Flupenthixol Decanoate

What it is and how it works

Flupentixol blocks dopamine D1 and D2 receptors in mesolimbic and mesocortical pathways, producing antipsychotic effects; it also has some serotonin 5-HT2 and alpha-adrenergic blocking activity. At low doses it has mood-elevating effects. The decanoate ester is a long-acting depot formulation for intramuscular injection.

Indications

Schizophrenia and other psychoses, including long-term maintenance (depot injection for patients with poor adherence); low-dose oral flupentixol is also used for depression with or without anxiety.

Dosage and administration (summary)

Psychosis: orally usually 3–9 mg twice daily, adjusted to response (maximum stated in product information); depot: deep intramuscular injection of flupentixol decanoate, starting with a test dose and then typically 20–40 mg every 2–4 weeks, adjusted to response. Depression: orally 0.5–3 mg daily (doses above 2 mg divided), given in the morning or early afternoon.

Contraindications

Comatose states, CNS depression, circulatory collapse, phaeochromocytoma, and (for depression use) excitable or overactive patients; not recommended in severe agitation.

Warnings and precautions

Extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome, QT prolongation, hyperprolactinaemia and lowered seizure threshold may occur; caution in cardiovascular disease, epilepsy, parkinsonism, hepatic or renal impairment and in the elderly. Antipsychotics increase the risk of stroke and death in elderly patients with dementia, and venous thromboembolism has been reported.

Pregnancy

Use only if clearly needed; neonates exposed in the third trimester are at risk of extrapyramidal and withdrawal symptoms.

Storage and supply

Tablets: store below 25 °C. Depot injection: store below 25 °C and protect from light.

Source: reference summary prepared from the EU SmPC/EPAR, BNF and WHO Model Formulary. The approved product information in Iran governs.