[A control study of aripiprazole and tiapride treatment for tic disorders in children]

OBJECTIVE

To evaluate the efficacy and safety of aripiprazole in the treatment of tic disorder when tiapride is used as a control.

METHODS

Sixty-five children aged 6-14 years old with tic disorders were randomly assigned to two groups: aripiprazole (2.5-10 mg/d) and tiapride treatment (25- 400 mg/d). After 12 weeks treatment, the clinical efficacy was assessed by the Yale Global Tie Severity Scale (YGTSS) score and the adverse reactions were observed.

RESULTS

The YGTSS score in both groups decreased from the second week of treatment. Compared with the tiapride treatment group, the aripirazole treatment group showed a more decreased YGTSS score (29+/-13)% vs (16+/-14)%; P<0.01 by the second week of treatment. The overall effective rate in the aripiprazole and tiapride treatment groups was 91% and 84%, respectively (P>0.05) 12 weeks after treatment. There were no significant differences in the incidence of adverse reactions between the aripiprazole and tiapride treatment groups and no severe adverse events were found in either group.

CONCLUSIONS

Low dose aripiprazole is safe and effective for treatment of tic disorders in children, suggesting that it represents a new valid option for the treatment of tic disorder.

[Case of enzyme-linked immunoglobulin with persistent elevation of lactate dehydrogenase activity in serum by administration of an anti-psychotic drug]

We presented a case, who showed extremely high activity of lactate dehydogenase (LD) and confirmed the presence of the LD linked immunoglobulin in her serum. The maximum activity of LD was 6830 IU/L, and the electrophoretic pattern of LD isozymes showed the broad spectrum from isozyme LD2 to LD5. Analysis by counter immuno electrophoresis revealed that immunogloblin was attached to the M subunit of LD and its subtype was an IgG, lambda-chain. The cause, which produced the complex, might be thought to be the side effects by tiapride administrated for her mild dementia. After discontinuance of this drug, the LD activity in serum had gradually reduced. The serum creatinine also increased gradually after administration of tiapride, and did not reverse to normal level by discontinuance of it. The patient died from acute renal failure, which aggravated from sporadic urinary tract infection. It was suggested that her basal renal dysfunction might be due to the LD IgG complexes. We propose a rapid disruption of suspicious drug for the course of the production of LD linked immunoglobulin, because very high titer of these complexes might suffer irreversible damage to the kidney, which chance to become acute renal failure.

[The benzamides tiapride, sulpiride, and amisulpride in treatment for Tourette's syndrome]

The treatment of Tourette's syndrome is a challenge. Dopamine receptor antagonists are the drugs of first choice for the treatment of tics. Because large controlled trials are lacking, there is no consensus about which of the different neuroleptic drugs should be preferred. In Germany, tiapride seems to be used most often for the treatment of tics in children - although only one small controlled trial has been performed on it till now. In adults, other dopamine receptor antagonists such as risperidone, pimozide, and sulpiride seem to be more effective than tiapride. Today it is unknown whether new atypical neuroleptic drugs including the benzamide amisulpride are more effective than the older benzamides tiapride and sulpiride.

Treatment of alcohol withdrawal syndrome with a combination of tiapride/carbamazepine: results of a pooled analysis in 540 patients

This was a retrospective study to examine the efficacy, practicability and medical safety of a combination of tiapride and unretarded (fast acting formula) carbamazepine in the treatment of alcohol withdrawal syndrome. In five hospitals using this combination for treatment of alcohol withdrawal, 540 patients who had been treated with this combination were identified. An intensive evaluation of patients files and charts was performed. Details of alcohol history and comorbid disorders were extracted from patient files. Severity of alcohol withdrawal had been assessed using the CIWA-A-Score. Gender differences and differences between patients in their first and at least second withdrawal were computed by means of variance analyses (GLM). At baseline (day 1) mean dosage given was 796 for tiapride and 543 mg for carbamazepine. A pooled analysis of the results showed that, in general, medication was well tolerated. Withdrawal symptomatology as indicated by CIWA-A scores clearly decreased over time. Although a significant number of patients had a history of alcohol withdrawal delirium (103) and epileptic seizures (151), few patients suffered from them during treatment (8 and 5, respectively). Only 24 (4.4%) patients dropped out because of lack of efficacy or change of medication, 15 (2.8%) because of side effects. No case of malignant neuroleptic syndrome was recorded. Data analysis showed gender differences and differences between patients in their first and at least second withdrawal for side effects, complications, and in some CIWA-A-scores. In general, severe complications of withdrawal syndrome were more frequent in men compared to women and in patients with repeated inpatient treatment. In line with previous research, the results from this study give further evidence that a combination of the anticonvulsant carbamazepine and tiapride is an effective and safe treatment for alcohol withdrawal treatment.

Efficacy and Safety of Outpatient Alcohol Detoxification with a Combination of Tiapride/Carbamazepine: Additional Evidence

BACKGROUND

Few medications have been tested for outpatient alcohol detoxification. Previously we had shown a combination of carbamazepine and tiapride to be effective in an open study. This database is an extension of our previous work.

METHODS

This was an open prospective study to examine the efficacy, practicability and medical safety of a combination of tiapride and carbamazepine in outpatient detoxification of alcohol dependent patients. Patients were carefully screened for relevant neuropsychiatric disorders and then seen on a daily outpatient basis.

RESULTS

A total number of 116 consecutively admitted patients entered the programme; 107 (92%) successfully ended the treatment. The mean initial dose for tiapride was 289 mg and for carbamazepine 502 mg. No serious medical complications or adverse events were observed except for one case of delirium tremens. Only four patients dropped out because of side effects. In general medication was well tolerated. Withdrawal symptomatology as indicated by CIWA-A-scores decreased over time.

CONCLUSIONS

Results from this study give further evidence for a combination of tiapride and the anticonvulsant carbamazepine as an effective and safe treatment for outpatient alcohol detoxification in patients with moderate severity of withdrawal syndrome. Further randomized trials are warranted to examine the efficacy of this combination in outpatient alcohol withdrawal.

Pheochromocytoma unmasked by amisulpride and tiapride

OBJECTIVE

To describe the unmasking of pheochromocytoma in a patient treated with amisulpride and tiapride.

CASE SUMMARY

A 42-year-old white man developed acute hypertension with severe headache and vomiting 2 hours after the first doses of amisulpride 100 mg and tiapride 100 mg. Both drugs were immediately discontinued, and the patient recovered after subsequent nicardipine and verapamil treatment. Abdominal ultrasound showed an adrenal mass, and postoperative histologic examination confirmed the diagnosis of pheochromocytoma.

DISCUSSION

Drug-induced symptoms of pheochromocytoma are often associated with the use of substituted benzamide drugs, but the underlying mechanism is unknown. In our case, use of the Naranjo probability scale indicated a possible relationship between the hypertensive crisis and amisulpride and tiapride therapy.

CONCLUSIONS

As of March 24, 2005, this is the first reported case of amisulpride- and tiapride-induced hypertensive crisis in a patient with pheochromocytoma. Physicians and other healthcare professionals should be aware of this potential adverse effect of tiapride and amisulpride.

Treatment of alcohol withdrawal: tiapride and carbamazepine versus clomethiazole. A pilot study

In Germany, clomethiazole (CLO) and benzodiazepines are predominantly used as therapeutic agents in the treatment of the alcohol withdrawal syndrome (AWS). These agents have disadvantages such as sedation, risk of respiratory insufficiency, and cardiovascular complications as well as addictive potential. Alternatively, it could be demonstrated that both tiapride (TIA) and carbamazepine (CBZ) are efficient in the treatment of AWS with less toxicity. However, they seem to be less effective in AWS than CLO as single agents. But no systematic comparison of the combination of TIA and CBZ against an established therapeutic standard can be found in the literature. Therefore, we compared the combination of TIA and CBZ with CLO in two open exploratory studies with matched samples. Outcome parameters were heart rate, blood pressure, complications, withdrawal symptoms (CIWA-Ar scale), and general clinical state (CGI scale). A retrospective evaluation of medical records (30 TIA+CBZ, 30 CLO) was followed by an open prospective study (40 TIA+CBZ, 40 CLO). Both studies revealed similar efficacy in terms of psychopathologic and vegetative symptoms. Vegetative recovery seems to be faster with TIA+CBZ. Results of this exploratory study have to be confirmed by a controlled double-blind study with severity of AWS as an experimental factor.

Double blind study of tiapride versus haloperidol and placebo in agitation and aggressiveness in elderly patients with cognitive impairment

OBJECTIVE

The aim of the present study was to compare the efficacy and safety of tiapride versus haloperidol and placebo in the treatment of agitation and aggressiveness in elderly patients with mild or moderate mental impairment.

METHOD

This international, multicentre, randomized, double blind, three parallel groups study compared efficacy and safety of a 21 -day regimen of tiapride 100-300 mg/day versus haloperidol 2-6 mg/day and placebo in 306 elderly patients with mild or moderate dementia according to DSM III R and behavioural troubles with the Multidimensional Observation Scale for the Elderly Subjects (MOSES) irritability/aggressiveness subscore ranging from 16 to 30.

RESULTS

The percentage of responders (defined as patients with at least a 25% MOSES irritability/aggressiveness subscore decrease between the inclusion and the end of the treatment) was significantly greater in the tiapride (63%, P=0.04) and haloperidol (69%, P=0.004) groups than in the placebo group (49%), with no significant difference between the active drugs. Similar results were observed for the mean MOSES irritability/aggressiveness subscores on D7, D21 and at D(end) which were significantly smaller in the tiapride and haloperidol groups than in the placebo group. The decrease between D0 and D(end) was significantly greater in the tiapride (6.57, P=0.009) and haloperidol groups (6.75, P=0.005) than in the placebo group (4.71). The global improvement CGI was significantly better in the tiapride and haloperidol groups than in the placebo group (P=0.03 and P=0.02). No significant difference was observed between the two active drugs or among the three treatment groups for the Folstein's Mini Mental Status scale (MMS) total score, and there was no notable change during treatment. The number of patients with adverse events, assessed on the Udvalg Kliniske Undersogelser scale (UKU), and the number of UKU symptoms were smaller in the tiapride group (62 patients, 61%, 212 events) than in the haloperidol group (77 patients, 76%, 305 events) and identical to that observed in the placebo group (69 patients, 67%, 234 events). Of interest, the number of patients with at least one extrapyramidal symptom was significantly lower (P=0.003) in the tiapride group (16 patients, 16%) than in the haloperidol group (34 patients, 34%) and similar to that of the placebo group (18 patients, 17%); the difference observed between the haloperidol and placebo groups was significant (P=0.008).

CONCLUSION

Tiapride is not different from haloperidol in the treatment of agitation and aggressiveness in elderly patients and better tolerated, in particular with significantly fewer extrapyramidal symptoms.

Effects of tiapride on electroencephalograms and cognitive functions in the elderly

Tiapride is a substituted benzamide with selective dopamine D2 and D3-antagonist properties which appears to have preferential affinity for extra-striatal dopamine receptors. Tiapride is used in the treatment of agitation, aggressiveness and anxiety in the elderly. To define the effects of a single dose of tiapride 100 mg on psychomotor performance and cognitive functions and electroencephalogram (EEG), a randomized, double-blind, three-way crossover, placebo-controlled study using lorazepam 1 mg as a positive control was carried out in 12 elderly individuals (six women and six men, mean age +/- SD: 69 +/- 3 years). A 1-week wash-out interval was allowed between each administration. Psychomotor and cognitive functions were assessed using both objective [EEG, critical flicker fusion, simple reaction time, tapping, body sway, continuous performance task (CPT), digit symbol substitution test, Sternberg memory scanning and a learning memory test using word lists] and subjective (visual analogue scales) measures before and up to 6 h after dosing. Tiapride was devoid of any detrimental or sedative effects on EEG and all of the performance tasks used and did not impair memory compared with-placebo. In contrast, a single dose of lorazepam produced significant deleterious effects on psychomotor performance (decrease in tapping and in sustained attention (CPT) and an increase in reaction time and body sway), and sedative effects on EEG (significant increase in delta and decrease in alpha waves) as well as significant impairment in working memory (Sternberg) and anterograde amnesia (decrease in immediate and delayed free recall) up to 6 h after dosing compared with placebo and tiapride. In conclusion, the present study showed that in contrast to lorazepam 1 mg there is no evidence to suggest that a single dose of tiapride 100 mg has any sedative and amnestic effects in the elderly which may interfere with everyday life activities.

[Value of tiapride for agitation in the elderly. Review of published studies]

Among elderly disruptive behavior agitation and aggressiveness are frequent and often related to dementia. They are known for increasing the risk of patients' institutionalization and causing distress to families and care givers. When a drug prescription is required, physicians have to take into account the high sensitivity of elderly. Tiapride is an atypical neuroleptic which acts preferentially on D2 and D3 dopaminergic receptors. Several papers concerning results of clinical trials conducted in Europe and Japan have been published and reviewed in this article. The interest of tiapride in the treatment of elderly agitation and aggressiveness has been assessed in four double blind clinical trials including more than 700 patients. The efficacy of tiapride (aggressiveness, agitation, delusion and wandering) was demonstrated in a trial versus placebo (p = 0.027) including 324 patients treated for 28 days with 75 to 150 mg/d. Furthermore the superiority of tiapride (175 to 450 mg/d) on chlorpromazine (18 to 112.5 mg/d) was shown in two trials where 262 patients were treated for four weeks, and a recent survey highlighted that tiapride (400 mg/d) is as efficient as melperone (100 mg/d), the only neuroleptic to be indicated in treatment of elderly agitation and aggressiveness in Germany. Besides, 30 open clinical trials including around 1,000 patients have been conducted and have shown homogeneous and positive results. In the two trials versus chlorpromazine, the safety of tiapride was better, with especially less drowsiness, extrapyramidal symptoms, and dry mouth. Compared to lorazepam, in healthy subjects, tiapride caused less memory impairment. European and Japanese open studies confirmed the safety of tiapride in the elderly. In conclusion, tiapride at doses of 100 to 300 mg/d, appeared to be a therapy of elderly agitation and aggressiveness, at less as efficient as the other drugs used in this indication. Furthermore, the safety of tiapride is an advantage compared to benzodiazepines and neuroleptics.

Measuring the efficacy of psychopharmacological treatment of psychomotoric restlessness in dementia: clinical evaluation of tiapride

A major problem in psychogeriatrics is the treatment of demented patients suffering from severe restlessness and aggressive behavior. There have been few controlled studies of the efficacy of antipsychotic drugs in the treatment of this condition. Therefore, a multi-centre, double-blind, randomized study, measuring the efficacy and safety of tiapride vs. melperone in hospitalized dementia patients suffering from psychomotoric agitation, was conducted in 24 psychiatric hospitals in Germany. A total of 176 patients were enrolled: 175 of them were included in the safety analysis and 156 were evaluated for efficacy. Both treatment groups were comparable regarding the severity of disease and demographic data as well as with regard to the neuropsychological baseline assessment. The CGI (item, 2) was the primary efficacy parameter. Both groups yielded an identical response rate of 74.36%. The secondary efficacy parameters (NOSIE, AIMS, RAPSU, BePU, VAS) showed correspondingly a marked improvement for both groups. No significant changes of the safety parameters (blood pressure, pulse rate, ECG, clinical examination) occurred in the study. The overall number of adverse events was slightly higher in the tiapride group, serious events occurring less frequently. This study demonstrates that tiapride is as effective and as safe as melperone. These results are consistent with international experience on tiapride.

[Porphyria variegata. Apropos of a case]

A patient hospitalized because of somatic disturbances without any sign of detectable cerebral organicity and because of secondary anxiety disorder and major depression presents different clinical pictures with a neurological aspect. All this pictures, that evoke the diagnostic of hysteria conversion in particular, are complicated by a tetraplegia with emission of red urine that enable us to think of a diagnostic of hepatic-porphyria (variegata). Hereditary metabolic diseases, which categories of bioclinic symptoms (that enable us to evoke the diagnostic and to prevent the complications that are breeded by the prescription of forbidden drugs for ill subject) are reminded.

Use of tiapride on stuttering in children and adolescents

Reported here is the therapeutic efficacy of Tiapride with 10 10- to 17-yr.-old patients afflicted with severe stuttering problems. During the 20-wk. open, controlled study (baseline, low dose of Tiapride, high dose of Tiapride, follow-up observation without medication) the stuttering in various speech situations decreased markedly. No substantial change in different parameters of acoustic analysis and psychopathological characteristics accompanied the reduction in stuttering when group data were compared although positive effects concerning these variables could be seen in some cases. Several conclusions based on these results are presented. One assumed effect of the medication is improvement of central nervous regulatory mechanisms of speech motor coordination. Further, the value of the medication Tiapride in comprehensive stuttering therapy is discussed.

Tiapride. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in geriatric agitation

Tiapride is a substituted benzamide derivative with selective dopamine D2-receptor antagonist properties which appears to have preferential affinity for extrastriatal dopamine receptors. Animal and clinical studies show that tiapride has anxiolytic properties but the mechanism of action is uncertain. Results from limited studies indicate that the clinical efficacy of tiapride in the treatment of agitation, aggressiveness, anxiety and sleep disorders in the elderly appears superior to that of placebo, chlorpromazine, lorazepam and meprobamate. Tiapride also exerts a beneficial effect on vigilance and alertness in elderly patients and causes less sedation than chlorpromazine. Tiapride is well tolerated at the dosages recommended for elderly patients. Further well designed comparative studies with newer drugs are needed to determine the relative place of tiapride in the treatment of geriatric agitation, and such studies should also address the quality-of-life benefits for the patient. Additional clinical experience to determine the efficacy of tiapride in elderly patients with more than one disease condition, receiving concomitant medications, and/or with renal impairment is also required. However, despite these current limitations, tiapride may have potentially important applications in this difficult area of clinical medicine.

[The therapeutic effect of tiapride in the treatment of dyskinetic forms of cerebral palsy in children]

The authors administered tiaprid (Tiapridal, Delagrange), to six patients with the dyskinetic form of cerebral palsy, mean dose 11.4 mg/kg/day in three portions. In five instances clinical improvement was recorded, all patients improved as regards tests of practical skills. On the EEG during tiaprid treatment reduction of muscular artefacts was recorded. By means of an original testing device the authors revealed that tiaprid exerts a relatively small influence on the reaction time in response to a light stimulus but that it prolongs significantly the time needed for the motor performance proper. More marked undesirable effects were manifested in one patient (subjectively reported short-term change of sensitivity of the lower extremities and increased amplitude of dyskinesias). The authors emphasize the positive properties of the preparation and recommend tiaprid as the drug of first choice for pharmacological inhibition of extrapyramidal hyperkinesias in patients with the dyskinetic form of cerebral palsy in children.

[Malignant Neuroleptic Syndrome during tiapride treatment]

Tiapride, a benzamide compound, is a neuroleptic drug used in the treatment of some behavior troubles, especially in the alcohol withdrawal syndrome. We report a new case of malignant neuroleptic syndrome during a tiapride treatment in a 39 year-old alcoholic patient who had been admitted after a minor trauma. Symptoms were typical, with malignant hyperthermia in the absence of sepsis, coma, extrapyramidal syndrome, rhabdomyolysis, and severe metabolic acidosis. Dantrolene succeeded to reverse hyperthermia and rigidity; probably due to its delayed administration however, irreversible acidosis led to the patient's demise.

Neuroleptically induced dystonia in Huntington's disease: a case report

A patient with Huntington's disease developed acute dystonia whilst treated with tiapride. Sulpiride and tetrabenazine also induced dystonia. The anticholinergic biperiden depressed the syndrome but worsened psychopathology. Finally a combination of tetrabenazine and clozapine was successful in treatment of both chorea and dystonia. According to this observation, acute dystonia may occur in Huntington's disease as a consequence of neuroleptic treatment.

Withdrawal syndrome following subchronic treatment with anxiolytic agents

The acute administration of diazepam (0.1-2.5 mg/kg IP), sulpiride (0.5-20 mg/kg IP) and tiapride (0.5-40 mg/kg IP) to the mouse enhanced exploratory activity (rearings/line crossings) in the brightly illuminated white area of a two compartment white/black anxiety test box, with a corresponding decrease in the black, indicating an anxiolytic action. This profile of change was maintained during a twice daily administration for 7 days with diazepam (2.5 and 10 mg/kg), sulpiride (5 and 20 mg/kg) and tiapride (10 and 40 mg/kg). However, 8 and 48 hr following withdrawal of diazepam, the profile of exploratory behaviour was reversed to a preference for the black area: by 96 hr values for behaviour had returned to control levels. In contrast, an anxiolytic profile of action was maintained 8 and 48 hr following the withdrawal of sulpiride and tiapride, the values returning to control levels after 96 hr. It is concluded that a sub-chronic treatment with diazepam, sulpiride and tiapride induces an anxiolytic profile of action in the mouse model, that an anxiogenic profile follows the abrupt withdrawal of diazepam but that this is not recorded following the abrupt withdrawal of sulpiride and tiapride.

Effects of tiapride in tardive dyskinesia

Tiapride, a selective D2 dopaminergic receptor blocking agent from the substituted benzamide class, was evaluated in a blind video-controlled trial in 10 psychiatric patients with tardive dyskinesia. There was a significant decrease in dyskinesia with a parallel increase in parkinsonism. This relationship between two opposite effects on movement suggests a common pathophysiological basis lying on a reciprocal hyper- and hypoactivity of the dopaminergic striatal system. Nevertheless, other mechanisms may be involved, for the evolution of individual parkinsonian and dyskinesia scores is not necessarily opposite: the tiapride-induced parkinsonism was generally acceptable and in two cases, the dyskinesia scores were reduced without an increase in parkinsonism. Therefore, more dyskinetic patients have to be evaluated in long-term studies with tiapride, before this drug could be recommended in tardive dyskinesia, when dyskinetic movements become intolerable.

Recurrent neuroleptic malignant syndrome due to tiapride and haloperidol: the possible role of D-2 dopamine receptors

Two typical recurrent episodes of neuroleptic malignant syndrome (NMS) in the same patient are described. The first episode was caused by a sulpiride derivative, tiapride. This is the first case in which a drug of the benzamide group has been reported to have caused such adverse drug reaction. In the second episode, NMS occurred due to haloperidol in the lowest dose ever reported and was accompanied by highly excessive levels of various muscle enzymes. Involvement of hypothalamic and striatal dopamine system, and particularly of D-2 subtype receptors, is suggested by this case.

[Controlled study of the analgesic efficacy of 2 drugs: tiapride versus aspirin]

Analgesic effect of aspirin 500 mg IM or IV and tiapride 300 mg IM or IV was compared in a double blind controlled study. Twenty-four patients with active cancer were each given both drugs successively, over 48 hours. No difference was demonstrated in analgesic effects of tiapride (14/24: 58%) and aspirin (11/24: 46%), or in toxicity which was minor for both drugs.

Tiapride versus placebo: a double-blind comparative study in the management of Huntington's chorea

A double-blind, placebo-controlled, crossover trial was carried out in 29 patients with Huntington's chorea to evaluate the effectiveness and tolerance of high doses of tiapride in the management of neurological symptoms. Patients were allocated at random into 3 groups to receive 3 g tiapride daily for two periods of 3 weeks either preceded, interrupted or followed by a 3-week period on placebo. Patients were assessed on entry and at the end of each treatment period using a battery of tests designed to measure choreatic movements, motor skills, recognition and reaction times, and mental state. Twenty-three patients completed the trial; only 2 of the 6 drop-outs withdrew because of drug-related side-effects (sedation and extrapyramidal signs). The results showed that tiapride treatment significantly improved choreatic movements and motor skills and these findings were supported by the objective psychometric measurements. Overall evaluation of effectiveness by the physician and patients indicated the significant superiority of tiapride over placebo. Treatment was generally well tolerated and although there were significantly more reports of sedation and extrapyramidal signs whilst patients were receiving tiapride, these effects were rated as mild in most cases and did not interfere with treatment.

[Use of tiapride in the anxious alcoholic]

The alcoholic patient is usually anxious. Anxiety is increased by withdrawal. The anxiety-relieving effect of tiapride was studied in 20 alcoholics, with a mean age of 44 years. 18 patients were male. Alcoholism was chronic in 18 cases and paroxystic in two. At the time of withdrawal each patient was given 3 intramuscular injections daily for 7 days, then 3 tablets per day. Results, which were evaluated according to the Hamilton score, were excellent in 9 cases, good in 10 and poor in 1: no failure was recorded. The symptoms which responded best were fear, somatic and psychic manifestations of anxiety, depressive feelings and sleep disturbances. Concomitantly, digestive disorders, anorexia, tremor and pain were alleviated. Tolerance was excellent: no neurologic, digestive, cardiovascular or biologic manifestations were recorded. In caring for alcoholic patients, the critical time of withdrawal is undeniably facilitated by the use of tiapride.

Application of a primate model for tardive dyskinesia

Persistent signs of oral dyskinesia (tongue protrusion and facial grimacing) had developed as a result of earlier chronic treatment with neuroleptics in a Cebus apella monkey. When this animal was given single doses of any classical neuroleptic, a transient deterioration of dyskinesia occurred, preceded by a temporary abolishment of dyskinesia sometimes with an attack of acute dystonia. Fluphenazine (5-25 micrograms/kg) causes dose-related deteriorations of dyskinesia. Six different drugs were tested on this monkey for their capacity to elicit aggravation of dyskinetic signs: three antihistamines (brompheniramine, promethazine, diphenhydramine) and three dopamine D2 receptor antagonists (sulpiride, tiapride, metoclopramide). High doses of promethazine and diphenhydramine (5 mg/kg) induced a temporary alleviation of dyskinesia, possibly through sedation. All three D2 receptor antagonists precipitated signs of acute dystonia at some dose levels, but out of the test drugs only metoclopramide caused deterioration of dyskinetic symptoms. According to the present results only metoclopramide stands out as a drug with an inherent propensity to cause tardive dyskinesia.

[Tiapride in psychosomatic medicine]

In psychosomatic medicine the indication of tiapridal may appear incomplete if it is based only on symptoms. This study takes into account certain psychopathological tendancies of the patient which are always present in a more or less attenuated form. Numerous psychosomatic manifestations are thus found to be episodic expressions of minor depression or moderate psychoneurotic disorders. Tiapridal is remarkably effective in resolving these symptoms.

Tiapride versus glafenine: a double-blind comparative study in the management of acute rheumatic pain

A double-blind study was carried out in 42 patients suffering from acute rheumatic pain to compare the analgesic effectiveness and tolerance of tiapride with that of glafenine, a widely used analgesic in Europe. Patients were allocated at random to receive either 100 mg tiapride or 200 mg glafenine 3-times daily over a period of 14 days. Pain intensity was rated daily by the patients using a visual analogue scale and an overall assessment of response to treatment was made by both patients and physician at the end of the study. The results showed that, whilst both treatments resulted in a marked reduction in mean pain scores, pain disappeared completely in 16 (76%) of the 21 patients treated with tiapride compared with 9 (43%) of the 21 receiving glafenine. There was also a significant difference in favour of tiapride in the physician's overall assessment of response which was considered as excellent in 71% of the patients on tiapride compared with 31% receiving glafenine. Both treatments were well tolerated and few side-effects were reported. Drowsiness occurred in 6 patients on tiapride but this was only mild in 5 and moderate in the other patient.

[Treatment of alcoholic patients with tiapride]

The neuropsychiatric manifestations of alcoholism can be amended by neutralizing the somatic effects of alcohol on nervous centers. Tiapride acts electively on the mesolimbic area. Promising results have been obtained with tiapride in the various clinical forms of alcohol intoxication. Sixty patients (40 men and 20 women) were given tiapride for abnormal symptoms due to alcohol. Tolerance was good: no side-effects were recorded, with the exception of extrapyramidal manifestations in one patient. Symptoms due to alcohol abuse were alleviated. Relief of tremor was significant. Tiapride proved helpful in anxiety and depression and caused hallucinations to disappear in 35 cases.

[Clinical experience with tiapride in the treatment of extrapyramidal syndromes]

Tiapride was given at an average dosage of 300-900 mg per day, intramuscularly for the first three days, then by oral route, to 62 patients with abnormal movements of various types. The best responses were recorded in chorea and bucco-lingua-facial dyskinesia as well as in dyskinetic movements induced by levo-dopa in Parkinson patients. Clinical and biological tolerance of tiapride was excellent, with only one case of drowsiness and two cases of galactorrhea.

[Post-traumatic headache in outpatient therapy]

The author reports results achieved by a benzamide, tiapride, in the treatment of 43 subjects showing post-traumatic headaches in a INAIL out patient department of neurology. The drug was administered per os at a dose of one tablet twice a day at the beginning of the treatment. In 9 cases, the posology was afterwards increased to 3 tablets. Results were good in 72,1% of the cases and the positive action of the drug was not limited to the disappearance of the headache, but was extended to the total symptomatology of the subjective syndrome of the patients suffering from cranium trauma. The drug was well tolerated in all the cases except in one: the treatment had to be interrupted on account of vertigo sensations. The author confirms the possible activity of the molecule in posttraumatic headaches. He also points out the facility that it offers for the social and working recovery of the subject.

[Clinical trial of tiapride in patients with dyskinesia (author's transl)]

Twenty-five patients with various forms of dyskinesia were given tiapride for three months. Maximal dosage was 900 mg per day. A double-blind trial of tiapride versus placebo showed significantly better results in the group given tiapride. The forms of dyskinesia which responded best to tiapride were the following: iatrogenic dyskinesia, tics (Gilles de la Tourette syndrome), and chronic chorea (Huntington disease). Patients with complex dyskinesia resulting from neonatal encephalopathy or vascular disease were not improved. The protocol used in l-dopa-induced dyskinesia is described. Changes in dyskinesia and "on-off" effect following variations in tiapride and l-dopa dosage are detailed. An unequivocal, although minor, tiapride-induced parkinson syndrome was recorded in a few patients. No instances of tiapride-induced dyskinesia or akathisia were seen. The other side-effects were either psychic (depression, drowsiness, agitation) or endocrinologic (menstrual disorders, overeating, galactorrhea).

[A clinical study of tiapride in ten patients with chronic respiratory failure and in ten patients before fiberoptic bronchoscopy (author's transl)]

Ten patients with chronic respiratory failure (PaO2 = 56,19 +/- 10,54; PaCO2 = 49,17 +/- 7,31 torr) were given intramuscular injections of tiapride, Changes in alveolar ventilation were assessed clinically and by monitoring blood gases. No adverse effects were recorded. PaO2 was similar before and one hour after tiapride. There was no hypoventilation but, on the contrary, a slight decrease in PaCO2 (49,17 +/- 7,3 and 47,10 +/- 7,3 torr) and a significant increase in pH (7,358 +/- 0,023 and 7,378 +/- 0,028; p less than 0,05). Tiapride was also given to ten patients before fiberoptic bronchoscopy. Endoscopy was well tolerated in eight patients, in six there was no anxiety, and in all normal vigilance was retained.

Treatment of acute alcohol withdrawal syndrome with carbamazepine: a double-blind comparison with tiapride

A double-blind, randomized trial is described which was designed to compare the clinical effect of 600 mg daily of carbamazepine (Tegretol) and of tiapride (Sereprile) in hospitalized patients with pre-delirium tremens. Physicians' assessment of patients' progress was made following 2, 4 and 7 days of treatment. Of the sixty patients admitted to the study, five dropped out for various reasons, leaving fifty-five patients who completed the study. Both drugs were effective in the treatment of alcohol withdrawal symptoms; no significant difference was found between the two treatments with respect to total symptoms, score and visual analogue scale assessment. Carbamazepine gave faster relief of symptoms and demonstrated a preferential action on symptoms like fear and hallucinations. No case of delirium tremens was observed in those patients who completed the trial.

Acute dyskinesias in monkeys elicited by halopemide, mezilamine and the "antidyskinetic" drugs, oxiperomide and tiapride

Oxiperomide and tiapride are dopamine receptor antagonists claimed to have "antidyskinetic" properties in animal models and the clinic. Halopemide and mezilamine are other dopamine antagonists predicted to lack extrapyramidal side effects in man on the basis of animal studies. Acute dyskinesias, a neuroleptic-induced acute extrapyramidal syndrome, were elicited in squirrel monkeys by oxiperomide (1 mg/kg), tiapride (30 mg/kg), and halopemide (10 mg/kg). The dyskinesias were virtually indistinguishable from those caused by a standard behaviorally equivalent dose of haloperidol (1.25 mg/kg PO) in the same individual monkeys. Mezilamine (0.3 mg/kg) also induced dyskinesias, which appeared to be less pronounced than those following haloperidol. The antidyskinetic properties of oxiperomide and tiapride evidently do not confer protection against dyskinetic movements induced by dopamine antagonism.

[Migraine and tiapride. A controlled study (author's transl)]

Patients complaining of migraine often consult the hepato-gastro-enterologist because of dyspepsia or "crise de foie". The treatment of the migraine must improve those symptoms which lead to a wrong diagnosis and to inadequate treatments. Several medication are available to treat the migraine. The tiapride, already known as being effective in common or secondary headaches, was given to 40 patients complaining of migraine. The controlled study done versus placebo clearly proves that this medication is effective. It should be used in the treatment of migraine.

[Tiapride and painful attacks of drepanocytosis (author's transl)]

Patients with drepanocytosis require frequent hospitalization for treatment of the severe attacks of pain induced by the disease process. Therapy is often of limited extent and vasodilators, the usual medication employed, do not give very satisfactory results. A study with tiapride demonstrated that this compound could be effective both for curative and preventive treatment, probably in relation to its direct action on pain centres. Very good results were obtained in 11 cases, good results in 8, moderate results in 2, and no result in one case only.