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Med/Mental Health Update

The Neurologist has me on Fluvoxamine now; started me on 50mg for 3 weeks in the beginning of last month, then up to 100mg. The 100mg fucked with me too much, though no where near as bad as the Abilify did. It just made me worryingly depressed, like Prozac did. So I took it upon myself to go back down to 50mg. So far on 50mg, I don't have anything negative to say, but I also don't have anything positive either.

My panic attacks have lessened considerably, but I'm not sure if it's bc of the meds or therapy since I started them around the same time. I guess it doesn't really matter which? Though it feels like it should.

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How Will Fluvoxamine Dosage Be In the Future in the United States?

Fluvoxamine maleate belongs to the class of drugs known as selective serotonin reuptake inhibitors. These drugs function in a similar manner. These drugs help to increase the volume of serotonin in our brain. This synthetic aids in the treatment of exaggerated impulsive behavior. Fluvoxamine measurements have been based on their medical condition, and a specialist's advice should be followed. The standard portion of this drug was mentioned here. The strength of the medication determines the volume of the medication. Regardless, the number of servings and dosages will be determined by your clinical problem.

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Explicit serotonin reuptake inhibitors, such as fluvoxamine maleate, are a type of medication. These medicines act in the same way. These drugs help to increase the amount of serotonin in our frontal cortex. This engineer aids in the treatment of a dangerously incautious condition.

Fluvoxamine covid estimates have been based on their clinical issue, and a professional's recommendation should be followed. The standard part of this drug was referred to here. The drug's strength determines how much medicine is produced. The number of pieces and measurements will, in any event, be determined by your clinical problem.

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Depression Management Case Study

What Are The Symptoms Of Depression At The End Of Life?

Sadness is a clinical ailment including the body and brain. Because of the comprehension of the restricted future of kicking the bucket patients, they may confront a more noteworthy chance of fostering a clinical conclusion of despondency or a clinical finding of deteriorating discouragement.

Normal side effects include:

·       Misery/despondency

·       Peevishness, loss of interest/delight in typical exercises

·       A sleeping disorder or over the top rest

·       Changes in hunger or expanded yearnings for food

·       Fretfulness

Different side effects include:

·       Eased back reasoning or actual development (eased back mental development)

·       Diminished focus, weariness

·       Loss of energy

·       Sensations of uselessness or contemplation

·       Regular considerations of death

·       Crying spells

·       Unexplained actual issues

What Assessments Must Be Made Before Starting An Antidepressant?

Prior to beginning prescription, it is imperative to reject different variables that may cause wretchedness or irritate sorrow, like drugs or comorbidities. Check the rundown of drugs and attempt to connect medicine changes with the beginning of side effects and preclude other auxiliary causes, for example,

·       Comorbidities

o   Frailty

o   Malignant growth

o   Coronary illness

o   Endocrine problems

o   Contaminations

o   Metabolic issues

o   Sensory system problems

·       Medications

o   Baclofen

o   Barbiturates

o   Benzodiazepines

o   Beta-blockers

o   Clonidine

o   Corticosteroids

o   Diuretics

o   Narcotics

·       Others

o   Liquor addiction

o   Psychosocial issues

o   Agony

o   A sleeping disorder

Assess patients utilizing DSM-IV standards, or utilize other wretchedness screening evaluation devices, or basically ask patients: "Would you say you are feeling discouraged?"

Utilize the accompanying as a feature of the differential analysis and perceive that the anticipation will influence the treatment:

·       Significant Depression – Medication in addition to psychotherapy

·       Undefined Depression – Continuous assessment; can be treated with prescription and psychotherapy

·       Variation Barriers For Low Mood – Support directing for adapting abilities and critical thinking for addressing or killing stressors

·       Misery – treatment through steady guiding or psychotherapy

·       Low Morale – Treatment through strong directing or psychotherapy

 How To Choose The Right Antidepressant?

 Sadness might be interceded by the utilization of a few synapses, including norepinephrine, serotonin, and dopamine. Antidepressants influence the conduct of these synapses, however how to improve side effects is muddled. All antidepressants have comparable impacts, so a medication ought to be chosen dependent on the patient's clinical history and comorbidities, guess, results and bearableness, potential medication associations, and cost. All medications give some indication improvement in the initial not many long stretches of treatment, yet patients may require 1-2 months of portion titration and framework variation to completely profit.

Save antidepressants to end-stage patients with a more drawn out guess. It might help recognize normal antagonistic impacts (ideal impacts sometimes) of the patient's best prescriptions, including sexual brokenness, weight acquire, rest, energy, nervousness, and torment.

Kindly note that everyone for the most part doesn't utilize

·       (Monoamine oxidase inhibitor – MAOI), antidepressants (phenethylamine – Nardil), (trans-cyclopropylamine – Parnate)

As introductory treatment or start in hospice care. On the off chance that you of a patient, if it's not too much trouble, counsel your drug specialist for direction on accepting MAOI.

 Selective Reuptake Inhibitors (SSRIs)

Specialist: Citalopram (Celexa), Citalopram (Lexapro®), Fluoxetine (Prozac), Fluvoxamine (Luvox®), Paroxetine (Paxil), Sertraline (Zoloft)

Reasonable For: Prognosis – a half year

Think about The Following Factors: With nervousness, psychomotor log jam.

Keep away from/Caution: Accompanying fretfulness, a sleeping disorder (particularly fluoxetine and sertraline), sexual brokenness.

Note: Citalopram and sertraline have low medication drug communication potential. Fluoxetine and paroxetine have a higher potential in drug communications.

Different Agents Similar To SSRI

Vortioxetine (Trintellix)

Appropriate For: Prognosis – a half year

Consider The Following Factors: Concomitant psychomotor lull

Stay away from/Caution: Nausea issue

Note: Combination of serotonin reuptake inhibitor and serotonin receptor incomplete agonist

Vibrazione (Viibryd)

Reasonable For: Prognosis – a half year

Note: Combination of serotonin reuptake inhibitor and serotonin receptor incomplete agonist

Particular Norepinephrine Reuptake Inhibitors (SNRIs)

Specialist: Duloxetine (Cymbalta), Venlafaxine (Effexor), Desvenlafaxine (Pristiq), Levomilnacipran (Fetzima)

Reasonable For: Prognosis – a half year

Consider The Following: Concomitant neuropathic torment, psychomotor lull, nervousness

Keep away from/Be Careful: High pulse, anxiety or a sleeping disorder, sexual brokenness

Heterocyclic Antidepressants

Specialist: Mirtazapine (Remeron), Trazodone (Desyrel)

Appropriate For: Prognosis – a half year

Think about The Following Factors: Concomitant a sleeping disorder (mirtazapine, trazodone), loss of hunger (mirtazapine), anxiety (mirtazapine), sexual brokenness

Stay away from/Caution: Overweight issue

Note: No attending signs for use are not viewed as first-line treatment.

Tricyclic Antidepressants (TCA)

Specialist: Amitriptyline (Elavil), Desipramine (Norpramin), Doxepin (Sinequan), Imipramine (Tofranil), Nortriptyline (Pamelor)

Reasonable For: Prognosis – a half year

Think about The Following Factors: With a sleeping disorder and neuropathic torment

Keep away from/Be Careful: Structural coronary illness, attending medications to expand the QT span.

Note: First-line treatment isn't thought of. Older patients have helpless resistance to anticholinergic.

Amino Ketone

Specialist: Bupropion (Wellbutrin, WellbutrinSR, WellbutrinXL)

Appropriate For: Prognosis – a half year

Think about The Following Patients: Patients with low energy (light aggravation), overweight issues, sexual brokenness issues Avoid/focus on the accompanying: a background marked by epilepsy (lower seizure limit), patients with a sleeping disorder.

Note just adjuvant treatment.

Mental Stimulants

Medication: Methylphenidate (Ritalin)

Appropriate To: Prognosis ≤ a half year

Think about The Following Factors: Patients with a short visualization, predictable objectives, spryness, and energy

Stay away from/Caution: Accompanied by tension, fomentation, loss of hunger Note: It produces results inside a couple of days and is just compelling for half a month, and the results increment after some time. Momentary treatment of recalcitrant misery is the best.

How Do I Manage To Switch From One Antidepressant To Another?

When changing starting with one energizer then onto the next (for instance, to medication remembered for a hospice solution), think about the patient's clinical history and forecast. In the event that the patient has a background marked by wretchedness and the current manifestations of the medication have balanced out, at that point proceeding to utilize the medication might be more advantageous to the patient, particularly for patients with a guess of a few days to a little while. On the off chance that the side effects are new and the patient has been on antidepressants for a brief time frame, and the forecast is a while,

Exchanging specialists might be more fitting. Screen patients and change transformation systems for withdrawal indications, results, or repeat of burdensome manifestations. Manual for changing starting with one specialist then onto the next:

·       Traditionalist Switch Or Moderate Switch

 o   Diminishing steadily, at that point cleanse/cleanse the "old" specialist prior to beginning the "new" specialist, and afterward go through the cleanse period.

o   The flushing period is drug-explicit, and time ought to be permitted to kill cessation from the patient's framework. Complete end is assessed by ascertaining the t1/2 (disposal half-existence) of multiple times the medication (the time needed for the plasma drug focus in the body to diminish significantly) (i.e., the t1/2 of duloxetine is 12.5 hours by and large, so the flushing time is 62.5 hours ( About three days).

o   This strategy is unrealistic and isn't suggested for use in hospice emergency clinics. Halting one medication will permit a specific measure of time prior to beginning another medication, which may bring about withdrawal condition (dazedness, touchiness, queasiness, weariness) or repeat of side effects. When changing from serotonergic drugs (ie, SSRI, SNRI) to non-serotonergic drugs (ie, heterocycles, TCA)

 ·       Medication Withdrawal Syndrome Is The Most Concerned

o   Switch straightforwardly, following day, or Applicable to the circumstance where the "old" specialist and the "new" specialist have a place with similar class or comparative classifications (ie, SSRI and SNRI). Take the last portion of the "old" drug one day, and afterward start the "new" drug at a low portion around the same time for the second continuous day. Step by step increment the impact. Kindly note that fluoxetine has a long half-life, so if fluoxetine is an "old" drug, kindly stand by 4-7 days prior to beginning the new medication.

·       Cross Taper Switch

o   Appropriate for patients whose "old" drugs and "new" drugs are not in similar class and whose side effects/infection repeat hazard is high. The tightening includes bit by bit adding "new" drugs while diminishing "old" medicates so patients can take two antidepressants simultaneously.

o   Illustration of progressive decrease of "old" drug: Reduce the portion by 25% every week until the portion arrives at the low/beginning portion (ie, for "Sertraline 100mg each day")- Week 1: 75mg/day, second Week: 50mg/day, Week 3: 25mg/day, Week 4: D/C)

o   Illustration of bit by bit expanding the "new" drug: increment the portion by 25% every week until the remedial portion is reached (for example for "mirtazapine")- week 1: 7.5 mg/day, week 2: 15 mg/day, the third week: 30mg/day the day of the fourth week: if treatment is required, proceed to 30mg each day, or consider expanding to 45mg each day)

·       Medication Specific Instructions

1.       Steadily/step by step increment paroxetine for at any rate a month.

o   Progressively/bit by bit increment different SSRIs, venlafaxine, and duloxetine, for a sum of 1 a month

o   Sertraline or venlafaxine, 25 to 50 mg each day each 1 fourteen days

o   Paroxetine or citalopram is required each 1 fourteen days at a portion of 5 to 10 mg each day

o   Escitalopram 5 mg day by day each 1 fourteen days

2.       There is an absence of writing on supplanting trazodone or vortioxetine with another medication. Due to the serotonergic component, it is viewed as overseen like SSRI. When beginning trazodone, follow the titration plan suggested by the maker.

3.       There is an absence of writing on supplanting desvenlafaxine or lev-milnacipran with another medication. Because of the comparative component of activity, it is considered a venlafaxine treatment.

Drug Specialist Assessment

NW experiences coronary illness, and misery is basic among them. Her medication list contains drugs that may cause discouragement manifestations (carvedilol, furosemide, spironolactone, morphine), yet she has been ingesting these medications for quite a while, and her downturn side effects have as of late began to show up. Her different manifestations, including agony and dyspnea, are normally all around controlled. In light of an appraisal led as a team with the clinical head of hospice care, it very well may be resolved that the patient is encountering another scene of undefined discouragement. NW has been taking duloxetine for about fourteen days and her forecast is assessed to be a while. The hospice emergency clinic needed to change to physician recommended drugs, and the family concurred.

[alloverchemistusa]

Fluvoxamine May Well Be a Conformity Pill in USA

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1st and foremost, don't skip a dose since this might delay your recovery. Also, if you forget to want your medicine, take it as presently as you remember. Overdosing won't assist you to recover quickly from your illness. Follow your doctor' directions for administering your drug. The oral pill Fluvoxamine 100 mg has been incontestable to be effective in the treatment of depression and neurotic disorder. it's really advantageous to any or all folks.

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Uses of Fluvoxamine in USA

Obsessive-compulsive disorder is treated with fluvoxamine (OCD). It aids in the reduction of unwanted/persistent thoughts (obsessions) as well as the desire to undertake repetitive tasks (compulsions such as hand-washing, counting, and checking) that obstruct daily living. Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI). This drug works by restoring the balance of a natural molecule in the brain called serotonin.

Interaction

Drug interactions can cause your medications to function strangely or put you at risk for dangerous side effects. This isn't a comprehensive list of all probable medication interactions. Make a note of everything you're taking (including prescription and nonprescription drugs, as well as herbal supplements) and talk to your doctor and pharmacist about it. Do not start, stop, or change the dose of any medications without consulting your doctor first.

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Update (March 29, 2018)

I haven’t written anything in here for a few days (weeks?). It’s been hard to focus on anything, and writing about what’s going on requires a lot of attention. It’s exhaustive, it makes me sleepy, it confuses me because there are so many changes going on every week. I keep trying to write but end up saving zillions of drafts that I never finish. But after what happened yesterday, I think it’s better if I write something.

I’ve been gaining weight, but very slowly. I’m doing my best to eat all my meals, and I think I’m doing a good job. My family has finally understood I need help to do it right, so we’re having family meals often and they help me drink my supplement I hate (it tastes really bad).

My blood test showed anemia is not as bad as it used to be, but the iron level is still extremely low. My dietician said that’s probably because I started eating meat again just a little before the blood test. Despite this, the rest is OK. The only exception was the concentration of valproic acid.

Valproic acid (Depakene, quite similar to Depakote) is the right mood stabilizer for me, that’s for sure. My psychiatrist and I agree on that. However, the blood work showed that the 1,500mg dose I was taking was intoxicating me due to malnutrition, that makes it hard for the body to properly metabolise it. When we saw that, it was kind of a shock to me, but my doctor was expecting it after talking to my endocrinologist. The problem was: 1,500mg was the dose that helped me the most. There was a high risk of things going bad if she decreased 500mg. However, since there was intoxication, there was no option. To try and compensate, she increased the lamotrigine dose from 100mg to 200mg.

That was on Tuesday. On Wednesday, me and my family started noticing something was wrong. It could be my organism adjusting to the new doses, so we waited, despite the bizarre things I was doing. However, days were passing and my symptoms were escalating rapidly. It wasn’t even a change every day, but several changes the same day. Constantly irritability, alterning extreme bad mood and euphoria, worsening of skin picking, the excessive energy I felt that could only come out if I cut, hand tremors, hypersexuality. I was masturbating so much I actually hurt my vagina to the point of feeling pain when peeing. On Sunday, it was decided I’d have an emergency appointment on Tuesday this week, instead of waiting until April 24.

I’d written a list of symptoms I was experiencing because I know I wouldn’t be able to list them by speaking, as I couldn’t focus on anything. While waiting for my appointment, I couldn’t stop talking to the other patients in the waiting room, telling them everything about my life, my tongue moving so fast I was stuttering, mt body shaking of agitation. When I handed the list of symptoms to my doctor, she noticed how bad I was shaking. She read the list and asked me a few things about the details I had written (such as wanting to have sex with sculptures and San Sebastian paintings). Then she said “Yes, 1,000mg is definitely not working...” She spent a long, long, looong time pondering, consulting my medical records, and pondering again. At last, she decided to increase the lamotrigine dose from 200mg to 300mg, and put me on carbamazapine 200mg.

So... On Wednesday I was supposed to be the first day with the new doses. I was supposed to take 100mg lamotrigine + 500mg valproic acid + 150mg fluvoxamine in the morning, 100mg lamotrigine in the afternoon, and 500mg valproic acid + 100mg lamotrigine at night. However... well, I am already known for missing my doses and all, but this time I was manic, which means I couldn’t even think without seeing bunnies and unicorns and Frank in my head, so I couldn’t focus on anything at all. Remember this: anything at all. So turns out I had all the three lamotrigine pills for the day at once. 300mg lamotrigine on an empty stomach at 9AM.

When I noticed what I had done, I decided not to take valproic acid and fluvoxamine. However, 10 minutes later, 10 fucking minutes later, my arms were already cold and my eyesight was distorted. Again, I was manic, so I thought “Nah, shit’s gonna end soon, let’s enjoy the adventure while it lasts!!!!” Yeah, 1 hour later the adventure was killing me. My hands were ridiculously cold, I was super sleepy, my eyesight was even worse, like, really worse. I could hardly stand on my feet. I went upstairs (though I couldn’t hardly see the steps), lay down in my bed, tapping my fingers on my hand so I wouldn’t sleep. My brother was in the room, so I said “Please ask dad to come here. Urgent.” And when my dad came, I said “Please take me to the hospital right now.” He asked “What happened?” and I tried to explain what was going on.

Long story short, I spent the day in bed, throwing up again and again, crying, needing help to go to the bathroom, seeing almost nothing, and scared of falling asleep and die. Awesome. However, today I’m much better. My parents are taking care of my meds from now on. This was the first time my lacking focus during mania caused me so much harm, and it was scary as fuck. At least now I think it’s over. With the help of my parents to control my doses I’m feeling much better. I’m trying to get back to my meal plan, since easting was just impossible yesterday. Like I said to my dietician this week, I don’t want to lose wait. I want to get better and I’m doing my best. The bad day I had yesterday won’t ruin my efforts or stop me from moving forward.

[alloverchemistusa01]

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1st and superior, don't skip a dose since this might delay your recovery. Also, if you forget to want your medicine, take it as shortly as you remember. Overdosing won't assist you to recover quickly from your illness. Follow your doctor' directions for administering your drug. The oral pill Fluvoxamine 100 mg has been incontestable to be effective in the treatment of depression and psychoneurotic disorder. it's terribly useful to any or all or any people.

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Tâm thần phân liệt kháng thuốc.

Liều lượng – Cách dùng

Khởi đầu: 12,5 mg (nửa viên 25 mg) x 1 lần/ngày đầu tiên, sau đó tăng lên 1 – 2 viên vào ngày 2. Tăng dần từng nấc 25 – 50 mg, tối đa 300 mg/ngày trong 2 – 3 tuần. Tối đa: 900 mg/ngày. Khi có kế hoạch ngưng điều trị, cần giảm liều dần trong 1 – 2 tuần.

Chống chỉ định:

Quá mẫn với thành phần thuốc. Tiền sử giảm bạch cầu hạt. Suy giảm chức năng tủy xương. Ðộng kinh không kiềm chế được. Loạn tâm thần do rượu & nhiễm độc, ngộ độc thuốc, hôn mê. Suy tuần hoàn hoặc suy nhược thần kinh. Suy gan, tim hay thận nặng.

Tương tác thuốc:

Không dùng với các thuốc có khả năng làm giảm chức năng tủy xương. Làm tăng tác dụng của rượu, IMAO, thuốc ức chế thần kinh trung ương. Lưu ý trên bệnh nhân đang dùng thuốc hướng tâm thần, kháng cholinergic, thuốc hạ huyết áp hay ức chế hô hấp, thuốc gắn kết với protein. Cimetidine, fluoxetine, fluvoxamine. Phenytoin. Lithium, a-adrenergic.

Tác dụng phụ:

Giảm & mất bạch cầu hạt. Mệt mỏi, ngủ gà, trầm uất, choáng váng, nhức đầu, đôi khi: lú lẫn, bồn chồn, hoang tưởng. Khô miệng, nhìn mờ. Nhịp tim nhanh & hạ huyết áp tư thế. Buồn nôn, nôn, táo bón & hiếm gặp: tắc ruột, viêm tụy cấp. Ðái dầm, bí tiểu. Sốt cao, phản ứng da.

Chú ý đề phòng:

Bệnh nhân có tiền sử co giật, bệnh tim mạch, thận, rối loạn tại gan, liều trung bình nên 12,5 mg/1 lần/ngày đầu tiên, sau đó tăng liều chậm với từng mức thấp. Theo dõi công thức máu định kỳ. Tránh lái xe hay vận hành máy. Trẻ em, người già, phụ nữ có thai & cho con bú không dùng.

Thông tin thành phần Clozapine

Dược lực:

Thuốc an thần kinh nhóm benzodiazepine.

Dược động học :

Sau khi uống thuốc, clozapine hầu như được hấp thu hoàn toàn (90-95%), cho dù thể thức dùng có khác nhau, như uống thuốc lúc đói hoặc uống trong bữa ăn. Tmax thay đổi (1-6 giờ). Clozapine được phân phối rộng rãi trong cơ thể (thể tích phân phối trung bình là 2 ± 1,2l/kg) và liên kết mạnh với protein huyết tương (95%). Ðộ khả dụng sinh học tuyệt đối của clozapine khoảng 55%. Clozapine được chuyển hóa ở gan, chủ yếu là oxy hóa và loại gốc methyl ở vị trí N. Chỉ có dẫn xuất N-demethyl là có hoạt tính dược lý như clozapine, tuy nhiên hàm lượng không cao và thời gian tác động ngắn. Thời gian bán hủy dao động, trung bình khoảng 12 giờ sau khi dùng liều duy nhất. 50% hoạt chất được đào thải dưới dạng chất chuyển hóa theo nước tiểu và 40% được đào thải qua mật. Các thông số dược động học thay đổi theo từng cá nhân.

Tác dụng :

Clozapine có tác động kháng tâm thần mạnh, có hiệu lực đồng thời trên các triệu chứng hưng cảm và trầm cảm. Clozapine có đặc tính: – hiếm gây tác dụng ngoại tháp, – không làm tăng đáng kể prolactine huyết. Clozapine gây an thần nhanh và mạnh. Về phương diện dược lý, clozapine khác với những thuốc an thần kinh cổ điển: theo các khảo sát trên súc vật, clozapine không gây chứng giữ nguyên thế và không ức chế hành vi lặp lại điệu bộ, lời nói như khi điều trị bằng apomorphine. Ngoài tác động ức chế thụ thể dopaminergique (D1 cũng như D2), clozapine còn có tác động đối kháng trên thụ thể 5-HT2 và có tác động kháng cholinergic và hủy noradrenaline mạnh.

Chỉ định :

Tâm thần phân liệt mãn tính nặng (tiến triển từ ít nhất là 2 năm) trong trường hợp kháng trị (không thuyên giảm trên lâm sàng và xã hội mặc dù đã kê toa ít nhất 2 loại thuốc an thần kinh liều cao trong ít nhất 6 tuần) hoặc không dung nạp chủ yếu với các loại thuốc an thần kinh cổ điển (tác dụng phụ nghiêm trọng về mặt thần kinh và gây tàn phế, không chữa trị được bằng cách chỉnh liều tốt hơn hoặc bằng những loại thuốc chữa trị thông thường).

Liều lượng – cách dùng:

Liều khởi đầu: 12,5mg trong ngày đầu tiên, sau đó tăng từng nấc từ 25 đến 50mg/ngày, để đạt đến liều 300mg/ngày ở ngày thứ 14 đến ngày thứ 21. Liều trung bình: 300 đến 450mg/ngày, chia làm nhiều lần. Liều tối đa: 600 đến 900mg/ngày. Liều duy trì: 150 đến 300mg/ngày. Ngưng điều trị: giảm liều từ từ trong 1 đến 2 tuần lễ. Dùng thuốc lại: tham khảo “liều khởi đầu”. Dùng thuốc lại ở bệnh nhân đã ngưng thuốc trên 2 ngày: 12,5mg x 1 đến 2 lần trong ngày đầu tiên. Sau đó tăng liều có thể nhanh hơn so với khi mới bắt đầu điều trị bằng Clozapine. Chuyển từ một thuốc an thần kinh cổ điển sang Clozapine : ngưng từ từ thuốc này trong vòng 1 tuần lễ, sau khi ngưng được 24 giờ, bắt đầu dùng Clozapine theo cách thức nêu trên.

Chống chỉ định :

– Quá mẫn với clozapine. – Tiền sử giảm bạch cầu hạt hoặc mất bạch cầu hạt do thuốc hoặc bệnh lý máu đặc trưng. – Loạn tâm thần do rượu và nhiễm độc, ngộ độc thuốc, hôn mê. – Bệnh gan, thận hoặc tim trầm trọng. – Glaucome góc đóng. – Rối loạn đường niệu do phì đại tuyến tiền liệt.

Tác dụng phụ

– Mất bạch cầu hạt, thường xuất hiện trong 18 tuần điều trị đầu tiên, thường có thể hồi phục sau ngưng điều trị, đôi khi đưa đến tử vong; tăng bạch cầu; tăng bạch cầu ái toan. – Hạ huyết áp tư thế (hiếm khi gây trụy mạch với ngưng hô hấp hoặc ngưng tim); huyết áp cao; biến đổi trên điện tâm đồ; nhịp tim nhanh; loạn nhịp; viêm ngoại tâm mạc và viêm cơ tim (đôi khi đưa đến tử vong). – Táo bón, nôn, mửa, rối loạn gan, tăng transaminase và hiếm hơn là tăng cholestase. – Rối loạn cơ vòng hay bí tiểu, cương đau dương vật. – Khô miệng, rối loạn điều tiết mắt, tăng nhãn áp. – Biến đổi điện não đồ (phức hợp mũi-sóng), giảm ngưỡng gây động kinh, cơn động kinh (ít gặp), biểu hiện ngoại tháp bao gồm run rẩy, không ngồi yên chỗ và cứng đờ người. – Một số tác dụng khác: tăng tiết nước bọt, buồn ngủ, suy nhược, hội chứng ác tính của thuốc an thần kinh, đột tử không rõ lý do, lên cân.

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