Total Dosage of Chlorpromazine and Ocular Opacities

Buffaloe, William J.; Johnson, Albin W.; Sandifer, Myron G.

doi:10.1176/ajp.124.2.250

Cited by 17 publications

(4 citation statements)

References 5 publications

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“…[70] Of course, some patients may develop eye opacities with even small doses of phenothiazines, while others may not experience such findings even at higher drug dosages. [71] This kind of adverse event is also probably dose dependent for thioridazine; this is why the maximum recommended dosage of this antipsychotic is much less than 800 mg/day. [72] Concerning the evolution of opacities caused by these antipsychotics, it is believed that there is progressive accumulation of fine whitish (to yellowish) granules in the anterior cortex just beneath the capsule and around the pupillary aperture.…”

Section: Phenothiazinesmentioning

confidence: 99%

Ocular Adverse Effects of Common Psychotropic Agents

Richa¹,

Yazbek²

2010

CNS Drugs

174

143

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All psychotropic medications have the potential to induce numerous and diverse unwanted ocular effects. Visual adverse effects can be divided into seven major categories: eyelid and keratoconjunctival disorders; uveal tract disorders; accommodation interference; angle-closure glaucoma; cataract/pigmentary deposits in the lens and cornea; retinopathy; and other disorders. The disorders of the eyelid and of the keratoconjunctiva are mainly related to phenothiazines and lithium. Chlorpromazine, at high dosages, can commonly cause abnormal pigmentation of the eyelids, interpalpebral conjunctiva and cornea. It can also cause a more worrisome but rarer visual impairment, namely corneal oedema. Lithium can rarely lead to a bothersome eye irritation by affecting sodium transport. Uveal tract problems are mainly associated with tricyclic antidepressants (TCAs), typical antipsychotics, topiramate and selective serotonin reuptake inhibitors (SSRIs). TCAs, typical antipsychotics and SSRIs can all cause mydriasis that is often transient and with no major consequences, but that can promote closure of angles in susceptible patients. Topiramate has been frequently associated with a number of significant ocular symptoms including acquired myopia and angle-closure glaucoma. Problems with accommodation are related to TCAs and to low-potency antipsychotics. TCAs cause transient blurred vision in up to one-third of patients. Angle-closure glaucoma is a serious condition that has been mainly associated with TCAs, low-potency antipsychotics, topiramate and, to a lesser extent, SSRIs. When patients with narrow angles are given TCAs, they all appear to experience induction of glaucomatous attacks. Antipsychotics and SSRIs may lead to an added risk of developing angle-closure glaucoma, but only in predisposed eyes. Topiramate can lead to an allergic-type reaction whereby structures of the lens and ciliary body are displaced, which results in angle-closure glaucoma. Cataractous changes can result from antipsychotics, mainly from high dosages of chlorpromazine or thioridazine. These two drugs, when used at high dosages and for prolonged periods, frequently cause lenticular opacifications. Retinopathy has been shown to be related to high dosages of typical antipsychotics, mainly chlorpromazine and thioridazine. The frequency of occurrence of retinal effects seems to be proportional to the total amount of drug used over a long period of time. Other visual problems of special concern are the ocular dystonias, other eye movement disorders, and decreased ability to perceive colours and to discriminate contrast. Ocular dystonias can occur with antipsychotics (especially high-potency ones), carbamazepine (especially in polytherapy), topiramate and, rarely, with SSRIs. Disturbance in various eye movements is frequently seen with benzodiazepines, antiepileptic drugs and lithium. Impairment in the perception of colours and the discrimination of contrasts has been shown to occur not uncommonly with carbamazepine and lorazepam. Thus, typical antipsycho...

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Section: Phenothiazinesmentioning

confidence: 99%

Ocular Adverse Effects of Common Psychotropic Agents

Richa¹,

Yazbek²

2010

CNS Drugs

174

143

View full text Add to dashboard Cite

show abstract

“…Nowadays, patients presenting with these severe side effects are exceptional, as CPZ is not used anymore as a first‐line therapy in the treatment of schizophrenia. Most cases described in the literature involve women who had been on chronic therapy with 500 mg/day or more for more than 1 year; however, pigmentation has also been reported at much lower doses . The pigmentation in all instances appears to require prolonged exposure to the sun, in contrast to the more familiar type of pigmentation due to photosensitivity, which is of rapid onset.…”

Section: Discussionmentioning

confidence: 99%

“…Most cases described in the literature involve women who had been on chronic therapy with 500 mg/ day or more for more than 1 year; 9 however, pigmentation has also been reported at much lower doses. 10 The pigmentation in all instances appears to require prolonged exposure to the sun, in contrast to the more familiar type (a) (b) (d) (c) Figure 3 Slit-lamp photographs showing (a, b) lens opacity with discrete yellow-white dots concentrated at the center with radiating streaks, and (c, d) multiple fine deposits over corneal surface of pigmentation due to photosensitivity, which is of rapid onset. Few psychiatrists, even in mental hospitals, are in the habit of using doses of 500 mg or more of CPZ over periods of more than a few months.…”

Section: Discussionmentioning

confidence: 99%

Chlorpromazine‐induced severe skin pigmentation and corneal opacities in a patient with schizophrenia

et al. 2015

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“…Women, possibly because of estrogen-enhanced melanosis (2), and people with light brown hair (5) may be more susceptible. While some authors (1,4) suggest that chronic therapy with daily dosages of 500 mg or more is necessary for pigmentation, others (7,8) report pigmentation at much lower doses, which refutes the theory of a threshold dosage for induction of skin pigmentation. Pigment produced in the skin is transported to the blood stream by inflammatory cells and deposited throughout the body, causing a generalized melanosis of the viscera (5).…”

Section: Discussionmentioning

confidence: 99%