Molindone, marketed under the brand name Moban among others, is an atypical antipsychotic medication that has been used in the treatment of schizophrenia.

It belongs to a class of drugs known as typical and atypical antipsychotics, which are primarily used to manage the symptoms of psychotic disorders such as schizophrenia and bipolar disorder.

Molindone works by affecting certain neurotransmitters in the brain, particularly dopamine and serotonin, which play key roles in mood regulation, behavior, and perception.

It's believed that by modulating the activity of these neurotransmitters, Molindone can help alleviate the positive symptoms of schizophrenia (such as hallucinations, delusions, and disorganized thinking) and improve overall functioning in individuals with the disorder.

Molindone (Moban) is an antipsychotic drug that is used in patients with schizophrenia. It acts by inhibiting D2 receptors in the brain.

Molindone Uses:

• Schizophrenia:
  • Management of schizophrenia
• Off Label Use of Molindone in Adults:
  • Psychosis and anxiety related to dementia.

Read: 

• Aripiprazole lauroxil (Abilify)
• Olanzapine (Zyprexa)

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Molindone Dose in Adults:

Molindone (Moban) Dose in the treatment of Schizophrenia: Oral:

Starting Dose:

• Typically, the starting dose is 50 to 75 milligrams per day taken orally.

• If everything is going well after 3 to 4 days, the dose may be increased to 100 milligrams per day.

Adjustments:

• The dose may increase gradually based on your response to the medicine and your ability to tolerate it.

• The maximum amount you might take in a day is 225 milligrams.

Keeping Stable:

• Once your condition is stable, for milder symptoms, you may take 5 to 15 milligrams (3 to 4 times a day).
• For moderate symptoms, the dose may range from 10 to 25 milligrams (3 to 4 times a day).
• In severe cases, you might take up to 225 milligrams per day. Always follow your healthcare provider's guidance on dosing.

Maintenance:

• To maintain control, it is recommended to keep doses within the range of 30 to 100 milligrams per day, according to guidelines.

If You're Not Feeling Well:

• If you're not in good physical condition, it may be advisable to start with lower doses.

Discontinuation of therapy:

 

• When deciding to discontinue antipsychotic medication, it's crucial to do so gradually to minimize the risk of withdrawal symptoms and the potential return of your symptoms.
• Guidelines from organizations such as the American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), and World Federation of Societies of Biological Psychiatry (WFSBP) recommend a slow tapering-off process.
• This approach is designed to promote a smoother transition and reduce the likelihood of adverse effects associated with abrupt discontinuation.
• Always consult with your healthcare provider for personalized advice and guidance when considering changes to your medication regimen.

Here are some key points from the guidelines:

Tapering Period:

According to the guidelines from the Canadian Psychiatric Association (CPA), tapering off antipsychotics should occur over a period of 6 to 24 months.

Similarly, the American Psychiatric Association (APA) recommends a gradual reduction, suggesting a decrease of about 10% of the dose each month.

This slow and careful tapering process is intended to allow your body to adjust, minimizing the risk of withdrawal symptoms and reducing the likelihood of symptom relapse.

It's important to follow these guidelines under the supervision of a healthcare professional for a safe and effective discontinuation of antipsychotic medication.

Withdrawal Symptoms: 

Some medications for mental health, like antipsychotics, can cause problems if you stop them suddenly.

They might lead to withdrawal symptoms, which can be uncomfortable.

To avoid this, doctors recommend reducing the dose slowly over time, usually taking several months.

This helps your body adjust and lowers the chances of feeling bad or having your symptoms return.

Continuing Support:

 

To avoid withdrawal symptoms, your doctor might suggest keeping medications that help with conditions like Parkinson's disease for a short period even after you've stopped taking the antipsychotic.

Switching Antipsychotics:

When switching from one antipsychotic to another, there are various strategies. Here are a few:

Cross-titration:

Gradually reduce the dose of the first antipsychotic while gradually increasing the new one.

Overlap and Taper:

Keep the dose of the first antipsychotic stable while gradually increasing the new one, then taper the first one.

Abrupt Change:

Abruptly stop the first antipsychotic and either gradually increase the new one or start it at the full treatment dose.

There's no one-size-fits-all answer, and the best strategy depends on your specific situation.

It's essential to discuss these options with your doctor to find the most suitable approach for you.

Limited Evidence:

It's crucial to highlight that there isn't a lot of clear evidence regarding the best strategies for switching medications and the rates at which to reduce them.

Various studies have provided conflicting results, and there may not be a one-size-fits-all solution.

This emphasizes the importance of individualized care and consulting with your healthcare provider to determine the most suitable approach for your specific situation.

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Molindone Dose in Childrens:

Molindone (Moban) Dose in the treatment of Schizophrenia:

Important Note:

In treating schizophrenia in children and teenagers, doctors typically favor second-generation antipsychotics over Molindone, as recommended by the American Academy of Child and Adolescent Psychiatry (AACAP) in 2013.

When Molindone is prescribed, it's important to use the smallest effective dose for the shortest required duration.

Regularly assess whether ongoing treatment is necessary.

This approach helps minimize potential side effects and ensures that the medication is used judiciously. Always follow your healthcare provider's guidance for the safest and most effective use.

Dosage for Children Aged 12 and Up and Teenagers:

• Starting Dose:

  • Give the child 50 to 75 milligrams (mg) orally every day.

  • Depending on how the child responds and tolerates the medication, the dose may increase to 100 mg within the first 3 to 4 days.

  • Adjust the dose as necessary thereafter, but do not exceed 225 mg in a single day. Always follow these dosing instructions provided by the healthcare provider for the child's safety and well-being.

• Regular Dose:
  • For milder symptoms, take 5 to 15 mg three to four times a day. If symptoms are moderate, take 10 to 25 mg three to four times a day.
  • In severe cases, the dosage might go up to 225 mg in one day. Always follow the prescribed dosages provided by your healthcare provider for your specific situation.

Note for Adults: Guidelines for adults suggest maintaining doses between 30 to 100 mg daily.

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Pregnancy Risk Category: N

• Studies on animals have indicated problems when given antipsychotic drugs during pregnancy.

• If pregnant women take these drugs in the later stages of pregnancy, their babies might experience issues such as shaky movements, difficulty eating, excessive tension or floppiness, breathing problems, sleepiness, or shaking after birth.

• These problems may resolve on their own, or the baby might require hospitalization.

• If a pregnant woman genuinely needs this medication, it's advised to take the smallest effective dose to minimize the risk of these issues in the baby.

• It's crucial for pregnant individuals to discuss the potential risks and benefits with their healthcare provider to make informed decisions about medication use during pregnancy.

Use during breastfeeding:

• The passage of molindone into breast milk is uncertain or not well-established.

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Molindone Dose in Kidney Disease:

 

If the official instructions for the medicine do not provide any specific changes to the dose in the presence of kidney problems, it's essential to follow the prescribed dose and consult with a healthcare professional.

However, individuals with kidney problems may still need close monitoring for potential side effects, and any concerns or questions should be discussed with their healthcare provider.

It's crucial to ensure that the prescribed medication is safe and appropriate for the specific health condition and individual circumstances.

Molindone Dose in Liver disease:

If the medicine's label does not provide guidance on how to adjust the dose for individuals with liver problems, it's important to exercise caution when using it.

Liver function can affect how the body processes medications, and certain drugs may pose risks for individuals with liver issues.

In such cases, it's crucial to consult with a healthcare professional who can assess the potential risks and benefits and provide personalized recommendations for safe and effective use of the medication.

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Side effects of Molindone (Moban):

• Cardiovascular:
  • Tachycardia
  • Orthostatic Hypotension
  • Cardiac Arrhythmia
• Central Nervous System:
  • Sedation
  • Disruption Of Body Temperature Regulation
  • Neuroleptic Malignant Syndrome (NMS)
  • Euphoria
  • Hyperactivity
  • Extrapyramidal Reaction (Akathisia, Dystonia, Parkinsonian-Like Syndrome, Tardive Dyskinesia)
  • Restlessness
  • Drowsiness
  • Seizure
  • Depression
• Dermatologic:
  • Skin Rash
• Endocrine & Metabolic:
  • Weight Gain (Minimal Compared To Other Antipsychotics)
  • Galactorrhea
  • Menstrual Disease
  • Weight Loss
  • Increased Libido
  • Gynecomastia
  • Amenorrhea
• Gastrointestinal:
  • Xerostomia
  • Nausea
  • Salivation
  • Constipation
• Genitourinary:
  • Urinary Retention
  • Priapism
• Ophthalmic:
  • Cataract
  • Retinal Pigment Changes
  • Blurred Vision

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Contraindications to Molindone (Moban):

• Do not use molindone if you are allergic to it or any part of the medicine.

• Additionally, avoid using it if you have severe brain sluggishness or are in a coma.

• There may also be reactions if you have had allergies to similar drugs called phenothiazines.

• Always inform your healthcare provider of any known allergies or adverse reactions to medications before starting a new treatment.

Warnings and Precautions

Altered cardiac conduction:

• There is a rare chance that molindone could impact the rhythm of your heart.
• Occasionally, even regular doses of antipsychotic drugs like molindone may lead to dangerous heart rhythm problems that could be life-threatening.
• It's important to be aware of these potential risks and to promptly report any unusual symptoms or concerns to your healthcare provider while taking this medication.
• Regular monitoring and communication with your healthcare team are essential for your safety.

Anticholinergic effects:

• Molindone may lead to side effects such as constipation, dry mouth, blurry vision, and difficulty urinating.
• Exercise caution when using it in individuals with stomach movement issues, blocked intestines, trouble urinating, enlarged prostate, dry mouth, or vision problems.
• In comparison to similar drugs, molindone is less likely to cause these side effects. However, it's crucial to monitor and report any adverse effects to your healthcare provider for appropriate management.

Antiemetic effects:

• Molindone has the potential to mask vomiting that may be caused by other harmful drugs or serious health issues, such as blocked intestines, Reye syndrome, or brain tumors.
• This is because molindone can prevent or reduce feelings of nausea and the urge to vomit.
• It's important to be aware of this effect and communicate openly with your healthcare provider about any changes in your symptoms or concerns, especially if there's a possibility of underlying health issues that need attention.

Blood dyscrasias:

• Some individuals using antipsychotic drugs, such as molindone, have experienced issues with their blood, including a reduction in the number of white blood cells.
• This can be a serious and potentially life-threatening condition.
• If someone has a history of these blood problems or has experienced them due to other medications, it's advisable to undergo regular blood tests.
• If the blood tests indicate signs of these problems or if the white blood cell count becomes very low, discontinuing the use of the medication is recommended.
• Regular monitoring and communication with a healthcare provider are crucial to ensure the safety of individuals taking antipsychotic drugs..

CNS depression:

• Molindone can cause drowsiness or reduced alertness, which may impact the ability to perform tasks that require attention, such as driving or operating machinery.
• However, when compared to similar drugs, molindone is less likely to induce sleepiness.
• It's important for individuals taking molindone to be cautious about engaging in activities that require focus and coordination, and they should discuss any concerns about side effects with their healthcare provider.

Esophageal dysmotility/aspiration:

• Taking antipsychotic drugs, including molindone, may occasionally lead to swallowing difficulties and an increased risk of food entering the lungs instead of the stomach.
• This risk is higher in older individuals, particularly those over 75 years old.
• Exercise extra caution when administering these drugs to individuals who already have a heightened risk of this problem, such as those with Alzheimer's disease.
• If there are concerns about swallowing issues or related risks, it's crucial to discuss them with a healthcare provider for appropriate management and monitoring.

Extrapyramidal symptoms:

• Molindone can lead to movement problems known as EPS (extrapyramidal symptoms), which may include Parkinson's-like shakes, sudden muscle stiffness, restlessness, and involuntary movements that could develop over time (tardive dyskinesia).

• The risk of certain symptoms, such as muscle stiffness, may increase with higher doses, particularly in younger men and those taking older types of antipsychotics.

• People more likely to develop tardive dyskinesia include older individuals, postmenopausal women, those with Parkinson's, mood disorders like depression, and individuals with certain health conditions or habits such as diabetes, brain injuries, alcoholism, or high doses of antipsychotics.

• If someone begins to exhibit signs of these uncontrollable movements, it's advisable to consider discontinuing the medication and consult with a healthcare provider for appropriate guidance.

• Regular monitoring for such side effects is essential during antipsychotic treatment.

Falls:

• Molindone can increase the risk of falls because it may cause drowsiness, sudden drops in blood pressure upon standing, or issues with movement and sensation.
• If someone is taking this medication, it's important to assess their likelihood of falling when they first start the treatment and periodically thereafter.
• This is especially crucial if they have other health problems or are taking other medications that may also contribute to an increased risk of falls.
• Regular monitoring and assessment by healthcare providers can help manage and reduce the risk of falls in individuals taking molindone.

Hyperprolactinemia:

• Taking molindone can elevate the levels of prolactin, a hormone, in the body.
• However, it's uncertain what implications this may have for individuals with cancers or tumors that grow due to prolactin.
• If there are concerns about how molindone might affect pre-existing conditions or if there are specific health issues related to elevated prolactin levels, it's important to discuss these concerns with a healthcare provider.
• They can provide guidance based on an individual's medical history and tailor the treatment plan accordingly.
• Regular monitoring and open communication with the healthcare team are key in managing the use of molindone in such cases.

Neuroleptic malignant syndrome (NMS):

• Molindone can occasionally lead to a serious condition known as Neuroleptic Malignant Syndrome (NMS).

• Be vigilant for symptoms such as confusion, fever, stiff muscles, or problems with automatic body functions like heartbeat.

• If someone recovers from NMS, careful consideration is needed before reintroducing the drug.

• If the decision is made to resume the medication, close monitoring for any signs of NMS recurrence is crucial.

• Always consult with a healthcare provider for guidance in such situations to ensure the safety and well-being of the individual.

Orthostatic hypotension:

• Molindone can occasionally lead to a sudden drop in blood pressure when a person stands up.
• Exercise caution when using it in individuals who might be more at risk for this effect or could be harmed by it, such as those with brain or heart issues, low blood volume, or those taking other medications that also lower blood pressure or slow the heart rate.
• It's important to assess and manage the risk factors associated with blood pressure changes in individuals taking molindone to ensure their safety.
• Always consult with a healthcare provider for personalized advice based on an individual's health status and medication regimen.

Temperature regulation:

• Taking antipsychotics, including molindone, can impact the body's ability to regulate temperature.
• Caution should be exercised with vigorous exercise, exposure to hot environments, dehydration, or the use of other medications that can also influence body temperature control.
• It's essential to be mindful of these factors and take preventive measures to avoid overheating or heat-related issues.
• Individuals taking molindone should discuss any concerns or considerations related to temperature regulation with their healthcare provider for personalized guidance and recommendations.

Dementia: [US Boxed Warning]:

• A strong warning: Older individuals experiencing memory loss associated with dementia, when treated with antipsychotics such as molindone, face an elevated risk of mortality compared to those not using these medications.

• The majority of these deaths appear to be associated with heart problems or infections like pneumonia.

• People with specific types of dementia, such as Lewy body or Parkinson's-related dementia, should exercise extra caution as the risks are higher for them.

• Doctors generally prefer newer antipsychotics over older ones like molindone for older patients with this type of psychosis because they might be safer.

• It's crucial to note that molindone is not officially approved to treat dementia-related psychosis.

• The decision to use any antipsychotic medication in older individuals with dementia should be carefully evaluated, considering the potential risks and benefits, and made in consultation with a healthcare provider.

Hepatic impairment:

• Exercise caution when using molindone in individuals with liver problems.

• There have been rare reports of changes in liver enzymes associated with its use.

• Regular monitoring of liver function may be advisable in individuals with pre-existing liver conditions, and any signs of liver issues should be promptly reported to a healthcare provider.

• The decision to use molindone in individuals with liver problems should be made based on a careful assessment of potential risks and benefits, and under the supervision of a healthcare professional

Seizure disorder:

• Caution should be exercised when using molindone in individuals who might have seizures or have a history of seizures.
• Antipsychotic medications, including molindone, may lower the seizure threshold, potentially increasing the risk of seizures.
• It's important to inform healthcare providers about any history of seizures or conditions that may predispose individuals to seizures before starting molindone.
• Close monitoring and appropriate management strategies may be necessary in such cases to ensure the safety of the individual.
• Always follow the guidance and recommendations of healthcare professionals when using molindone in individuals with a history of seizures.

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Molindone: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy)
Acetylcholinesterase Inhibitors	May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors.
Acetylcholinesterase Inhibitors (Central)	Antipsychotic Agents' neurotoxic (central) effects might be amplified.  In some cases, severe extrapyramidal symptoms have manifested.
Alcohol (Ethyl)	Alcohol's CNS depressing effect may be amplified by CNS depressants (Ethyl).
Alizapride	CNS depressants may have an enhanced CNS depressant impact.
Amifampridine	Amifampridine may have a stronger neuroexcitatory and/or seizure-potentiating impact when combined with substances with  seizure threshold lowering potential.
Amphetamines	Antipsychotic drugs may lessen amphetamines' stimulating effects.
Anticholinergic Agents	Other anticholinergic agents' negative or hazardous effects might be amplified.
Botulinum Toxin-Containing Products	May strengthen an anticholinergic agent's anticholinergic action.
Brexanolone	Brexanolone's CNS depressing effects may be amplified by other CNS depressants.
Brimonidine (Topical)	CNS depressants may have an enhanced CNS depressant impact.
BuPROPion	Agents With Seizure Threshold Lowering Potential may have an enhanced neuroexcitatory and/or seizure-potentiating impact.
Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Cannabis	May enhance the CNS depressant effect of CNS Depressants.
Chloral Betaine	May enhance the adverse/toxic effect of Anticholinergic Agents.
Chlorphenesin Carbamate	May enhance the adverse/toxic effect of CNS Depressants.
CNS Depressants	Other CNS depressants' harmful or toxic effects might be exacerbated.
Deutetrabenazine	Could intensify the negative or hazardous effects of antipsychotic drugs. Particularly, there may be a  higher chance of developing  akathisia, parkinsonism, or neuroleptic malignant syndrome.
Dimethindene (Topical)	CNS depressants may have an enhanced CNS depressant impact.
Doxylamine	CNS depressants may have an enhanced CNS depressant impact. Management: The producer of the pregnancy-safe drug  Diclegis (doxylamine/pyridoxine) particularly advises against combining it with other CNS depressants.
Dronabinol	CNS depressants may have an enhanced CNS depressant impact.
Esketamine	CNS depressants may have an enhanced CNS depressant impact.
Gastrointestinal Agents (Prokinetic)	Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).
Glucagon	Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased.
Guanethidine	Antipsychotic Agents may diminish the therapeutic effect of Guanethidine.
HydrOXYzine	May enhance the CNS depressant effect of CNS Depressants.
Itopride	Anticholinergic Agents may diminish the therapeutic effect of Itopride.
Kava Kava	CNS depressants may have an enhanced CNS depressant impact.
Lithium	Antipsychotic Agents' neurotoxic effects might be amplified. Lithium may lower the level of antipsychotic agents in the blood.  Particularly relevant with chlorpromazine.
Lofexidine	May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Magnesium Sulfate	May enhance the CNS depressant effect of CNS Depressants.
Methylphenidate	Antipsychotic drugs may intensify methylphenidate's harmful or toxic effects. Methylphenidate may make antipsychotic  agents more harmful or poisonous.
MetyroSINE	CNS Depressants may enhance the sedative effect of MetyroSINE.
MetyroSINE	May enhance the adverse/toxic effect of Antipsychotic Agents.
Mianserin	May enhance the anticholinergic effect of Anticholinergic Agents.
Minocycline (Systemic)	May enhance the CNS depressant effect of CNS Depressants.
Mirabegron	Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron.
Nabilone	May enhance the CNS depressant effect of CNS Depressants.
Nitroglycerin	Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption.
Quinagolide	Antipsychotic Agents may diminish the therapeutic effect of Quinagolide.
Ramosetron	Ramosetron's constipating effects may be enhanced by anticholinergic drugs.
Rufinamide	CNS depressants' harmful or toxic effects could be increased. Particularly, drowsiness and lightheadedness could be worsened.
Selective Serotonin Reuptake Inhibitors	Selective serotonin reuptake inhibitors may have a worsened or more hazardous effect when taken with CNS depressants.  Particularly, there may be an increased risk of psychomotor impairment.
Serotonergic Agents (High Risk)	Could intensify the negative or hazardous effects of antipsychotic drugs. Particularly, serotonergic drugs may intensify the effects  of dopamine  blocking, thus raising the danger of neuroleptic malignant syndrome. Serotonergic agents' serotonergic action may be  enhanced by antipsychotic drugs (High Risk). Serotonin syndrome might occur from this.
Tetrabenazine	May enhance the adverse/toxic effect of Antipsychotic Agents.
Tetrahydrocannabinol	May enhance the CNS depressant effect of CNS Depressants.
Tetrahydrocannabinol and Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Thiazide and Thiazide-Like Diuretics	Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics.
Topiramate	Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate.
Trimeprazine	CNS depressants may have an enhanced CNS depressant impact.
Risk Factor D (Consider therapy modification)
Anti-Parkinson Agents (Dopamine Agonist)	Antipsychotic Agents (First Generation [Typical]) may diminish the therapeutic effect of Anti-Parkinson Agents (Dopamine Agonist). Anti-Parkinson Agents (Dopamine Agonist) may diminish the therapeutic effect of Antipsychotic Agents (First Generation [Typical]). Management: Avoid concomitant therapy if possible and monitor for decreased effects of both agents when these combinations cannot be avoided. Atypical antipsychotics such as clozapine and quetiapine may be less likely to reduce the effects of antiParkinson agents.
Blonanserin	CNS Depressants may enhance the CNS depressant effect of Blonanserin.
Buprenorphine	CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants.
Chlormethiazole	May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used.
Droperidol	May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Flunitrazepam	CNS Depressants may enhance the CNS depressant effect of Flunitrazepam.
HYDROcodone	CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Iohexol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iomeprol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iomeprol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iopamidol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Lemborexant	CNS depressants may have an enhanced CNS depressant impact. Management: Due to the possibility of additive  CNS depressant effects when lemborexant  and concurrent CNS depressants are administered concurrently, dosage  modifications may be required. Effects of CNS depressants must be closely monitored.
Mequitazine	Mequitazine's arrhythmogenic action may be enhanced by antipsychotic medications. Management: When possible, look  into alternatives to one of these agents. Despite the fact that this combination is not clearly contraindicated, mequitazine  labelling states that it should be avoided.
Methotrimeprazine	The CNS depressing action of methotrimeprazine may be enhanced by CNS depressants. The CNS depressant action of CNS  Depressants may be strengthened by methotrimeprazine. Management: Start concurrent methotrimeprazine therapy  while reducing the adult dose of CNS depressants by 50%. Only once a clinically effective dose of methotrimeprazine  has been established should additional CNS depressant dosage modifications be made.
Opioid Agonists	CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
OxyCODONE	CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Perampanel	May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination.
Pramlintide	May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract.
Secretin	Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin.
Sodium Oxybate	CNS depressants may have an enhanced CNS depressant impact. Management: Take into account substitutes for combined use.  Reduce the doses of one or more medications when simultaneous use is necessary. It is not advised to use sodium  oxybate with alcoholic beverages or hypnotic sedatives.
Suvorexant	Suvorexant's CNS depressing effects may be amplified by other CNS depressants. Treatment: Suvorexant and/or any other  CNS depressant dosage reduction may be required. Suvorexant shouldn't be taken with alcohol, and it shouldn't  be taken for sleeplessness with any other medication either.
Tapentadol	CNS depressants may have an enhanced CNS depressant impact. Treatment: When feasible, refrain from using  tapentadol and benzodiazepines or other CNS depressants simultaneously. Only in the event that other treatment choices  are insufficient should these medications be combined. Limit the duration and dosage of each medicine when used together.
Zolpidem	CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol.
Risk Factor X (Avoid combination)
Aclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.
Amisulpride	Antipsychotic drugs may intensify Amisulpride's harmful or hazardous effects. Management: Separate drug  interaction monographs go into further detail about the medications indicated as exceptions to this book.
Azelastine (Nasal)	Azelastine's CNS depressing impact may be amplified by CNS depressants (Nasal).
Bromopride	May enhance the adverse/toxic effect of Antipsychotic Agents.
Bromperidol	May enhance the CNS depressant effect of CNS Depressants.
Cimetropium	Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium.
Eluxadoline	Anticholinergic Agents may enhance the constipating effect of Eluxadoline.
Glycopyrrolate (Oral Inhalation)	Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation).
Glycopyrronium (Topical)	May strengthen an anticholinergic agent's anticholinergic action.
Ipratropium (Oral Inhalation)	May strengthen an anticholinergic agent's anticholinergic action.
Levosulpiride	Levosulpiride's therapeutic impact may be diminished by anticholinergic medications.
Metoclopramide	Could intensify the negative or hazardous effects of antipsychotic drugs.
Orphenadrine	CNS Depressants may enhance the CNS depressant effect of Orphenadrine.
Oxatomide	May enhance the anticholinergic effect of Anticholinergic Agents.
Oxomemazine	May enhance the CNS depressant effect of CNS Depressants.
Paraldehyde	CNS Depressants may enhance the CNS depressant effect of Paraldehyde.
Piribedil	Piribedil's therapeutic effects may be diminished by antipsychotic drugs. Piribedil may lessen an antipsychotic agent's therapeutic  impact. Treatment: Piribedil should not be used in combination with antiemetic neuroleptics and is not advised to be  used with  antipsychotic neuroleptics, with the exception of clozapine.
Potassium Chloride	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride.
Potassium Citrate	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate.
Revefenacin	Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin.
Sulpiride	Antipsychotic Agents may enhance the adverse/toxic effect of Sulpiride.
Thalidomide	CNS Depressants may enhance the CNS depressant effect of Thalidomide.
Tiotropium	Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium.
Umeclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.

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Monitoring parameters:

Mental & Physical Health:

• In the context of using a medication, the following monitoring measures are recommended:

• Check mental status regularly.
• Monitor vital signs as needed.
• Measure height, BMI (Body Mass Index), and waist size:
  • At the beginning of the treatment.
  • At every visit for the first 6 months.
  • Every 3 months if the individual is on a stable dose of the drug.

• These monitoring practices help healthcare providers assess the effectiveness and potential side effects of the medication over time, ensuring the individual's well-being and adjusting the treatment plan as necessary.

Blood Tests:

• Medical monitoring for individuals on a specific medication includes the following recommendations:

  Complete Blood Count (CBC):

• As needed.
• More frequent in the first few months if there is a history of low white blood cell count.

• Check electrolytes and liver function:

• Every year and as needed.

• Blood sugar level:

• At the beginning and then yearly.
• Check again 4 months after starting the drug if there's a risk of diabetes or weight gain.

• Lipids (like cholesterol):

• At the beginning.
• Every 2 years if LDL cholesterol is normal.
• Every 6 months if LDL is higher than 130 mg/dL.

• These regular assessments help healthcare providers monitor potential side effects, assess the impact of the medication on various health indicators, and make informed decisions about the ongoing treatment plan.

Reproductive Health:

• Regular monitoring for changes in specific aspects of reproductive health is recommended, including:

  Check for changes in:

• Periods.
• Sex drive.
• Unexpected milk production.
• Erection and ejaculation.

• Monitoring frequency:

• Each visit for the first 12 weeks after starting the drug.
• Yearly after the drug dose is stable.

• These assessments help healthcare providers evaluate the impact of the medication on reproductive health and address any changes or concerns that may arise during the course of treatment.

• Regular communication with healthcare professionals is essential to ensure comprehensive care and appropriate adjustments to the treatment plan.

Movement Issues:

• Monitoring for specific movement-related side effects is crucial. Here are the recommendations:

  Check for involuntary movements or signs of Parkinson's:

• At the beginning.
• Weekly until the dose has been stable for 2 weeks.
• After any significant increase in dose.

• Tardive dyskinesia (uncontrolled movements):

• Every 6 months.
• Every 3 months for those at high risk.

• Regular assessments for these movement-related issues help healthcare providers identify potential side effects early on and adjust the treatment plan as needed to ensure the well-being of the individual.

• Monitoring frequency may vary based on the individual's response to the medication and their risk factors.

Eye Health:

• Regular monitoring of vision is important, and the following recommendations are made:

  Ask about vision changes:

• Yearly.

• Eye exams:

• Yearly for patients over 40.
• Every 2 years for younger patients.

• These assessments help identify and address any changes in vision, ensuring that potential issues are detected early and appropriate measures can be taken. Regular eye exams become increasingly important with age to monitor and maintain eye health.

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How to administer Molindone (Moban)?

The medication is taken orally three or four times a day, and it can be taken with or without meals. It is recommended to take it at the same time each day for consistency.

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Mechanism of action of Molindone (Moban):

Main Action:

• Molindone mainly works by blocking certain receptors (called dopaminergic D receptors) in specific parts of the brain: the striatum, nucleus accumbens, and ventral tegmental area.

Other Effects:

• Molindone has specific receptor interactions, and it's notable that it doesn't significantly affect certain receptors in different parts of the brain. Specifically:

• It doesn't have a significant effect on the histamine H1 receptor or the alpha-1 adrenergic receptor in the frontal part of the brain.
• It doesn't impact the muscarinic acetylcholine receptor in the caudate nucleus, another brain region.
• It has a moderate effect on the alpha-2 adrenergic receptor in the frontal part of the brain.

• Understanding the receptor profile of a medication provides insights into its specific actions and helps in predicting potential side effects and therapeutic effects.

How Long It Lasts:

• The effects of Molindone last for around 24 to 36 hours.

Getting into the Body:

• The body absorbs molindone quickly.

Protein Binding:

• About 76% of molindone attaches to proteins in the blood (like a lock and key).

Processing in the Body:

• The liver helps break down molindone.

Time It Takes to Leave:

• Molindone's half-life (the time it takes for half of the drug to leave the body) is about 1.5 hours.

When It Peaks in the Blood:

• The highest amount of molindone in the blood is reached around 1.5 hours after taking it.

Leaving the Body:

• Most of the molindone is removed through urine and feces. Only a small amount (2% to 3%) is unchanged molindone.

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International Brand Names of Molindone:

• Moban

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Molindone Brand Names in Pakistan:

Not Available.