Phenothiazine drugs are primarily used for the treatment of schizophrenia and other forms of psychosis.
Medications in this family include
- Chlorpromazine hydrochloride (Thorazine)
- Fluphenazine (Permitil, Prolixin)
- Mesoridazine besylate (Serentil)
- Perphenazine (Trilafon)
- Prochlorperazine (Compazine)
- Promazine hydrochloride (Sparine)
- Promethazine hydrochloride (Anergan [injectable], Phenergan)
- Thioridazine hydrochloride (Mellaril)
- Trifluoperazine hydrochloride (Stelazine)
- Triflupromazine hydrochloride (Vesprin [injectable])
- and others
Preliminary studies suggest that phenothiazine drugs might deplete the body of coenzyme Q 10 (CoQ 10 ). 1,2 While there is as yet no evidence that taking CoQ 10 supplements provides any specific benefit, supplementing with CoQ 10 on general principle might be a good idea if you are taking phenothiazine drugs.
Fish oil contains essential fatty acids in the omega-3 family. Fish oil, its constituents, and a slightly modified fish oil constituent called ethyl-EPA have all been tested for treatment of depression. Incomplete and inconsistent evidence hints that these substances might augment the effectiveness of standard medications used for schizophrenia . 15-20
Milk thistle might protect against the liver toxicity sometimes caused by phenothiazine drugs. 3
Preliminary evidence suggests that ginkgo might reduce the side effects and increase the efficacy of various antipsychotic medications. 4,12
One of the most feared side effects of phenothiazines is the development of a permanent side effect called tardive dyskinesia (TD). This late-developing (tardy, or tardive) complication consists of annoying uncontrollable movements (dyskinesias), particularly in the face.
In early studies, vitamin E had shown some promise for treating tardive dyskinesia, 5,6 but the largest and best-designed study failed to find benefit. 21 For more information, see the full Tardive Dyskinesia article.
A pilot study suggests that vitamin B 6 may be helpful for the treatment of tardive dyskinesia (TD). In this 4-week, double-blind crossover trial of 15 individuals, treatment with vitamin B 6 significantly improved TD symptoms as compared to placebo. 11 Benefits were seen after 1 week of treatment. However, the dosage of vitamin B 6 used in this study was quite high (400 mg daily). Toxicity has been reported with daily intake of vitamin B 6 at half this dose.
Vitamin B 6 might also reduce symptoms of akathesia, a type of restlessness associated with phenothiazine antipsychotics. 13
One small, double-blind study found that use of DHEA reduced the Parkinson-like movement disorders that may occur in people taking phenothiazine drugs. 14
Phenothiazine drugs are most effective for the "positive" symptoms of schizophrenia, such as hallucinations and delusions. (Such symptoms are called "positive" because they indicate the presence of abnormal mental functions, rather than the absence of normal mental functions.) In general, however, these medications are less helpful for the "negative" symptoms of schizophrenia, such as apathy, depression, and social withdrawal. Some evidence hints that the supplement glycine might enhance the effectiveness of phenothiazines regarding this latter class of symptoms. 22-24
There are some indications that using the supplement phenylalanine while taking antipsychotic drugs might increase your risk of developing tardive dyskinesia. 7,8
Besides the late-developing complication of tardive dyskinesia, antipsychotic drugs can cause more immediately another movement disorder: dystonic reactions, sudden intense movements of the neck and eyes. There is some evidence that the herb kava can increase the risk or severity of this side effect. 9
Phenothiazines can cause increased sensitivity to the sun. Various herbs, including St. John's wort and dong quai , can also cause this problem. Combined treatment with herb and drug might increase the risk further.
The herb yohimbe is relatively toxic, and can cause problems if used incorrectly. Phenothiazine medications may increase the risk of toxicity. 10
References
REF1 Folkers K. Basic chemical research on coenzyme Q 10 and integrated clinical research on therapy of diseases. In Lenaz G, ed. Coenzyme Q. New York: John Wiley and Sons, 1985.
REF2 Kishi T, Makino K, Okamoto T, et al. Inhibition of myocardial respiration by psychotherapeutic drugs and prevention by coenzyme Q. In: International Symposium on Coenzyme Q. Biomedical and clinical aspects of coenzyme Q. Vol 2. New York, NY: Elsevier Science Publishing Co; 1980: 139-157.
REF3 Palasciano G, et al. The effect of silymarin on plasma levels of malondialdehyde in patients receiving long term treatment with psychotropic drugs. Curr Ther Res 1994;55:537-545, 1994.
REF4 Liu P, et al. Combined use of Ginkgo biloba extracts on efficacy and adverse reactions of various antipsychotics. Zhongguo Linchuang Yaolixue Zaxhi. 1997;13:193-198.
REF5 Adler LA, et al. Vitamin E treatment of tardive dyskinesia. Am J Psychiatry. 1993;50:1405-1407.
REF6 Adler LA, et al. Long term treatment effects of vitamin E for tardive dyskinesia. Biol Psychiatry. 1998;43:868-872.
REF7 Richardson MA. Amino acids in psychiatric disease. Washington, DC: American Psychiatric Press; 1990.
REF8 Mosnik DM, Spring B, Rogers K, and Baruah SL. Tardive dyskinesia exacerbated after ingestion of phenylalanine by schizophrenic patients. Neuropsychopharmacology 1997;16:136-146.
REF9 Schelosky L, et al. Kava and dopamine antagonism. J Neurol Neurosurg Psych 1995;58:639-640.
REF10 Brinker F. Herb contraindications and drug interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications. 1998: 140-141.
REF11 Lerner V, Miodownik C, Kaptsan A, et al. Vitamin B 6 in the treatment of tardive dyskinesia: a double-blind, placebo-controlled, crossover study. Am J Psychiatry. 2001;158:1511-1514.
REF12 Zhang XY, Zhou DF, Zhang PY, et al. A double-blind, placebo-controlled trial of extract of Ginkgo biloba added to haloperidol in treatment-resistant patients with schizophrenia. J Clin Psychiatry . 2001;62:878-883
REF13 Lerner V, Bergman J, Statsenko N, et al. Vitamin B(6) treatment in acute neuroleptic-induced akathisia: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry . 2004;65:1550-1554.
REF14 Nachshoni T, Ebert T, Abramovitch Y, et al. Improvement of extrapyramidal symptoms following dehydroepiandrosterone (DHEA) administration in antipsychotic treated schizophrenia patients: A randomized, double-blind placebo controlled trial. Schizophr Res . 2005 Aug 25. [Epub ahead of print]
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REF17 Fenton WS, Dickerson F, Boronow J, et al. A placebo-controlled trial of omega-3 fatty acid (ethyl eicosapentaenoic acid) supplementation for residual symptoms and cognitive impairment in schizophrenia. Am J Psychiatry. 2001;158:2071-2074.
REF18 Emsley R, Myburgh C, Oosthuizen P, et al. Randomized, placebo-controlled study of ethyl-eicosapentaenoic Acid as supplemental treatment in schizophrenia. Am J Psychiatry. 2002;159:1596-1598.
REF19 Fenton WS, Dickerson F, Boronow J, et al. A placebo-controlled trial of omega-3 fatty acid (ethyl eicosapentaenoic acid) supplementation for residual symptoms and cognitive impairment in schizophrenia. Am J Psychiatry. 2001;158:2071-2074.
REF20 Peet M. Eicosapentaenoic acid in the treatment of schizophrenia and depression: rationale and preliminary double-blind clinical trial results. Prostaglandins Leukot Essent Fatty Acids. 2003;69:477-485.
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