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(THIGH-oh-THIX-een)
Navane Concentrate
Class: Antipsychotic/thioxanthene

 Action Produces antipsychotic effects apparently due to dopamine receptor blocking in CNS.

 Indications Management of psychotic disorders such as schizophrenia. Unlabeled use(s): Treatment of Tourette’s syndrome; control of acute agitation in elderly; treatment of some symptoms of dementia.

 Contraindications Comatose or severely depressed states; presence of large amounts of CNS depressants; circulatory collapse; liver damage; subcortical brain damage; NS depression from any cause; bone marrow depression or blood dyscrasias.

 Route/Dosage

ADULTS: PO Up to 60 mg/day. IM 4 mg bid-qid (maximum 30 mg/day). ELDERLY OR DEBILITATED PATIENTS: PO Up to 30 mg/day. CHILDREN 12–18 YR: PO 0.3 mg/kg/day (usual range 5–42 mg/day).

 Interactions

Alcohol, other CNS depressants: May cause additive CNS depressant effects. Anticholinergics: May reduce therapeutic effects and increase anticholinergic effects of thiothixene; may lead to tardive dyskinesia. Guanethidine: May inhibit hypotensive effect of guanethidine.

 Lab Test Interferences False-positive pregnancy test results may occur, but are less likely to occur with serum test. Increases in protein-bound iodine have been reported.

 Adverse Reactions

CV: Orthostatic hypotension; tachycardia; syncope; lightheadedness; CG changes. CNS: Tardive dyskinesia; extrapyramidal symptoms (eg, pseudoparkinsonism, akathisia, dystonias); drowsiness; insomnia; restlessness; agitation; seizures; aradoxical exacerbation of psychotic symptoms. DERM: Rash; pruritus; urticaria; photosensitivity. EENT: Pigmentary retinopathy; lenticular pigmentation; blurred vision; nasal congestion. GI: Dry mouth; anorexia; diarrhea; nausea; vomiting; constipation. GU: Impotence, sexual dysfunction; amenorrhea. HEMA: Leukopenia; leukocytosis. META: Elevations of serum transaminase and alkaline phosphatase. RESP: Laryngospasm; bronchospasm; increased depth of respiration. OTHER: Breast enlargement; lactation; gynecomastia; hypoglycemia; hyperglycemia; lycosuria; polydipsia; increase in appetite and weight; peripheral edema; levated prolactin levels; increased sweating or salivation.

 Precautions

Pregnancy: Pregnancy category undetermined. Lactation: Undetermined. Children: Not recommended in children < 12 yr. Elderly patients: More susceptible to adverse effects. Special risk patients: Use drug with caution in patients with cardiovascular disease or mitral insufficiency, history of glaucoma, EEG abnormalities or seizure disorders, prior brain damage or hepatic or renal impairment. CNS effects: Drug may impair mental or physical abilities, especially during first few days of therapy. Hepatic effects: Jaundice (usually reversible) may occur, usually between second and fourth wk of treatment, and is considered hypersensitivity reaction. Neuroleptic malignant syndrome: Has occurred with similar agents and is potentially fatal. Signs and symptoms are hyperpyrexia, muscle rigidity, altered mental status, irregular pulse, irregular BP, tachycardia and diaphoresis. Pulmonary effects: Cases of bronchopneumonia, some fatal, have occurred. Sudden death: Has been reported; predisposing factors may be seizures or previous brain damage. Flareups of psychotic behavior may precede death. Tardive dyskinesia: Potentially irreversible involuntary body and facial movements may occur. Prevalence highest in elderly, especially women.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer at bedtime to minimize effects of sedation and orthostatic hypotension if prescribed as a single daily dose.
  • If using liquid concentrate, measure each dose and mix with a small amount of water for each administration.
  • If patient is reluctant to take medicine, observe that medication is taken and not hoarded.
  • Reconstitute powder for IM injection with 2.2 ml Sterile Water for Injection. Reconstituted powder can be stored at room temperature for up to 48 hr before discarding.
  • Deep IM injection should be given in gluteal muscle.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Assess for history of breast enlargement.
  • Assess vital signs (including orthostatic BP) and blood glucose.
  • Monitor weight.
  • Obtain ECG as ordered by physician.
  • If signs of changes in baseline psychiatric condition occur, notify physician.
  • Monitor LFTs periodically during therapy.
  • If hypotension, tachycardia, faint feeling, chest pain, nausea, vomiting, diarrhea, constipation, menstrual changes, sexual dysfunction, vision changes, mouth dryness, nasal blockage or skin changes occur, notify physician.
  • Notify physician of increasing breast size, increased appetite, salivation and sweating or changes in lab results.
  • Monitor patient for onset of extrapyramidal side effects, and notify physician if these occur.
OVERDOSAGE: SIGNS & SYMPTOMS
  Somnolence, coma, hypotension, extrapyramidal symptoms, agitation, restlessness, convulsions, fever, hypothermia, ECG changes, cardiac arrhythmias

 Patient/Family Education

  • Caution patient to avoid alcohol and other CNS depressants while taking this medication.
  • Advise patient not to take otc medications without consulting physician.
  • Instruct patient/family to notify physician of mental changes, chest pain, faint feeling, swelling, vision changes, headaches, skin changes, menstrual changes, stool discoloration or yellowing of skin or eyes.
  • Instruct patient to take sips of water frequently or to suck on ice chips, sugarless candy or chewing gum if dry mouth occurs.
  • Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Inform patient that patient may experience increased sweating while taking this medication.
  • Instruct family to call emergency number if patient has seizure.
  • Instruct patient to avoid sudden position changes to prevent orthostatic hypotension.
  • Advise patient that drug causes lightheadedness and drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
  • Advise patient that medication increases sensitivity to heat and to avoid exposure to high ambient temperatures.

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