molindone
Molindone is an antipsychotic medication used to treat schizophrenia. Compared to other antipsychotic medications, it tends to have more side effects and can be more expensive.
What is Molindone?
What is Molindone used for?
Schizophrenia
How Molindone works
Molindone is an antipsychotic medication that lowers dopamine levels in the brain. Dopamine is a natural chemical that controls your mood and thoughts. Too much dopamine can cause symptoms of schizophrenia, such as seeing things or hearing voices that don't exist (hallucinations) or having thoughts and beliefs that aren't true (delusions). By lowering dopamine, molindone helps to lessen these symptoms.
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What are the side effects of Molindone?
Common Side Effects
- Sleepiness
- Restlessness
- Stiff muscles
- Tremor
- Blurred vision
- Nausea
- Dry mouth
- Drooling
- Fast heart rate
Other Side Effects
- Low white blood cell count
- Absent or irregular menstrual periods
- Enlarged breasts
- Milky substances released from the nipple
- Higher sex drive
- Weight changes
- Depression
- Higher levels of activity
- Intense happiness or excitement
Serious Side Effects
- Neuroleptic Malignant Syndrome (NMS): high fever, stiff muscles, fast heart rate, rapid breathing, sweating, wide pupils, confusion
- Uncontrolled muscle movements (tardive dyskinesia): involuntarily sticking out your tongue, puffing out your cheeks, puckering your mouth, lip smacking, chewing, and foot tapping
- Seizures
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- High fever, stiff muscles, increased sweating, fast or irregular heartbeat, and confusion, which may be signs of neuroleptic malignant syndrome
- High prolactin level—unexpected breast tissue growth, discharge from the nipple, change in sex drive or performance, irregular menstrual cycle
- Infection—fever, chills, cough, or sore throat
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
- Seizures
- Trouble passing urine
- Uncontrolled and repetitive body movements, muscle stiffness or spasms, tremors or shaking, loss of balance or coordination, restlessness, shuffling walk, which may be signs of extrapyramidal symptoms (EPS)
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Constipation
- Drowsiness
- Dry mouth
- Nausea
Pros and cons of Molindone
Pros
Available in a less expensive generic form
Available in different strengths
Doesn't cause excessive weight gain like other antipsychotic medications
Cons
Has many side effects, such as sleepiness, restlessness, and stiff muscles
Movement-related side effects might become permanent for some people
Doses have to be taken several times per day
Pharmacist tips for Molindone
Molindone commonly causes sleepiness when you first start taking it. Don't drive or do any activity that requires concentration until you know how molindone affects you. The sleepiness should go away as you continue taking the medication. If it doesn’t go away, talk to your healthcare provider since you might need to use a lower dose.
Be careful when taking molindone with some seizure medications, like barbiturates. Together they can slow down your brain activity further and cause sleepiness, dizziness, dangerously low blood pressure, reduced heart rate, and slowed breathing. Discuss with your healthcare provider how to safely take your seizure medications with molindone.
Molindone contains calcium, which can lower your body's absorption of other medications, such as phenytoin (Dilantin) or tetracycline antibiotics like doxycycline (Monodox) or minocycline (Minocin). This means these medications won't work as well if taken with molindone. Talk to your healthcare provider before taking any new medications to avoid interactions.
Stand up slowly and carefully if you've been sitting or lying down for some time. Getting up too quickly while taking molindone can cause your blood pressure to suddenly drop, which can lead to falls.
Molindone can lower your white blood cell count. Your body needs white blood cells to fight infections and build a stronger immune system. Your healthcare provider might have you perform regular blood tests to make sure your numbers are within normal range.
Molindone can cause abnormal or uncontrollable movements of your tongue, face, jaw, or mouth. This is a serious condition known as tardive dyskinesia that might be permanent if not treated right away. Symptoms include sticking out your tongue, puffing out your cheeks, puckering your lips, or chewing uncontrollably. If you have any of these symptoms, let your healthcare provider know right away because you might need to stop taking the medication.
Frequently asked questions about Molindone
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What are the risks and warnings for Molindone?
Molindone can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Higher risk of death in older adults with dementia-related psychosis
Risk factors: Older adults with dementia-related psychosis
People over the age of 65 who also have dementia sometimes have some of the symptoms of schizophrenia, like hallucinations and delusions. This is called dementia-related psychosis, and it shouldn't be treated with molindone. If molindone is used for dementia-related psychosis, it can cause death. Let your healthcare provider know if you or your loved one has dementia before starting molindone.
Difficulty controlling muscle movements (tardive dyskinesia)
Risk factors: Older adults | Female | Long-term treatment with molindone | Taking higher doses of molindone | Stopping molindone
Some people have difficulty controlling movements of their tongue, face, jaw, or mouth while taking molindone, also known as tardive dyskinesia. It's seen most often in older people, especially females, but can occur in anyone taking molindone. The risk is higher if you've been taking molindone for a long time or if you're taking higher doses. Symptoms include sticking out your tongue, puffing out your cheeks, puckering your lips, or chewing uncontrollably. Call your healthcare provider right away, as your condition might become permanent if it's not treated urgently. You might need to stop taking molindone.
Sleepiness and falls
Risk factors: Older adults | Taking other medications that make you sleepy or dizzy | Taking other medications that lower your blood pressure | Drinking alcohol
Molindone can make you feel sleepy or dizzy when you first start taking it. This can make you more likely to fall and possibly break or fracture your bones. Your chances of falling are higher if you take other medications that can also make you feel sleepy or dizzy or if you drink alcohol.
If you've been sitting or lying down for a while, don't stand up too quickly because this might cause your blood pressure to drop and could lead to falls. This condition is known as postural hypotension, and your risk is higher if you also take medications that lower your blood pressure. It might help to raise the head of the bed while lying down, stand up slowly, and sit back down if you're feeling dizzy.
Neuroleptic Malignant Syndrome
Risk factors: Taking antipsychotic medications
Taking antipsychotic medications like molindone can cause Neuroleptic Malignant Syndrome (NMS), which is a rare but life-threatening condition that must be treated right away. Symptoms of NMS include a high fever, stiff muscles, fast heart rate, sweating, wide pupils, and confusion. If you experience any of these symptoms, stop taking molindone and get emergency help right away.
Low white blood cells
Risk factors: History of low white blood cells | Taking other medications that lower white blood cell count
Taking antipsychotic medications like molindone can lower your white blood cells. Your body needs white blood cells to build a stronger immune system to protect you from infection. If you have a history of low white blood cells, your healthcare provider might have you perform regular blood tests to make sure your numbers are within normal range while you're taking molindone. If your numbers drop too low, you might need to stop taking molindone. If you have any signs of an infection, such as a high fever, chills, night sweats, cough, diarrhea, nausea, or vomiting, call your healthcare provider.
Molindone dosage forms
Typical dosing for Molindone
Starting dose: The typical starting dose is 50 to 75 mg by mouth per day. Older adults or people who are more frail might be started on a lower dose.
Maintenance dose: Your healthcare provider will work with you to adjust your dose based on your symptoms and your response to treatment.
Mild to moderate symptoms: The typical maintenance dose is 5 to 25 mg by mouth three or four times per day.
Severe symptoms: The typical maintenance dose can go as high as 225 mg by mouth per day.
How much does Molindone cost?
Molindone contraindications
Severely slowed brain activity or coma
What are alternatives to Molindone?
Management of psychotic disorders
Schizophrenia
Nausea and vomiting
Restlessness and anxiety before surgery
Tetanus
Manic episodes of bipolar disorder
Hiccups that won't go away
Severe behavioral issues in children 1 to 12 years old (e.g., aggressive behavior, frustration, explosive or hyperexcitable behavior)
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