Very High Dosage vs Standard Dosage Fluphenazine in Schizophrenia

Sudden Death in Psychiatric Patients: The Role of Neuroleptic Drugs—by George M. Simpson, M.D., John Davis, M.D., James W. Jefferson, M.D., and Jorge F. Perez-Cruet, M.D.; task force report 27 of the American Psychiatric Association, 1988, 35 pages. Single copies available free from the Office of Research, APA, 1400 K Street, N.W., Washington, D.C. 20005

“…Twelve subjects had U-wave formation and nine had increased Q-T interval; all patients were on thioridazine. Similar changes have been noted in patients treated with trifluoperazine, mesoridazine, fluphenazine, promazine and thioxanthenes (Ban, 1965;Dillenkoffer et al, 1974a,b;Quitkin, 1976;Stimmel, 1979a,b). Also haloperidol infrequently produces cardiac side effects (Brannan, 1980).…”

Sudden Death in Psychiatric Patients: The Role of Neuroleptic Drugs—by George M. Simpson, M.D., John Davis, M.D., James W. Jefferson, M.D., and Jorge F. Perez-Cruet, M.D.; task force report 27 of the American Psychiatric Association, 1988, 35 pages. Single copies available free from the Office of Research, APA, 1400 K Street, N.W., Washington, D.C. 20005

“…Twelve subjects had U-wave formation and nine had increased Q-T interval; all patients were on thioridazine. Similar changes have been noted in patients treated with trifluoperazine, mesoridazine, fluphenazine, promazine and thioxanthenes (Ban, 1965;Dillenkoffer et al, 1974a,b;Quitkin, 1976;Stimmel, 1979a,b). Also haloperidol infrequently produces cardiac side effects (Brannan, 1980).…”

Does a plasma level of chlorpromazine help?

“…Conceivably, the detection of some extrapyramidal side-effects (EPS) may not be possible in an inaccessible patient. Both Quitkin et al (1975) and Van Putten et al (1974) have observed that EPS such as akinesia and akathisia may be elaborated into an exacerbation of psychosis.…”

“…Some patients may be 'slowresponders', requiring more than 6 weeks of exposure to an antipsychotic drug to respond; in such cases, increasing the dose may result in behavioural toxicity. For example, Quitkin et al (1975) compared 30 v. 1200 mg of fluphenazine hydrochloride in schizophrenic patients who had been resistant to 800 mg or more per day of CPZ or its equivalent for at least 6 weeks. After another 6 weeks of fluphenazine treatment, patients on the conventional (30 mg) dose (and presumably lower plasma levels) showed greater improvement, whereas high dose patients became more delusional.…”

Antipsychotic Dosing and Concurrent Psychotropic Treatments for Medicaid-Insured Individuals With Schizophrenia

“…Randomized, double-blind controlled trials spanning more than three decades have consistently found that high-dose antipsychotic treatment does not provide additional therapeutic benefit over low-dose treatment; instead, it only increases the risk of undesirable and irreversible side effects. The studies, ranging in duration from 2 weeks to 1 year and involving individuals aged 16–70 years, provide strong evidence to support the use of low-dose antipsychotic treatment, in either inpatient (Quitkin et al 1975; McEvoy et al 1991; Rifkin et al 1991; Volavka et al 1992; Stone et al 1995) or outpatient settings (Kane et al 1983; Kane et al 1985). Compared with high-dose antipsychotic treatment, low-dose antipsychotic treatment has not resulted in greater psychosocial dysfunction or a higher rate of relapse requiring hospitalization (Kane et al 1983).…”

Sudden Death in Psychiatric Patients: The Role of Neuroleptic Drugs—by George M. Simpson, M.D., John Davis, M.D., James W. Jefferson, M.D., and Jorge F. Perez-Cruet, M.D.; task force report 27 of the American Psychiatric Association, 1988, 35 pages. Single copies available free from the Office of Research, APA, 1400 K Street, N.W., Washington, D.C. 20005

“…Twelve subjects had U-wave formation and nine had increased Q-T interval; all patients were on thioridazine. Similar changes have been noted in patients treated with trifluoperazine, mesoridazine, fluphenazine, promazine and thioxanthenes (Ban, 1965;Dillenkoffer et al, 1974a,b;Quitkin, 1976;Stimmel, 1979a,b). Also haloperidol infrequently produces cardiac side effects (Brannan, 1980).…”

Does a plasma level of chlorpromazine help?

“…Conceivably, the detection of some extrapyramidal side-effects (EPS) may not be possible in an inaccessible patient. Both Quitkin et al (1975) and Van Putten et al (1974) have observed that EPS such as akinesia and akathisia may be elaborated into an exacerbation of psychosis.…”

“…Some patients may be 'slowresponders', requiring more than 6 weeks of exposure to an antipsychotic drug to respond; in such cases, increasing the dose may result in behavioural toxicity. For example, Quitkin et al (1975) compared 30 v. 1200 mg of fluphenazine hydrochloride in schizophrenic patients who had been resistant to 800 mg or more per day of CPZ or its equivalent for at least 6 weeks. After another 6 weeks of fluphenazine treatment, patients on the conventional (30 mg) dose (and presumably lower plasma levels) showed greater improvement, whereas high dose patients became more delusional.…”

Antipsychotic Dosing and Concurrent Psychotropic Treatments for Medicaid-Insured Individuals With Schizophrenia

“…Randomized, double-blind controlled trials spanning more than three decades have consistently found that high-dose antipsychotic treatment does not provide additional therapeutic benefit over low-dose treatment; instead, it only increases the risk of undesirable and irreversible side effects. The studies, ranging in duration from 2 weeks to 1 year and involving individuals aged 16–70 years, provide strong evidence to support the use of low-dose antipsychotic treatment, in either inpatient (Quitkin et al 1975; McEvoy et al 1991; Rifkin et al 1991; Volavka et al 1992; Stone et al 1995) or outpatient settings (Kane et al 1983; Kane et al 1985). Compared with high-dose antipsychotic treatment, low-dose antipsychotic treatment has not resulted in greater psychosocial dysfunction or a higher rate of relapse requiring hospitalization (Kane et al 1983).…”

Sudden Death in Psychiatric Patients: The Role of Neuroleptic Drugs—by George M. Simpson, M.D., John Davis, M.D., James W. Jefferson, M.D., and Jorge F. Perez-Cruet, M.D.; task force report 27 of the American Psychiatric Association, 1988, 35 pages. Single copies available free from the Office of Research, APA, 1400 K Street, N.W., Washington, D.C. 20005

“…Twelve subjects had U-wave formation and nine had increased Q-T interval; all patients were on thioridazine. Similar changes have been noted in patients treated with trifluoperazine, mesoridazine, fluphenazine, promazine and thioxanthenes (Ban, 1965;Dillenkoffer et al, 1974a,b;Quitkin, 1976;Stimmel, 1979a,b). Also haloperidol infrequently produces cardiac side effects (Brannan, 1980).…”

Does a plasma level of chlorpromazine help?

“…Conceivably, the detection of some extrapyramidal side-effects (EPS) may not be possible in an inaccessible patient. Both Quitkin et al (1975) and Van Putten et al (1974) have observed that EPS such as akinesia and akathisia may be elaborated into an exacerbation of psychosis.…”

“…Some patients may be 'slowresponders', requiring more than 6 weeks of exposure to an antipsychotic drug to respond; in such cases, increasing the dose may result in behavioural toxicity. For example, Quitkin et al (1975) compared 30 v. 1200 mg of fluphenazine hydrochloride in schizophrenic patients who had been resistant to 800 mg or more per day of CPZ or its equivalent for at least 6 weeks. After another 6 weeks of fluphenazine treatment, patients on the conventional (30 mg) dose (and presumably lower plasma levels) showed greater improvement, whereas high dose patients became more delusional.…”

Antipsychotic Dosing and Concurrent Psychotropic Treatments for Medicaid-Insured Individuals With Schizophrenia

“…Randomized, double-blind controlled trials spanning more than three decades have consistently found that high-dose antipsychotic treatment does not provide additional therapeutic benefit over low-dose treatment; instead, it only increases the risk of undesirable and irreversible side effects. The studies, ranging in duration from 2 weeks to 1 year and involving individuals aged 16–70 years, provide strong evidence to support the use of low-dose antipsychotic treatment, in either inpatient (Quitkin et al 1975; McEvoy et al 1991; Rifkin et al 1991; Volavka et al 1992; Stone et al 1995) or outpatient settings (Kane et al 1983; Kane et al 1985). Compared with high-dose antipsychotic treatment, low-dose antipsychotic treatment has not resulted in greater psychosocial dysfunction or a higher rate of relapse requiring hospitalization (Kane et al 1983).…”