Block 5
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Gabatino-Labra
Block 5
CASE 5
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45 year old
50 kg
male
referred for INCREASED SLEEPING HOURS and when awake would complain of DIZZY SPELLS.
CASE 5
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• Patient is a known schizophrenic • maintained on CHLORPROMAZINE
– 100 MG PER OREM 2X/DAY FOR 6 MONTHS. • Two weeks prior to consult, he was
prescribed PROPRANOLOL – 40 MG/TABLET 2 TABLETS 3X/DAY.
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QUESTION
• What caused the symptoms of the patient?
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Psychotic Disorders
Increase dosage gradually until symptoms are controlled.
Daily dosage of 200 mg is not unusual
Side Effect: Drowsiness
Chlorpromazine
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Metabolism
CYP 2D6
Chlorpromazine
7-hydroxylation
typically degraded by the liver by the action of cytochrome-P450 family
enzymes, usually CYP2D6
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Hypertension
40 mg Inderal twice daily as usual dose
Side effects on the Central Nervous System: depression & lassitude
Propranolol
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Metabolism
CYP 2D6
Propranolol
aromatic hydroxylation
4-hydroxy propranolol is a weak inhibitor of CYP2D6
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DRUG INTERACTION
Chlorpromazine + propranolol
Sleepiness and dizziness
Chlorpromazine
70%Propranolol
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DRUG INTERACTION