REPLACEMENT OF CHLORPROMAZINE WITH OTHER NEUROLEPTICS - EFFECT ON ABNORMAL SKIN PIGMENTATION AND OCULAR CHANGES

This paper describes the outcome of 15 patients with chlorpromazine (C PZ)-induced abnormal skin pigmentation (ASP) in whom CPZ was replaced with other neuroleptics for three to 13 years. Complete resolution of ASP occurred over a period of six months to rive years following subst itution with haloperidol (four patients), levomepromazine (three patie nts), trifluoperazine (one patient), thioproperazine (one patient) as the sole neuroleptic, by a combination of two of the three phenothiazi nes (four patients) or haloperidol plus pipotiazine (one patient). Res olution was maintained during the remainder of the follow-up period. I n one patient, at final follow-up, marked improvement was present thre e years after CPZ was replaced with levomepromazine. Bilateral lenticu lar pigmentary deposits persisted in all eight patients examined 3.3 t o 13 years after replacing CPZ and less than three months to nine year s after resolution of ASP; improvement was noted in only one of these patients. Bilateral endothelial corneal deposits, present in rive pati ents while on CPZ therapy, had disappeared in two patients seven and 1 3 years, respectively, after replacing CPZ; improvement was noted in t wo other patients. These findings indicate that: 1. CPZ-induced ASP is completely reversible in most, if not all, patients if CPZ is withdra wn; 2. a variety of neuroleptics including other phenothiazines can be used to replace CPZ without risk of re-emergence of ASP; 3. CPZ-induc ed lenticular changes persist whereas corneal changes may resolve slow ly over a period of many years following replacement of CPZ; 4. ASP an d ocular changes induced by CPZ may be subserved by two different path ophysiological mechanisms.