Molindone HCl

 Actions Unknown. Exerts its effect on ascending reticular activating system.

 Indications Management of manifestations of psychotic disorders.

 Contraindications Comatose or severe drug-induced depressed states (eg, barbiturates); hypersensitivity to the drug.

 Route/Dosage

ADULTS AND CHILDREN (12 yr and older): PO Initial dose: 50 to 75 mg/day, increasing dose to 100 mg/day in 3 or 4 days. Patients with severe symptoms may require 225 mg/day. Start elderly and debilitated patients on lower dosage. Maintenance dose: Mild symptoms: 5 to 15 mg tid or qid; Moderate symptoms: 10 to 25 mg tid or qid; Severe symptoms: 225 mg/day may be required.

 Interactions None well documented.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Tachycardia; transient, non-specific T-wave changes; hypotension. CNS: Drowsiness; depression; hyperactivity; euphoria; extrapyramidal reactions; akathisia; Parkinson syndrome; dystonic syndrome; tardive dyskinesia; increased libido. DERMATOLOGIC: Skin rash. EENT: Blurred vision. GI: Dry mouth; salivation; constipation; nausea. GU: Urinary retention; priapism; amenorrhea; gynecomastia. METABOLIC: Galactorrhea.

 Precautions

Pregnancy: Undetermined. Lactation: Undetermined. CHILDREN: Safety and efficacy not established in children less than 12 yr. ELDERLY and debilitated patients: Start therapy with a reduced dosage. Seizures: Convulsive seizures have been reported. Sulfites: Some products contain sulfites; therefore, avoid use in sulfite-sensitive patients. Neuroleptic malignant syndrome: This potentially fatal condition has been reported in association with antipsychotic agents. Signs and symptoms include hyperpyrexia, muscle rigidity, altered mental status, irregular pulse or BP, tachycardia, diaphoresis, cardiac arrhythmias. Tardive dyskinesia: This syndrome of potentially irreversible, involuntary dyskinetic movements has occurred with other antipsychotic agents. Incidence appears to be highest among the elderly.

 Administration/Storage

• Administer prescribed dose tid to qid.
• Store at controlled room temperature (59° to 86°F). Protect from light.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note history of sulfite sensitivity (molindone concentrate contains sodium bisulfite) and previous episodes of Neuroleptic Malignant Syndrome.
• Inform health care provider immediately if hyperpyrexia, muscle rigidity, altered mental status, irregular pulse and BP, tachycardia, and diaphoresis develop.
• Assess baseline neurological status, and during treatment, observe for involuntary body and facial movements and excessive drowsiness. Inform health care provider if noted.
• Assess and document effect of medication on psychotic symptoms.
• Assess medication compliance.

 Patient/Family Education

• Explain name, dose, action, and potential side effects of drug.
• Advise patient that dose may be slowly increased until maximum benefit is achieved and to not take more than prescribed or increase the dose more rapidly than advised.
• Instruct patient to not stop taking molindone when their symptoms have improved.
• Tell patient to immediately report high fever, muscle rigidity, involuntary body or facial movements, altered mental status, irregular pulse, or sweating to health care provider.
• Advise patient to avoid strenuous activity during periods of high temperature or humidity.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
• Instruct women to notify health care provider if becoming pregnant, planning on becoming pregnant, or breastfeeding.
• Advise patient to notify health care provider if excessive drowsiness occurs.
• Instruct patient to not take any prescription or OTC medications or dietary supplements unless advised by the health care provider.
• Advise patient that follow-up visits will be required to monitor therapy and to keep appointments.

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