Tolerability of melperone Melperone was reasonably well tolerated. One patient was discontinued due to ECG changes with a QTc interval of 498 ms. This patient also had akathisia. Another patient experienced extra-pyramidal side effects at a dose of 300 mg daily. One patient refused to continue melperone due to gastrointestinal disturbance, eye pain and insomnia. No other serious adverse effects such as seizures or blood dyscrasias were reported. Dose of melperone Dose was in the range of 225–600 mg daily for all but one patient who was treated on a dose of 900 mg daily. Discussion Although the data on the efficacy of melperone in treatment-resistant schizophrenia are rather limited,

Inhibitors,research,lifescience,medical it was initially perceived in our unit as ‘clozapine Inhibitors,research,lifescience,medical without blood tests’ and an option particularly for refractory CT99021 price patients who refused clozapine or those who were intolerant to the various adverse effects observed with clozapine. The sample treated comprised a cohort of patients with severe refractory psychotic disorders, with a relatively early onset of psychotic illness and mean duration of antipsychotic treatment of 13 years. The majority of patients had been previously treated on clozapine, Inhibitors,research,lifescience,medical hence there is some selection bias although it is noteworthy that of the sample who discontinued melperone, more than half were subsequently

re-exposed to clozapine with therapeutic benefits. This is in contrast to the findings by Meltzer and colleagues who found that nonresponders to melperone generally did not respond to clozapine treatment [Meltzer et al. 2001]. Of 21 patients treated, only three patients (14%) were discharged on melperone Inhibitors,research,lifescience,medical (the primary outcome measure). One patient was lost to follow up and two patients remain clinically stable on long-term treatment. Of these, one patient has a diagnosis of schizoaffective disorder, depressive type. She had remained well on clozapine for 2 years but discontinued due to weight gain and sedation and

suffered a relapse of her illness. She was tried on other medications without success and refused to go back on clozapine, hence the trial of melperone. Inhibitors,research,lifescience,medical She remains on melperone treatment check in addition to sodium valproate, mirtazapine and venlafaxine in the community. The second patient on long-term treatment with melperone has a diagnosis of severe depressive episodes with psychotic symptoms. She was previously treated on clozapine but developed myocarditis. She failed to respond to other anti-psychotic and antidepressant combinations as well as to ECT treatment. She is currently in a rehabilitation unit on treatment with melperone in combination with lithium, lamotrigine and mirtazapine. Limitations This is a rather small retrospective case notes review including only 21 patients. There may be bias in the sample population as more than half (13/21) the patients were treated in a tertiary referral centre and most had previous exposure to clozapine.