Haloperidol zotepine

Zotepine has been used in Japan and Germany for many years, but has only recently been marketed in the UK. Zotepine is referred to in two pharmacoeconomic publications (Byrom et al, 1998a, b), but no relevant data are provided. Two evaluations are apparently awaiting publication (Knoll, personal communication, 2001) one a 6-month comparison of zotepine and one a health-care model of outcomes associated with the use of zotepine and haloperidol. 

The use of zotepine in short-term trials (4-8 weeks) has been reviewed (86). Comparisons have been carried out with haloperidol (three trials n = 212), chlorpromazine (two trials n = 328), perazine (two trials n = 81), and tiotixene (one trial n = 94). In these double-blind trials, zotepine 150-300 mg/day was as effective as typical neuroleptic drugs in controlling the symptoms of schizophrenia. The results suggested that zotepine may be effective in the management of patients with negative symptoms... 

A 38-year-old man with schizophrenia was given a combination of zotepine 100 mg/day and haloperidol ester 100 mg every 2 weeks and complained of spontaneous ejaculation, which became more severe when the dosage of zotepine was increased to 150 mg/day. Zotepine was discontinued and the spontaneous ejaculation no longer occurred with haloperidol monotherapy. A combination of haloperidol 100 mg every 2 weeks and quetiapine was then used, and spontaneous ejaculation did not recur. 

Neuroleptic malignant syndrome is characterised by hyperthermia, severe muscle rigidity, autonomic dysfunction and altered mental state. A study of 24 patients who had received a variety of antipsychotics (chlorpromazine, zotepine, paliperidone, bromperidol, supliride, risperidone, thioridazine, olanzapine, fluphenazine, haloperidol, levoproma-zine) demonstrated a temporal relationship of muscle rigidity and elevated creatine kinase to fever [46 ]. 

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