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• Download a C&M handy Patient Information Leaflet (PILL), a two-page summary of the main questions and answers from here for sertindole. This can then be printed.

There are many other Patient Information Leaflets (PILs) across the world for patients and carers. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets

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Sertindole can be used to help treat the symptoms of psychosis and schizophrenia.

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The usual dose for adults in UK for schizophrenia was 4mg to start with, then increasing by 4mg a day every 4-5 days to the usual dose of 12-20mg a day. The usual dose should usually be lower in the elderly and people with a liver problem. It is not recommended in children but this is only because it has not been studied rather than because of any concerns about safety.

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This will rather depend on what you were taking it for. To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:

• Psychosis - main options, main medicines and handy chart

• Schizophrenia - main options, main medicines and handy chart

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

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There is a naturally occurring chemical ("neurotransmitter") in the brain called dopamine. Dopamine is the chemical messenger in the brain mainly involved with thinking, emotions, behaviour and perception. In some illnesses, this dopamine may be overactive and upsets the normal balance of chemicals in the brain. This excess dopamine helps to produce some of the symptoms of the illness. The main effect that sertindole has is to block some dopamine receptors in the brain, reducing the effect of having too much dopamine and correcting the imbalance. This reduces the symptoms caused by having too much dopamine.

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Take your sertindole each day as directed on the medicine label. Try to take it at a regular time each day. Taking it at mealtimes may make it easier for you to remember as there is no problem about taking sertindole with or after food.

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Sertindole tablets should be swallowed with at least half a glass of water whilst sitting or standing. This is to make sure that they reach the stomach and do not stick in your throat.

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Some of the effects of sertindole appear soon after starting e.g. any side effects. The most important action, however, to help your symptoms may take weeks of regular medication to become fully effective. In the same way if your dose or treatment is changed it may take an equally long period of time before you notice the effects of such a change. For more advice click the links for psychosis or schizophrenia.

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This should be discussed with your doctor as different people respond differently. You will probably, however, need to continue sertindole for quite a long time, possibly several years after your symptoms have gone to make sure you are fully over your illness. Long term treatment should be reviewed at regular intervals, for example every 3 to 6 months, or even sooner if there are problems. Click the links for more information on psychosis or Schizophrenia.

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Sertindole is not addictive. If you have taken it for a long time you may possibly experience some mild effects if you stop it suddenly. The main problem would be your symptoms coming back.

For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation. Sertindole has none of these and so is not addictive. Any discontinuation effects are probably more of an "adjustment" reaction from sudden removal of a drug rather than "withdrawal".

Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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Start again as soon as you remember unless it is nearly time for your next dose then take the next dose as normal. Do not try to catch up by taking two or more doses at once as you may get more side-effects. You should tell your doctor about this next time you meet. Missing the occasional dose (e.g. once a week) isn't usually a big problem.

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices which can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, in a car etc.

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It is unwise to stop taking it suddenly, even if you feel better. Your symptoms can return if treatment is stopped too early. This may occur some weeks or even many months after the drug has been stopped. You could also experience some mild withdrawal symptoms (as explained above). When the time comes your doctor will usually withdraw the drug by a gradual reduction in the dose taken over a period of several weeks. You should discuss this fully with your doctor.

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The table below will show you some of the main side effects you might get from sertindole.

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

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Sertindole may make you feel drowsy or sleepy, although this is unusual. You should not drive (see below) or operate machinery until you know how it affects you. You should be careful as it may affect your reaction times or reflexes.

^{Updated 11.11}

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Weight gain with many similar antispychotics is very common. About 1 in 10 (10%) of people taking sertindole gain a little weight and in about 1% of people (1 in 100) this is enough to be a real problem. Of the people who gain weight, most is gained during the first 6 to 12 months of treatment. It then tends to level out. It is not possible to say what the effect on your own weight may be because each person will be different. If you do start to put on weight or have problems with your weight, you should tell your doctor. He or she may be able to adjust your medicine or the dose to reduce this effect. Your doctor can also arrange for you to see a dietician for advice. If you do gain weight it is possible to lose it while you are still taking this medication, with expert advice about diet. If it causes you distress make sure your doctor knows about this.

Click here for a few tips on how to help you feel less hungry and lose weight.

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Unlike many other antipsychotic drugs, sertindole has not been reported to have a major adverse effect on the three stages, except by causing drowsiness. However, if this does happen, you should discuss this with your doctor, as a change in dose may help minimise the problem. The problem of reduced ejaculatory volume (less semen or "come" than normal) probably only happens with sertindole but this does not affect your chance of having children.

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You should have no problem with any foods or drinks, other than alcohol (see separate question).

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. epilepsy, asthma or a chest infection (as alcohol can make it harder to breathe)
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

If you drink alcohol while taking sertindole it may make you feel a little more sleepy. If this happens, you should drive or operate machinery. You must seek advice on this.  

It is not safe to drive after drinking alcohol, with or without sertindole. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

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Sertindole should be used with care with a number of other drugs e.g. some antidepressants (e.g. fluoxetine and paroxetine), carbamazepine, some antifungals (e.g. itraconazole and ketoconazole), quinidine, terfenadine and thioridazine. This does not necessarily mean the drugs can not be used together, just that you may need to follow your doctor's instructions very carefully. You should tell your doctor before starting or stopping these or any other drugs. Make sure your doctor knows about all the medicines you are taking. There are other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

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You should have no problems with "The Pill" and sertindole.

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking sertindole, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain (the tuberoinfundibular system if you want to know). This area of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain. This is just what we want to help reduce some of the symptoms caused by too much dopamine e.g. psychosis, paranoia. However, if these medicines also block dopamine in the area of the brain that keeps prolactin under control, prolactin can get out of control and increase. Higher than usual levels of prolactin in the brain and blood will stop your periods (or at least make them irregular or unpredictable). Much higher levels can lead to your breasts leaking milk or lactating (the medical term is galactorrhoea). The name of the hormone (prolactin) might help you guess this anyway i.e. pro- (meaning for) -lactin (as in lactation).  High prolactin can make it more difficult to become pregnant, and over many years can have an effect on your sex-life, and maybe even your bones.

Sertindole doesn't usually have any effect on dopamine in this part of the brain and so should not have any effects on your periods. However, this can happen rarely e.g. if you are on a high dose or are sensitive to sertindole. So, if your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find if there are any other causes. If sertindole seems to be the cause, the usual thing to do is switch to another similar medicine. Reducing the dose doesn't usually work.

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Federal Drug Administration) classifies medicines in pregnancy in five groups:

A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

Sertindole is not classified as it is not available in the USA. There is very little human data on sertindole so you should seek specialist advice.

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.
• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.
• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter
• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit
• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half
• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

We don't really know about sertindole in breast milk but it is thought that it gets into the milk and to the baby. You should make sure the baby is looked after carefully and checked up on by your doctor, nurse or health visitor if you decide to breast-feed with sertindole.

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Sertindole can affect your driving although this is unlikely. It could slow down your reactions or reflexes. Until this effect wears off, or you know how sertindole affects you, do not drive or operate machinery. You should be careful as it may affect your reaction times or reflexes even though you feel well.

If you are taking any medicines, the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

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You will need to have some tests on your heart to make sure the sertindole isn't affecting it.

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