For such drugs, the prescribing information (known as the summary of product characteristics “SPC” in Europe and “labeling” in the USA) would require careful crafting of the indication to reflect the population and the disease entity most, likely to benefit, as well as detailed information on the proarrhythmic risk with carefully selected dose regimen, appropriate contraindications, description of interactions, special precautions, and monitoring requirements during their clinical use.43 Reflecting the robust data on efficacy, restriction of an indication may be one way of minimizing the population

likely to be exposed Inhibitors,research,lifescience,medical to the NCE. Allied to the indication is the posology of the NCE. The posology section may be required to include information on starting dose, a shallow dose titration schedule depending on the half-life of the drug and the time required Inhibitors,research,lifescience,medical to reach steady state, maximum single dose, maximum daily dose, and the duration of therapy. The most recent example of restriction of indications is thioridazine. From

July 2000, the indication for Selleck Rapamycin Thioridazine in the US was amended by the FDA to state: “Thioridazine is now indicated only for schizophrenic Inhibitors,research,lifescience,medical patients who fail to show an acceptable response to adequate courses of treatment, with other antipsychotic drugs, either because of insufficient effectiveness or the inability to achieve an effective dose due to intolerable adverse Inhibitors,research,lifescience,medical effects. Thioridazine has not been systematically evaluated in controlled trials in treatment-refractory schizophrenic patients and its efficacy in such patients is unknown. ” In view of the long half-life of pimozide (55 h, but may be as high as 150 h in some), its dose schedule was

revised to recommended a starting Inhibitors,research,lifescience,medical dosage Ketanserin of 20 mg/day with a maximum dosage of 60 mg/day. Following reports of TdP and other ventricular arrhythmias, the dose schedule of pimozide for chronic schizophrenia was reamended to recommend an initial starting dosage of 2 mg/day (exceptionally 10 mg/day in acute schizophrenia, but even this recommendation too was subsequently removed). The dose was to be increased by a shallow dose titration (“dose increases should be made at weekly intervals or longer, and by increments of 2-4 mg in the daily dose”). The maximum dosage was reduced from 60 to 20 mg/day. The section of the SPC most likely to be effective in containing a clinical risk, if the prescribing physicians adhere to it, is that on contraindications.