Adult: Initially, 75 mg daily in divided doses, then increase doses by 25 mg daily at weekly intervals until optimum effect is achieved. Max: 300 mg daily. Elderly: Initially, 15-30 mg daily in divided doses. May increase dose if necessary according to patient tolerability. Child: ≥1 year weighing 10 kg: Initially, 500 mcg, increase by 1 mg for each additional 5 kg of body weight. Max: 10 mg daily. Dose may be increased gradually according to response. Maintenance dose should not exceed twice the initial dose; ≥12 years Same as adult dose.
Adult: Initially, 15-30 mg daily in 2 divided doses. Administer larger doses at bedtime. Elderly: Initially, 5-10 mg daily in divided doses. Administer larger doses at bedtime. Maintenance: Half or quarter of the adult dose.
Renal Impairment
Contraindicated.
Hepatic Impairment
Contraindicated.
Contraindications
Coma or altered states of consciousness due to CNS depressant intoxication, Parkinson’s disease, untreated seizure disorder, circulatory collapse, narrow-angle glaucoma, phaeochromocytoma, myasthenia gravis, hypothyroidism, prostate hypertrophy. Hepatic and renal impairment. Concomitant use with spinal or regional anaesthesia.
Special Precautions
Patient with epilepsy or history of seizures, cerebrovascular disease, severe CV disease, familial long QT syndrome, electrolyte imbalance (e.g. hypokalaemia, hypomagnesaemia), decreased gastrointestinal motility, paralytic ileus, urinary retention, xerostomia, other visual problems, risk factors for aspiration pneumonia (e.g. Alzheimer’s disease), Lewy body dementia, diabetes mellitus, head trauma, brain damage, alcoholism, hypovolaemia, risk factors for thrombosis, breast cancer or other prolactin-dependent tumours. Avoid abrupt withdrawal. Children. Elderly (including those with dementia-related psychosis). Pregnancy and lactation.
Adverse Reactions
Significant: Neuroleptic malignant syndrome, anticholinergic effects (e.g. constipation, xerostomia, blurred vision, urinary retention), altered cardiac conduction, QT prolongation, orthostatic hypotension, venous thromboembolism, blood dyscrasias (e.g. agranulocytosis, granulocytopenia, neutropenia), CNS depression, oesophageal dysmotility and aspiration, extrapyramidal symptoms, pseudoparkinsonism, acute dystonic reactions, akathisia, tardive dyskinesia, hyperprolactinaemia, fall; pigmentary retinopathy, corneal deposits, changes in skin pigmentation (prolonged use), impaired body temperature regulation, weight gain, glucose intolerance, hyperglycaemia, diabetic ketoacidosis, increased prolactin level. Blood and lymphatic system disorders: Leucopenia. Cardiac disorders: Atrioventricular block. Gastrointestinal disorders: Dry mouth, nausea, constipation, diarrhoea, cholestasis. faecal impaction, increased appetite. Hepatobiliary disorders: Jaundice, liver injury. Immune system disorders: Angioedema. Nervous system disorders: Insomnia, agitation, drowsiness, headache, dizziness. Psychiatric disorders: Paradoxical psychosis. Renal and urinary disorders: Urinary incontinence. Reproductive system and breast disorders: Galactorrhoea, gynaecomastia, amenorrhoea, impotence, priapism. Respiratory, thoracic and mediastinal disorders: Respiratory depression, nasal congestion, asthma, laryngeal oedema, pneumonia. Skin and subcutaneous tissue disorders: Rashes, diaphoresis. Vascular disorders: Deep vein thrombosis. Potentially Fatal: Ventricular arrhythmia, pulmonary embolism.
Patient Counseling Information
This drug may cause drowsiness, if affected, do not drive or operate machinery. Avoid direct sunlight.
Symptoms: CNS depression manifested as drowsiness or loss of consciousness, hypotension, tachycardia, ventricular arrhythmia, ECG changes, hypothermia; severe extra-pyramidal dyskinesias. Management: Supportive treatment. Perform gastric lavage within 6 hours of ingestion. May give activated charcoal. Maintain airways or allow assisted respiration in case of CNS depression. In cases of circulatory collapse, raise patient’s legs, volume expansion by IV fluids (severe cases), may administer inotropes (e.g. dopamine) if needed. In cases of hypotension, place patient in the head down position, and give IV norepinephrine or phenylephrine. Administer benztropine in cases of severe extrapyramidal reactions.
Drug Interactions
Increased risk of arrhythmias with QT prolonging drugs (e.g. antiarrhythmics, antidepressants, other antipsychotics). Enhanced therapeutic effect of antihypertensive agents (e.g. α-adrenoceptor blocking agents). Enhanced CNS depressant effect with barbiturates, benzodiazepines, and other sedatives. Diminished therapeutic efficacy of levodopa, clonidine, guanethidine, and adrenaline. Increased risk of agranulocytosis with carbamazepine. May increase plasma concentration of amitriptyline. Decreased absorption with antacids, anti-Parkinson drugs, or lithium. May increase or decrease the plasma concentrations of propranolol or phenobarbital.
Food Interaction
Increased CNS depressant effect with alcohol.
Lab Interference
May cause a false-positive pregnancy test.
Action
Description: Mechanism of Action: Periciazine is a phenothiazine with a piperidine side chain which produces a more pronounced sedative action and weak antipsychotic properties. It blocks subcortical dopamine receptors in the brain and decreases the amount of hypothalamic and hypophyseal hormones.
Synonym: pericyazine
Chemical Structure
Periciazine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 4747, Periciazine. https://pubchem.ncbi.nlm.nih.gov/compound/Periciazine. Accessed Oct. 26, 2020.
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