molindone (Moban, Lindone)

Introduction

Tradename: Moban.

Indications

symptomatic management of psychotic disorder

Contraindications

• narrow angle glaucoma
• bone marrow depression
• CNS depression
• liver disease

Caution:

• cardiovascular disease
• seizure disorder

pregnancy category = c

safety in lactation = ?

Dosage

• start 25 mg PO TID
• adjust in 3-4 days as needed
• start elderly on lower dose
• max 225 mg/day
• doses of 400 mg/day have been used

Tabs: 5, 10, 25, 50, 100 mg.

Liquid: 20 mg/mL.

Pharmacokinetics

• rapidly & completely absorbed from the GI tract
• rapidly metabolized in the liver to inactive metabolites
• < 3% excreted unchanged in the urine

elimination via liver

elimination via kidney

Adverse effects

• common (> 10%)
  • akathisia, extrapyramidal effects, persistent tardive dyskinesia, blurred vision, constipation, decreased sweating, dry mouth, orthostatic hypotension
• less common (1-10%)
  • depression, change in menstrual cycle, breast swelling
• uncommon (< 1%)
  • tachycardia, arrhythmias, sedation, drowsiness, restlessness, anxiety, seizures, altered temperature regulation, neuroleptic malignant syndrome, hyperpigmentation, pruritus, rash, galactorrhea, gynecomastia, weight gain, dry mouth, agranulocytosis*, leukopenia#, retinal pigmentation, photosensitivity
• other
  • low sedation, anticholinergic & orthostatic hypotensive effects
  • extrapyramidal symptoms (moderate)
    • tardive dyskinesia
    • pseudoparkinsonism
    • dystonias
    • akathisia
  • neuroleptic malignant syndrome (rare)
  • QT prolongation
  • direct myocardial suppression

* agranulocytosis is more common in women between 4th & 10th week of therapy

# leukopenia generally occurs with large doses for prolonged periods

• drug adverse effects of antipsychotic agents
• drug adverse effects of psychotropic agents

Drug interactions

• see chlorpromazine
• molindone tablets contain CaSO4 & may inhibit absorption of:
  • phenytoin
  • tetracyclines
  • quinolones

• drug interaction(s) of antipsychotics & dopamine receptor agonists
• drug interaction(s) of antipsycotics with benzodiazepines

Mechanism of action

• intermediate potency antipsychotic agent
• relatively selective domapine D2 receptor antagonist
• see chlorpromazine

More general terms

• antipsychotic agent

Additional terms

• chlorpromazine (Thorazine, Ormazine, Propaphenin, Sonazine, Chloractil)

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=23897
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=27421
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=522521