Drowsiness, usually mild to moderate, may occur, particularly during the first or second week, after which, it generally disappears. If troublesome, lower dosage or administer small amounts of dextroamphetamine.
Jaundice: Overall incidence has been low, regardless of indication or dosage. Most investigators conclude that it is a sensitivity reaction.
Agranulocytosis: Observe patients regularly for sudden appearance of sore throat or other signs of infection. If white blood counts and differential smears indicate cellular depression, stop treatment and start antibiotic and other suitable therapy.
EKG Changes: Particularly nonspecific, usually reversible Q and T-wave distortions have been observed in some patients. Their relationship to myocardial damage has not been confirmed.
CNS Effects: Neuromuscular extrapyramidal reactions, closely resembling parkinsonism and motor restlessness have occurred most frequently in psychiatric patients receiving high dosages.
Behavioral Effects: Psychotic symptoms and catatonic-like states have been reported rarely.
Persistent Abnormal Movements: Persistent dyskinesia, most commonly involving the face, tongue and jaw. These phenomena have been reported most frequently in elderly patients with organic brain damage.
Endocrine Disorders: Lactation and moderate breast engorgement may occur in females on large doses. If persistent, lower dosage or withdraw the drug. Amenorrhea, gynecomastia, hyperglycemia and glycosuria have been reported.
Autonomic Reactions: Occasional dry mouth, nasal congestion, constipation, adynamic ileus, miosis and mydriasis.
Special Considerations in Long-Term Therapy: Skin pigmentation and ocular changes have occurred in some patients.