Flupenthixol (flupentixol)
Indications
Flupenthixol (flupentixol) is used for:
Depression, Schizophrenia, Psychoses
Adult Dose
Oral
Psychoses
Adult: Initially, 3-9 mg bid, adjusted according to response. Max: 18 mg daily.
Elderly: Initial dose: ¼ or ½ of the usual initial dose.
Oral
Depression with or without anxiety
Adult: Initially, 1 mg daily increased after 1 wk to 2 mg daily and then to a max of 3 mg daily, last dose should be given not later than 4 p.m.
Doses >2 mg should be given in 2 divided doses. Discontinue treatment if there is no improvement within 1 wk of using the max dose.
Elderly: Initially, 0.5 mg daily increased after 1 wk to 1 mg daily with the last dose given not later than 4 p.m. Max: 2 mg daily in 2 divided doses.
Intramuscular
Psychoses
Adult: As decanoate: Initially, 20 mg is given as test dose.
After at least 7 days and depending on the response, subsequent doses of 20-40 mg may be given at intervals of 2-4 wk.
Usual maintenance dose: 50 mg every 4 wk to 300 mg every 2 wk. Up to 400 mg wkly may be used in severe or resistant cases.
Elderly: Initial dose: ¼ or ½ of the usual initial dose.
Child Dose
Renal Dose
Administration
May be taken with or without food.
Contra Indications
Hypersensitivity. Extremely excitable and overactive patients; mania; porphyria; coma; preexisting CNS depression; bone-marrow supression; phaeochromocytoma. Lactation.
Precautions
Patients with convulsive disorders; advanced hepatic, renal, CV or resp disease; tasks requiring mental alertness; elderly (especially with dementia), and debilitated patients; neuroleptics with sedative effect must be withdrawn gradually; history of angle-closure glaucoma; urinary retention; prostatic hyperplasia; breast cancer, prolactin dependent tumours; parkinsonism; myasthenia gravis; pregnancy; Avoid direct sunlight.
Pregnancy-Lactation
Pregnancy category: C
Lactation: Drug enters breast milk; not recommended
Interactions
May potentiate the adverse effects of drugs with antimuscarinic effects e.g. TCAs. Reduced efficacy of levodopa. Increases adverse extrapyramidal symptoms with dopamine antagonists (metoclopramide and prochlorperazine).
Potentially Fatal: Potentiates CNS effects of alcohol, general anaesthetics, hypnotics, anxiolytics and opioids. Blocks antihypertensive effect of guanethidine.
Adverse Effects
Side effects of Flupenthixol (flupentixol) :
Rigidity, tremors, restlessness, tardive dyskinesia, insomnia, dryness of mouth, wt gain, sexual dysfunction, galactorrhoea and menstrual disturbances.
Potentially Fatal: Neuroleptic malignant syndrome (hyperthermia, hypertonicity of skeletal muscles, unconsciousness and autonomic nervous system instability).
Mechanism of Action
Flupentixol is a thioxanthene antipsychotic that inhibits dopamine-mediated effects by blocking postsynaptic dopamine receptors in the CNS.