THERAPEUTICS

Brands

• Harmonyl

Generic?

• Yes

Class

• Monoamine-depleting agent

Commonly Prescribed for

(FDA approved in bold)

• Hypertension

• Psychotic states

• Gilles de la Tourette syndrome (GTS) or tics

• Chorea and dyskinesias in Huntington’s disease

• Hemiballism

• Dystonia (especially tardive)

• Myoclonus

How the Drug Works

• Depleting agent that depletes stores of catecholamines (dopamine, norepinephrine) and serotonin in the brain and adrenal medulla. Depression of sympathetic nerve function lowers heart rate and blood pressure

How Long Until It Works

• Hypertension: less than a week

• Psychosis, movement disorders: effects can be seen within a few days

If It Works

• In neurological conditions, continue to assess effect of the medication and determine if still needed

If It Doesn't Work

• Chorea: consider benzodiazepines and AEDs (valproate). Neuroleptics are usually effective. Tetrabenazine (another antiadrenergic) is often better tolerated

• Generalized dystonia: anticholinergics, baclofen, or benzodiazepines may be effective. Surgical treatments (including pallidotomy, thalamotomy, deep brain stimulation, myotomy, rhizotomy, or peripheral denervation) are reserved for refractory cases

• GTS/tics: neuroleptics and α2-adrenergic agonists are often effective

Best Augmenting Combos for Partial Response or Treatment-Resistance

• AEs, such as CNS depression, often increase when used with other agents, but if tolerated consider combinations with AEDs or benzodiazepines

Tests

• Monitor blood pressure and pulse

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Related to depletion of catecholamines and serotonin

Notable AEs

• Bradycardia, edema, angina-like symptoms

• Drowsiness, dizziness, depression, nightmares

• Nausea, dry mouth, anorexia, impotence, dyspnea, nasal congestion

• Rash, purpura

Life-Threatening or Dangerous AEs

• Hypersensitivity reactions

• Deafness, optic atrophy

• Parkinsonism and extrapyramidal tract dysfunction (less common than neuroleptics)

Weight Gain

• Common

Weight Gain

• Common

Sedation

• Problematic

What to Do About AEs

• Stop drug for serious AEs, and use the lowest needed dose