Tuesday, October 10, 2017

Thorazine - An Old Fashioned Cure-All

Thorazine was thought of as a revolutionary breakthrough medication similar to Penicillin when the FDA approved it's use in the early 1950's. It was the very first psychiatric medication useful in the treatment of schizophrenia. Before Thorazine,  institutions used leather restraints, alternating cold and hot body packs and of course crude psychosurgery such as lobotomy.

In a bizzare side note Freud never received the Nobel prize for his work, but the fellow with that ice pick brain surgery  got the call from Sweeden to come pick up his Nobel prize for lobotomy. Efforts to recall this Nobel have been unsuccessful.

Thorazine was discovered while searching for a cure for malaria and worked by blocking dopamine receptors  in the brain - a chemical lobotomy. After Thorazine disables the dopamine receptors all sorts of bad things happen. Blocking dopamine does blunt the psychosis, but fooling around with neurotransmitters never has a happy ending. Akathesia (constant uncontrolled restlessness,) sustained muscle sasms leading to a debilitating constant muscle activity called tardive dyskinesia. I always thought of Thorazine as the equivalent of weeding a garden with a hand grenade. Sure the psychosis was blunted, but so was everything else that made the person an individual. These people were mere shells of human beings. The reeks and wrecks found on the backward of any long term psych hospital were not there only for their psychosis. The institutionalization and side effects of long term phenothiazine therapy were at fault too.

Thorazine was supplied in a wide range of dosage forms including;  syrup,  concentrate, injectable vials and even suppositories.  On my first medication passing adventure at Downey VA I had a med card that indicated the patient was to receive 2000mg of Thorazine concentrate. I was taught the maximum dose was around 200 mg. How could a patient receive 2 grams of this potent tranquilizer and survive? I was told this was the correct dose and the patient acquired a tolerance over the decades and to go ahead and give it. The patient shuffled up to the med room, gulped it down and went about his business. Simply amazing.

Some of the long term Thorazine concentrate consumers requested the nasty tasting substance "straight."  This meant giving the drug in a small medicine cup diluted with just a splash of tap water. The concentrate turned a brilliant shade of pink when the water was added and this was long before the color was associated with cancer survivors. Thorazine concentrate was just plain nasty smelling. Cracking that big brown tinted bottle unleashed a scent not unlike the Testors glue that I used as a youngster to assemble plastic model kits. We usually diluted it in a thick sugary substance called simply "citric." I doubted this tactic made it any more palatable, but at least it knocked some of the unpleasant smell down.

There is ample truth to the old adage that when there are 3 or more treatments for the same condition, none of them are effective. The pharmacologic corollary- If one drug is used to treat multiple divergent illnesses; it's not an effective drug. Here is an interesting hodge-podge of ailments that Thorazine was purported to cure in 1950s ads. A foolish panacea if I do say so.

Hmm.. this might just work. Snow him on Thorazine and see if he makes it to the bar.

I wonder if her "serene detachment" persisted through the muscle spasms of tardive dyskinesia.

In my experience, Thorazine induced rapid, shallow respirations-not sure how well this would play out for asthmatics.

Thorazine was known for it's hypotensive actions. Throw in an old time general
anesthetic with a Thorazine pre-op and watch the B/P drop like a lead balloon.

Wow.. never realized Thorazine was such a miracle drug with an assortment of therapeutic applications. It did work well for nausea in small doses of 25mg, but patients never asked for a repeat dose. I always asked post-op patients if their nausea was relieved by the small dose of Thorazine and their reply was always something to the effect that it worked but made their mouth very dry and induced a profound malaise and general feeling of unwellness. "Don't give that to me again!" was a frequent request.

When drugs are touted as having so many uses I suspect it's because they don't work too well for anything. Of course this lesson has been well learned and would never happen today. HeHe.

No comments:

Post a Comment