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Indications

Psychoses, Depression with or without anxiety, Psychoses

Therapeutic Class

SSRIs & related anti-depressant drugs

Pharmacology

Flupentixol is a thioxanthene antipsychotic that inhibits dopamine-mediated effects by blocking postsynaptic dopamine receptors in the CNS.

Dosage

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.

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.

Intramuscular-
Psychoses:

• Adult: Initially, 20 mg (1 ml of a 2% oily solution) 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.

Administration

May be taken with or without food.

Interaction

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).

Contraindications

Hypersensitivity. Extremely excitable and overactive patients; mania; porphyria; coma; preexisting CNS depression; bone-marrow supression; phaeochromocytoma. Lactation.

Side Effects

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).

Pregnancy & Lactation

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus

Precautions & Warnings

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.

Storage Conditions

Store below 25° C.