February 3, 2019 6:52 AM   Subscribe

How long does it take thioridazine to become effective?

A family member has schizoaffective disorder. They have a history of not always taking their medication. They are prescribed 150 mg of thioridazine, taken as three 50 mg tablets at night. They take their dosage shortly before bed. Over the past several weeks I noticed their hallucinations/delusions growing stronger.

Three tablets over seven days equals twenty one tablets per week. I counted their tablets one week ago and again yesterday, and determined that they'd only taken eleven tablets over the previous seven days, rather than twenty one tablets. They insist that they've been taking all their medication. I watched them carefully last night, and saw they only took two tablets. (I did insist they take the third tablet.)

I don't live with this person. Their spouse died a while back, and they're alone right now. We've started remodeling our home in anticipation of moving them in with us.

I don't trust that they'll be taking their medication properly if they're by themselves. This means I have to stay overnight in their home for some time until they get back on track. I don't live close by, and there's no one else. This is a disruption to my life, but I don't know what else to do.

How long might I expect to wait before the thioridazine becomes effective? After that, I can stay half the week with them and at least make sure they're taking their full dosage when I'm there. Hopefully the remodeling will be done soon, and I'll handle things from there.
posted by anonymous to Health & Fitness (5 answers total)
I'm not very familiar with Thioridazine, but per UpToDate it's peak serum concentration is 1-4 hours, and it's half life is around 7-24 hours, which suggests that the effects should be seen shortly after taking the medication.

Because of your concerns including the increasing delusions and hallucinations, your family member would likely benefit from a medication that is administered intramuscularly. These are called "depots" and it resolves issues surrounding medication compliance as they don't need to remember to take their medications (and/or can't opt out of taking their medications). They typically go in once a month to get the medication administered. It would be worthwhile speaking with your family member's doctor about this as an alternative.
posted by ghostpony at 7:00 AM on February 3, 2019 [4 favorites]

Has this person taken this particular drug and responded well to it before? Not all people respond to every antipsychotic. They may have try several. Additionally, this an old drug that isn’t used much anymore and I’m a bit surprised it was picked for them. Also if they have schizoaffective disorder they may need a mood stabilizer (if bipolar type) or an antidepressant (if depressed type) as well as the antipsychotic for full symptom control. When mood symptoms are uncontrolled it can be difficult to control the psychotic symptoms with only an antipsychotic in schizoaffective disorder. I am psychiatric social worker but not your psych sw.
posted by Waiting for Pierce Inverarity at 10:38 AM on February 3, 2019 [3 favorites]

Your family member may have the habit of 'stretching' medication to keep costs down, or they might be accustomed to a two-tablet dose of this or some previous medication. If it's a matter of disliking taking three pills, perhaps they would prefer taking the dose as 1.5 100mg tablets. GoodRx link for thioridazine cost comparisons, discount coupons, Medicare coverage.

[Per GoodRx: "This medicine should only be used when other medications have not worked, because it can cause serious heart-related side effects." Thioridazine may be the end of a long and winding prescribing road for your relative; otherwise, I agree with the previous posters that another medication or delivery method could suit.]
posted by Iris Gambol at 3:04 PM on February 3, 2019

Seconding the recommendation to consider an injectible. There’s some evidence that people on injectibles live longer and healthier lives than those on oral medication, simply because they get seen by their provider regularly, and the provider can spot and treat other, even unrelated health concerns early.
posted by MrBobinski at 5:38 PM on February 3, 2019 [1 favorite]

Do you know if they're not taking it because they don't want to, or because they got confused? If it's because they're confused, it might help them to put a week's worth of pills in a dispenser so they know to take everything that's in there on a given day, or do have PillPacks delivered that have bags for each dose with the date and time printed on it.
posted by metasarah at 10:11 AM on February 4, 2019

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