Molindone

Pronunciation

(moe LIN done)

U.S. Brand Names

Moban®

Synonyms

Molindone Hydrochloride

Generic Available

Canadian Brand Names

Moban®

Use

Management of schizophrenia

Use - Unlabeled/Investigational

Management of psychotic disorders

Pregnancy Risk Factor

Lactation

Excretion in breast milk unknown

Contraindications

Hypersensitivity to molindone or any component of the formulation (cross-reactivity between phenothiazines may occur); severe CNS depression; coma

Warnings/Precautions

May be sedating, use with caution in disorders where CNS depression is a feature. Use with caution in Parkinson's disease. Caution in patients with hemodynamic instability; bone marrow suppression; predisposition to seizures; subcortical brain damage; severe cardiac, hepatic, renal, or respiratory disease. Esophageal dysmotility and aspiration have been associated with antipsychotic use - use with caution in patients at risk of pneumonia (ie, Alzheimer's disease). Caution in breast cancer or other prolactin-dependent tumors (may elevate prolactin levels). May alter temperature regulation or mask toxicity of other drugs due to antiemetic effects. May alter cardiac conduction; life-threatening arrhythmias have occurred with therapeutic doses of neuroleptics. May cause orthostatic hypotension - use with caution in patients at risk of this effect or those who would tolerate transient hypotensive episodes (cerebrovascular disease, cardiovascular disease, or other medications which may predispose).

May cause anticholinergic effects (confusion, agitation, constipation, xerostomia, blurred vision, urinary retention); therefore, they should be used with caution in patients with decreased gastrointestinal motility, urinary retention, BPH, xerostomia, or visual problems. Conditions which also may be exacerbated by cholinergic blockade include narrow-angle glaucoma (screening is recommended) and worsening of myasthenia gravis. Relative to other neuroleptics, molindone has a low potency of cholinergic blockade.

May cause extrapyramidal symptoms, including pseudoparkinsonism, acute dystonic reactions, akathisia, and tardive dyskinesia (risk of these reactions is moderate-high relative to other neuroleptics). May be associated with neuroleptic malignant syndrome (NMS) or pigmentary retinopathy.

Adverse Reactions

Frequency not defined.

Cardiovascular: Orthostatic hypotension, tachycardia, arrhythmia

Central nervous system: Extrapyramidal reactions (akathisia, pseudoparkinsonism, dystonia, tardive dyskinesia), mental depression, altered central temperature regulation, sedation, drowsiness, restlessness, anxiety, hyperactivity, euphoria, seizure, neuroleptic malignant syndrome (NMS)

Dermatologic: Pruritus, rash, photosensitivity

Endocrine & metabolic: Change in menstrual periods, edema of breasts, amenorrhea, galactorrhea, gynecomastia

Gastrointestinal: Constipation, xerostomia, nausea, salivation, weight gain (minimal compared to other antipsychotics), weight loss

Genitourinary: Urinary retention, priapism

Hematologic: Leukopenia, leukocytosis

Ocular: Blurred vision, retinal pigmentation

Miscellaneous: Diaphoresis (decreased)

Overdosage/Toxicology

Symptoms of overdose include deep sleep, extrapyramidal symptoms, cardiac arrhythmias, seizures, and hypotension. Treatment is symptom-directed and supportive.

Drug Interactions

Aluminum salts: May decrease the absorption of antipsychotics; monitor

Amphetamines: Efficacy may be diminished by antipsychotics; in addition, amphetamines may increase psychotic symptoms; avoid concurrent use

Anticholinergics: May inhibit the therapeutic response to antipsychotics and excess anticholinergic effects may occur; includes benztropine, trihexyphenidyl, biperiden, and drugs with significant anticholinergic activity (TCAs, antihistamines, disopyramide)

Antihypertensives: Concurrent use of antipsychotics with an antihypertensive may produce additive hypotensive effects (particularly orthostasis)

Bromocriptine: Antipsychotics inhibit the ability of bromocriptine to lower serum prolactin concentrations

CNS depressants: Sedative effects may be additive with antipsychotics; monitor for increased effect; includes barbiturates, benzodiazepines, narcotic analgesics, ethanol and other sedative agents

Epinephrine: Chlorpromazine (and possibly other low potency antipsychotics) may diminish the pressor effects of epinephrine

Guanethidine and guanadrel: Antihypertensive effects may be inhibited by antipsychotics Levodopa: Antipsychotics may inhibit the antiparkinsonian effect of levodopa; avoid this combination

Lithium: Antipsychotics may produce neurotoxicity with lithium; this is a rare effect

Metoclopramide: May increase extrapyramidal symptoms (EPS) or risk.

Propranolol: Serum concentrations of antipsychotics may be increased; propranolol also increases antipsychotic concentrations

QTc-prolonging agents: Effects on QTc interval may be additive with antipsychotics, increasing the risk of malignant arrhythmias; includes type Ia antiarrhythmics, TCAs, and some quinolone antibiotics (sparfloxacin, moxifloxacin, and gatifloxacin)

Sulfadoxine-pyrimethamine: May increase antipsychotics concentrations

Tricyclic antidepressants: Concurrent use may produce increased toxicity or altered therapeutic response

Trazodone: Antipsychotics and trazodone may produce additive hypotensive effects

Valproic acid: Serum levels may be increased by antipsychotics

Ethanol/Nutrition/Herb Interactions

Ethanol: Avoid ethanol (may increase CNS depression).

Herb/Nutraceutical: Avoid kava kava, gotu kola, valerian, St John's wort (may increase CNS depression).

Stability

Protect from light; dispense in amber or opaque vials

Mechanism of Action

Molindone is a dihydroindoline antipsychotic whose mechanism of action mimics that of chlorpromazine; however, it produces more extrapyramidal symptoms and less sedation than chlorpromazine

Pharmacodynamics/Kinetics

Metabolism: Hepatic

Half-life elimination: 1.5 hours

Time to peak, serum: ~1.5 hours

Excretion: Urine and feces (90%) within 24 hours

Dosage

Oral:

Children: Schizophrenia/psychoses:

3-5 years: 1-2.5 mg/day in 4 divided doses

5-12 years: 0.5-1 mg/kg/day in 4 divided doses

Adults: Schizophrenia/psychoses: 50-75 mg/day increase at 3- to 4-day intervals up to 225 mg/day

Elderly: Behavioral symptoms associated with dementia: Initial: 5-10 mg 1-2 times/day; increase at 4- to 7-day intervals by 5-10 mg/day; increase dosing intervals (bid, tid, etc) as necessary to control response or side effects.

Monitoring Parameters

Vital signs; lipid profile, fasting blood glucose/Hgb A1c; BMI; mental status, abnormal involuntary movement scale (AIMS), extrapyramidal symptoms (EPS)

Patient Education

Use exactly as directed; do not increase dose or frequency. It may take 2-3 weeks to achieve desired results; do not discontinue without consulting prescriber. Avoid alcohol or caffeine and other prescription or OTC medications not approved by prescriber. Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. You may experience excess drowsiness, restlessness, dizziness, or blurred vision (use caution driving or when engaging in tasks requiring alertness until response to drug is known); constipation (increased exercise, fluids, fruit, or fiber may help); postural hypotension (use caution climbing stairs or when changing position from lying or sitting to standing); or decreased perspiration (avoid strenuous exercise in hot environments). Report persistent CNS effects (eg, trembling fingers, altered gait or balance, excessive sedation, seizures, unusual movements, anxiety, abnormal thoughts, confusion, personality changes); chest pain, palpitations, rapid heartbeat, severe dizziness; unresolved urinary retention or changes in urinary pattern; changes in menstrual pattern or breast tenderness; vision changes; skin rash or yellowing of skin; respiratory difficulty; or worsening of condition. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.

Dental Health: Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Xerostomia and changes in salivation (normal salivary flow resumes upon discontinuation). Anticholinergic side effects can cause a reduction of saliva production or secretion, contributing to discomfort and dental disease (ie, caries, oral candidiasis, and periodontal disease). Molindone can cause extrapyramidal reactions which may appear as muscle twitching or increased motor activity of the face, neck, or head.

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Dosage Forms

Tablet, as hydrochloride: 5 mg, 10 mg, 25 mg, 50 mg

References

Johnson SB, Alvarez WA, and Freinhar JP, "A Case of Massive Rhabdomyolysis Following Molindone Administration," J Clin Psychiatry , 1986, 47(12):607-8.

Katz SE, "Tardive Dyskinesia Associated With Molindone Treatment," Am J Psychiatry , 1990, 147(1):124-5 (letter).

Knight ME and Roberts RJ, "Phenothiazine and Butyrophenone Intoxication in Children," Pediatr Clin North Am , 1986, 33(2):299-309.

Malek-Ahmadi P and Allen SA, "Paroxetine-Molindone Interaction," J Clin Psychiatry , 1995, 56(2):82-3.

Peabody CA, Warner MD, Whiteford HA, et al, "Neuroleptics and the Elderly," J Am Geriatr Soc , 1987, 35(3):233-8.

Risse SC and Barnes R, "Pharmacologic Treatment of Agitation Associated With Dementia," J Am Geriatr Soc , 1986, 34(5):368-76.

Saltz BL, Woerner MG, Kane JM, et al, "Prospective Study of Tardive Dyskinesia Incidence in the Elderly," JAMA , 1991, 266(17):2402-6.

Seifert RD, "Therapeutic Drug Monitoring: Psychotropic Drugs," J Pharm Pract , 1984, 6:403-16.

International Brand Names

Moban® (CA, HK)

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process . A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2007 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Home > Medical Reference > Complementary Medicine