A female patient with AIDS has been treated with Mallorol (thioridazine) 250 mg per day for two to

Fråga: A female patient with AIDS has been treated with Mallorol (thioridazine) 250 mg per day for two to three weeks. The patient recently started to experience visual hallucinations (she sees black spiders everywhere). No other hallucinogenic or CNS effects have been noted. Fass mentions retinal pigmentation as a side-effect. As, according to the questioner, the symptoms in this case might be caused by retinal changes, more information concerning this side-effect is requested.

Sammanfattning: Pigmentary retinopathy can occur during treatment with thioridazine, even at doses lower than 800 mg per day, but is a rare adverse effect. The presence of visual hallucinations, such as those found in this case, is not related to pigmentary retinopathy.

Svar: Questions concerning pigmentary retinopathy during treatment with psychotropic drugs have been dealt with before (1,2,3). In summary, pigmentary retinopathy is a rare side-effect of phenothiazine derivatives, mainly thioridazine, usually during prolonged administration in high doses, 1200-1800 mg daily. However, cases have occurred with lower doses and clinicians should be aware that retinopathy may develop at doses lower than 800 mg per day (4). Of the pigmentary retinopathy cases that have been recorded, 20 per cent have occurred with daily doses of thioridazine of 800 mg or less (4). 1 Drugline nr 06251 (year 1988) 2 Drugline nr 04895 (year 1985) 3 Drugline nr 03619 (year 1983) 4 Ball WA, Caroff SN: Retinopathy, tardive dyskinesia, and low-dose thioridazine. Am J Psychiatry 1986; 143: 256-257