Remoxipride: consider in patients intolerant of or resistant to haloperidol

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Remoxipride should be considered for schizophrenic patients who have not responded to or are intolerant of haloperidol. It is at least as effective as haloperidol in patients with acute or chronic schizophrenia and causes fewer extrapyramidal effects.

However, remoxipride has been associated with aplastic anaemia in a small number of patients. Although a definite causal link has not been established, concern over this effect may severely limit use of the drug.

In the limited comparisons with other classical antipsychotics, remoxipride was less effective than chlorpromazine (in a study with a large proportion of treatment-resistant patients) and as effective as thioridazine. It was also at least as well tolerated as these drugs.

Remoxipride may be less effective against negative schizophrenic symptoms than clozapine or risperidone. Although there are case reports suggesting effectiveness in treatment-resistant patients, this has yet to be confirmed in a controlled trial.

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