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alertness; elderly (especially with dementia), and debilitated patients; neuroleptics with sedative effect must be withdrawn gradually; history of angle-closure glaucoma; urinary retention; prostatic hyperplasia; breast cancer, prolactin dependent tumours; parkinsonism; myasthenia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
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.