pericyazine: clinical use

Prescribing considerations

• Assess cardiac disease, QT history, bradycardia, electrolyte disturbance and concurrent QT-prolonging treatment.
• Use particular caution with epilepsy, diabetes risk, VTE risk, severe hepatic or renal impairment, and in older or volume-depleted people.
• Older people are more susceptible to sedation, orthostatic hypotension, extrapyramidal effects, constipation and medicine accumulation.
• Pericyazine is not licensed for dementia-related behavioural disturbance and should not be used alone where depression predominates.
• Avoid abrupt discontinuation because withdrawal effects and relapse may occur.

Contraindications and cautions

• Hypersensitivity to pericyazine, phenothiazines or product ingredients
• Risk of urinary retention from urethroprostatic disease
• Risk of angle-closure glaucoma
• History of agranulocytosis
• Concurrent contraindicated dopaminergic antiparkinsonian agents
• Children younger than one year
• The tablet SmPC additionally lists gluten hypersensitivity or intolerance due to wheat starch

Monitoring

• Complete blood count regularly and urgently if fever, sore throat, mouth ulcers or unexplained infection develops.
• Consider ECG and biochemical assessment before treatment and subsequently where QT or electrolyte risk factors exist.
• Monitor blood glucose in diabetes or where diabetes risk factors are present.
• Assess blood pressure, sedation, constipation, urinary retention and extrapyramidal or tardive movement symptoms.
• Review VTE risk factors before and during treatment.
• When syrup is used in a child, follow the SmPC's neurological and developmental monitoring precautions.

Clinical pharmacology

Pericyazine is a phenothiazine neuroleptic with strong central sedative and antiserotonin effects, plus antihistamine and cardiovascular actions. Human pharmacokinetic information is limited; phenothiazine metabolism and excretion may slow with age.

Formulation and product differences

• The selected products are oral tablets and syrup.
• The tablets contain lactose and methyl hydroxybenzoate and are essentially sodium-free.
• The tablet SmPC's gluten contraindication should be checked against current product documentation if clinically relevant, because wheat starch is not shown in its excipient list.
• The syrup contains sucrose, sulphites, sodium benzoate and sodium; consider allergies, diabetes, dental health and sodium intake.
• Sulphites in the syrup may rarely cause severe hypersensitivity or bronchospasm.
• Both formulations should be protected from light; the syrup has a limited in-use shelf life after opening.
• Avoid skin contact when handling the syrup because contact sensitisation can occur.

Syrup

Route: Oral

Strengths: 10 mg/5 mL

Tablet

Route: Oral

Strengths: 2.5 mg, 10 mg