MOLINDONE HYDROCHLORIDE

MOLINDONE HYDROCHLORIDE
(moe-lin'done)
Moban
Classifications: psychotherapeutic; antipsychotic, phenothiazine;
Therapeutic: antipsychotic

Prototype: Chlorpromazine
Pregnancy Category: C

Availability

5 mg, 10 mg, 25 mg, 50 mg, 100 mg tablets; 20 mg/mL liquid

Action

Phenothiazine antipsychotic thought to block postsynaptic dopamine receptors in the brain. Has less sedative but greater incidence of extrapyramidal adverse effects than chlorpromazine. EEG studies suggest ascending reticular system is chief site of action.

Therapeutic Effect

Reportedly lowers convulsive threshold and produces tranquilization without compromising alertness. Antipsychotic effect includes reduction in bizarre behavior, and control of aggressiveness.

Uses

Management of manifestations of psychotic disorders.

Contraindications

Known hypersensitivity to molindone or to phenothiazines, or sulfites; severe CNS depression; severe cardiovascular disease; comatose states; children less than 12 y, pregnancy (category C), lactation.

Cautious Use

Those harmed by increase in physical activity; prostatic hypertrophy; cardiovascular disease; previously detected cancer of breast.

Route & Dosage

Psychotic Disorders
Adult: PO 50–75 mg/d in 3–4 divided doses, may be increased to 100 mg/d in 3–4 d or may be able to decrease to 15–60 mg/d in divided doses (max: 225 mg/d)

Administration

Oral
  • Be certain patient swallows the medication.
  • Store medication in tightly capped, light-resistant bottles. Protect from heat and moisture.

Adverse Effects (≥1%)

CNS: Transient drowsiness, insomnia, extrapyramidal symptoms (dose related), euphoria, neuroleptic malignant syndrome. GI: Dry mouth, constipation, hepatotoxicity. Special Senses: Tinnitus, blurred vision, nasal congestion. Urogenital: Urinary retention. Skin: Mild photosensitivity. CV: Tachycardia. Body as a Whole: Change in weight. Endocrine: SLE-like syndrome, heavy menses, amenorrhea, galactorrhea, gynecomastia, increased libido, premature ejaculation.

Interactions

Drug: May potentiate CNS depression with cns depressants, alcohol. Herbal: Kava may increase risk and severity of dystonic reactions.

Pharmacokinetics

Absorption: Readily from GI tract. Peak: 1 h. Duration: 24–36 h. Distribution: Into breast milk. Metabolism: In liver. Elimination: In urine and feces. Half-Life: 1.5 h.

Nursing Implications

Assessment & Drug Effects

  • Withhold dose and consult with physician if the following symptoms occur: Tremor, involuntary twitching, exaggerated restlessness, changes in vision, light-colored stools, sore throat, fever, rash.
  • Monitor bowel pattern and urinary output. The depressed patient may not report constipation or urinary retention, both adverse effects of this medicine.
  • Supervise ambulation and other ADL in the older adult or debilitated or patient with impaired vision to prevent injury or falling because drug increases motor activity.
  • Be alert early during treatment to onset of parkinsonism (extrapyramidal) symptoms: Rigidity, immobility, reduction of voluntary movements, tremors, fine vermicular tongue movements. Withhold dose and report promptly to physician.

Patient & Family Education

  • Take drug as prescribed: do not alter dose regimen or stop medication without consulting physician.
  • Dizziness during early therapy usually disappears as treatment continues.
  • Do not drive or engage in potentially hazardous activities requiring mental or physical coordination until response to drug is known.
  • Avoid alcohol and self-medication with other depressants during therapy. Get physician approval before using any OTC drug.
  • Relieve dry mouth by rinsing frequently with warm water, increasing noncaloric fluid intake, sucking hard candy.
  • Avoid overexertion (patient with angina) and report increase in frequency of precordial pain.
  • Schedule periodic ophthalmic examinations when treatment is long-term.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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