Home Drug Guide Acetophenazine Maleate

Drug Guide

Generic Name

Acetophenazine Maleate

Brand Names Tindal

Classification

Therapeutic: Antipsychotic

Pharmacological: Phenothiazine derivative

FDA Approved Indications

Schizophrenia

Mechanism of Action

Blocks dopamine D2 receptors in the brain, leading to decreased dopaminergic transmission, which helps alleviate psychotic symptoms.

Dosage and Administration

Adult: Initial dose typically 6-10 mg three times daily, can be adjusted based on response and tolerability.

Pediatric: Not established; use under medical supervision if prescribed.

Geriatric: Start at lower doses due to increased sensitivity; adjust carefully.

Renal Impairment: Use with caution; no specific dose adjustment established.

Hepatic Impairment: Use cautiously; monitor closely.

Pharmacokinetics

Absorption: Rapidly absorbed from GI tract.

Distribution: Wide distribution, crosses blood-brain barrier.

Metabolism: Extensively metabolized in the liver, primarily via CYP450 enzymes.

Excretion: Excreted mainly in urine and bile.

Half Life: Approx. 12-24 hours, allowing for once or twice daily dosing.

Contraindications

Hypersensitivity to phenothiazines or other components.
Comatose states.
Severe CNS depression.

Precautions

Use cautiously in patients with cardiovascular diseases, epilepsy, or Parkinson’s disease.
Monitor for signs of neuroleptic malignant syndrome.
Pregnancy Category C; use only if clearly needed.

Adverse Reactions - Common

Sedation (Common)
Extrapyramidal symptoms (dystonia, parkinsonism, akathisia) (Common)
Dry mouth (Common)
Orthostatic hypotension (Common)

Adverse Reactions - Serious

Neuroleptic malignant syndrome (Rare)
QT prolongation and arrhythmias (Rare)
Aggressive behavior or confusion in elderly (Rare)

Drug-Drug Interactions

CNS depressants, additive sedative effects.
Other dopamine antagonists may increase side effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor mental status, blood pressure, and for extrapyramidal symptoms.

Diagnoses:

Risk for falls related to sedation and orthostatic hypotension.
Imbalanced nutrition less than body requirements due to dry mouth or nausea.

Implementation: Administer with food if GI upset occurs, monitor for adverse reactions.

Evaluation: Assess effectiveness in symptom control and monitor for adverse effects.

Patient/Family Teaching

Take medication exactly as prescribed.
Be cautious about activities requiring alertness.
Report symptoms such as muscle stiffness, high fever, or irregular heartbeat immediately.
Avoid alcohol and CNS depressants.

Special Considerations

Black Box Warnings:

Increased mortality in elderly patients with dementia-related psychosis.

Genetic Factors: Consider pharmacogenetic testing for CYP450 enzymes affecting metabolism.

Lab Test Interference: May alter liver function tests and blood counts.

Overdose Management

Signs/Symptoms: Severe drowsiness, decreased respiration, extrapyramidal symptoms, hypotension.

Treatment: Supportive care, activated charcoal if early, correcting hypotension, IV fluids, and monitoring cardiac status.

Storage and Handling

Storage: Store in a cool, dry place away from light.

Stability: Stable for 2-3 years when stored properly.