Q. I take 40mg paroxetine a.m. (I was on 50 mg but my doc recently reduced this), 300 mg carbamezapine a.m. and p.m., and just started 100 mg Mellaril at night. I was taking 40mg propranalol 3 times a day for anxiety but since my anxiety was getting worse I asked my doctor if I could have Mellaril which I found always helped a lot when I was given it on a prn basis as an inpatient. My doctor agreed and I stopped the propranalol and started taking 50 mg of Mellaril up to twice a day on a prn basis. When I saw the consultant a few days later he said I was not to take it on a prn basis but to take it regularly at a dose of 100 mg each night. I have been doing that for about ten days. The Mellaril helps and I am doing pretty well at the moment.

Then, today, I read an article on the internet supposedly from Novartis Pharmaceuticals Corporation addressed to doctors and pharmcists, an extract of which follows:

"Mellaril has been shown to prolong the QTc interval in a dose related manner.......and drugs with this potential...... have been associated with tosade de pointes-type arrhythmias and sudden death. .......... Mellaril is now contraindicated with certain other drugs, including......paroxetine."

Please can you 1) explain to me what this means.
2) tell me if you were aware of this i.e. should my doctor have been!.
3) with my dose should I be worried about this and bring it up with my doctor or just forget about it and accept the current drug combination seems to be helping me a lot?.

  A. The explanation would take awhile, and I am not sure it would change anything. Bring it up with your doctor, and ask them what they want to do. The side effect on your heart can be a problem, but it is pretty rare. Most antipsychotics have this effect, and the folks at Novartis are just saying what is legally prudent for those rare individuals that have a problem. It is probably safe to continue the Mellaril until you talk to your doctor. Let your doctor know about your concern, and definitely get guidance from them.