapies do not work, consider clozapine

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Augmentation of mesoridazine has not been systematically studied and can be dangerous, especially with drugs that can prolong QTc interval

Tests

• Baseline ECG and serum potassium levels should be determined
• Periodic evaluation of ECG and serum potassium levels
• Serum magnesium levels may also need to be monitored
• Since conventional antipsychotics are frequently associated with weight gain, before starting treatment, weigh all patients and determine if the patient is already overweight (BMI 25.0–29.9) or obese (BMI ≥30)
• Before giving a drug that can cause weight gain to an overweight or obese patient, consider determining whether the patient already has pre-diabetes (fasting plasma glucose 100–125 mg/dl), diabetes (fasting plasma glucose >126 mg/dl), or dyslipidemia (increased total cholesterol, LDL cholesterol and triglycerides; decreased HDL cholesterol), and treat or refer such patients for treatment, including nutrition and weight management, physical activity counseling, smoking cessation, and medical management
• Monitor weight and BMI during treatment
• Consider monitoring fasting triglycerides monthly for several months in patients at high risk for metabolic complications and when initiating or switching antipsychotics
• While giving a drug to a patient who has gained >5% of initial weight, consider evaluating for the presence of pre-diabetes, diabetes, or dyslipidemia, or consider switching to a different antipsychotic
• Should check blood pressure in the elderly before starting and for the first few weeks of treatment
• Monitoring elevated prolactin levels of dubious clinical benefit
• Phenothiazines may cause false-positive phenylketonuria results