References And Further Reading

McEvoy GK (ed). American Hospital Formulary Service Drug Information 87, American Society of Hospital Pharmacists, Bethesda, pp 1098–1103, 1987.

Morris PA, MacKenzie DH, Masheter HC. A comparative double blind trial of pimozide and fluphenazine in chronic schizophrenia. Br J Psychiatry 117: 683, 1970.

Physicians’ Desk Reference, 60th edn, Thomson PDR, Montvale NJ, pp 1220–1222, 2006.

Taub RN, Baker MA. Treatment of metastatic malignant melanoma with pimozide. Lancet 1: 605, 1979.

References and Further Reading

Fraunfelder FW. Twice-yearly exams unnecessary for patients taking quetiapine. Am J Ophthalmol 138: 870–871, 2004.

Fraunfelder FW. Twice-yearly exams unnecessary for patients taking quetiapine [author’s reply]. Am J Ophthalmol 140: 349, 2005.

Gaynes BI. Twice-yearly exams unnecessary for patients taking quetiapine [comment]. Am J Ophthalmol 140: 348–349, 2005.

Nasrallah HA, Dev V, Rak I, Raniwalla J. Safety update with quetiapine and lenticular examinations: experience with 300 000 patients [poster]. Presented at the Annual Meeting of the American College of Neuro­ psychopharmacology, Dec. 12–16, Acapulco, Mexico, 1999.

Shahzad S, Suleman M-I, Shahab H, et al. Cataract occurrence with anti­ psychotic drugs. Psychosomatics 43: 354–359, 2002.

Valibhai F, Phan NB, Still DJ, True J. Cataracts and quetiapine. Am J ­Psychiatry 158: 966, 2001.

Generic name: Quetiapine fumarate.

Proprietary name: Seroquel.

Primary use

This drug belongs to a new chemical class, dibenzothiazephine derivatives, used in the management of bipolar mania or in schizophrenia.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

Probable

1. Visual hallucinations

2. Myasthenia gravis

a.Diplopia

b.Ptosis

c.Paresis of extraocular muscles

d.Aggravates ocular sicca

Possible

1. Cataracts

Clinical significance

Ocular side effects attributed to quetiapine are rare, transitory and infrequent. Ocular sicca is probable, since dry mouth is one of the most frequent systemic side effects of this agent. Since this drug has caused lens changes in dogs and is an inhibitor of cholesterol biosynthesis, there has been interest as to the cataractogenic potential of this agent. Valibhai et al (2001) have reported a clinically suspect case. Large post-marketing surveillance studies have not found a higher incidence of cataracts.The lack of a characteristic pattern led to the conclusion, at worse, that the drug has a very weak cataractogenic potential.

Recommendations

The manufacturer recommends that any patient receiving chronic treatment be examined at the initiation of treatment and then twice yearly for lens changes. Fraunfelder (2004) recommends only having patients examined as per the guidelines established by the American Academy of Ophthalmology, regardless of whether or not the patient is on quetiapine. Gaynes

Generic names: Tiotixene.

Proprietary name: Navane.

Primary use

This thioxanthene derivative is used in the management of schizophrenia.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

2. Decrease or paralysis of accommodation

3. Oculogyric crises

4. Pupils

a.Mydriasis

b.Miosis

5. Cornea

a.Fine particulate deposits

b.Keratitis

6. Eyelids or conjunctiva

a.Allergic reactions

b.Photosensitivity

c.Angioneurotic edema

d.Urticaria

Probable

1.Lens

a.Fine particulate deposits

b.Stellate cataracts

2. Retinal pigmentary changes

Possible

1. Diplopia

2. Subconjunctival or retinal hemorrhages secondary to drug-induced anemia

3. Aggravate keratitis sicca

Clinical significance

In short-term therapy, ocular side effects due to this drug are reversible and usually insignificant. This drug has antimuscarinic properties, which may account for the occasional patient who