356 | Flupentixol decanoate

Flupentixol decanoate
(flupenthixol decanoate)
20 mg/mL oily solution in 1-mL and 2-mL ampoules; 1-mL and 2-mL syringes; 10-mL
vials
100 mg/mL oily solution in 0.5-mL and 1-mL ampoules; 5-mL vials
200 mg/mL oily solution in 1-mL ampoules
*

Flupentixol decanoate is a thioxanthene antipsychotic presented as a long-acting depot injection.

It is used in the treatment of schizophrenia and other psychoses.

Doses are expressed in terms of flupentixol decanoate.

Pre-treatment checks
*

Avoid in patients in comatose states, including alcohol, barbiturate, or opiate poisoning.

Not recommended for excitable or agitated patients.

Concomitant treatment with other antipsychotics should be avoided.

Caution in epilepsy, Parkinson disease, liver disease, renal failure, cardiac disease, depression,
myasthenia gravis, prostatic hypertrophy, narrow-angle glaucoma, hypothyroidism, hyperthyroidism, phaeochromocytoma, severe respiratory disease or if there are risk factors for stroke.

Biochemical and other tests

Blood pressure

LFTs

Bodyweight

Renal function: U, Cr, CrCl (or eGFR)

ECG

TFTs

FBC

Dose
Test dose: 20 mg to assess tolerability. Reduce test dose to 5 or 10 mg if patient is elderly.
Maintenance dose: commence at least one week after test dose, usual dose range 50 mg every 4
weeks up to 300 mg every 2 weeks. Some patients may require up to 400 mg weekly.

Intramuscular injection
Preparation and administration
1. Withdraw the required dose. The maximum volume to be administered at one site is 2 mL.
Volumes >2 mL should be distributed between two injection sites.
2. Give by deep IM injection into the upper outer buttock or lateral thigh. Aspirate before injection
to avoid inadvertent intravascular injection. Rotate injection sites for subsequent injections.

Technical information
Incompatible with

Do not mix with other drugs in the same syringe.

Compatible with

Flupentixol decanoate products made by the same manufacturer may be mixed

in the same syringe.
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Flupentixol decanoate

| 357

Technical information (continued )

pH

Not relevant - oily injection

Sodium content

Nil

Storage

Store below 25 C in original packaging.

Monitoring
Measure

Frequency

Rationale

Therapeutic
improvement

Periodically

To ensure that treatment is effective.

EPSEs

During dose
adjustment and every
3 months

Causes extrapyramidal symptoms, e.g. dystonias.

Renal function

At least annually

As part of regular health check.

As part of regular health check.

May cause weight gain

LFTs
Blood pressure
Blood glucose
Lipids (including
cholesterol, HDL, LDL
and triglycerides)
Weight and obesity

Obesity measured by waist:hip ratio or waist

circumference.

ECG

Annually

Can "QT interval.

Prolactin

See rationale

If symptoms of hyperprolactinaemia develop.

Additional information
Common and serious
undesirable effects

Injection-related: Occasionally erythema, swelling or nodules have been

reported.
Other: EPSEs, blurring of vision, "pulse, urinary incontinence and frequency.
Dose-related postural #BP may occur, particularly in elderly patients. Weight
gain.

Pharmacokinetics

Elimination half-life is 8 days (single dose); 17 days (multiple doses).

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358 | Flupentixol decanoate

| Folic acid

Additional information (continued )

Significant
interactions

The following may "flupentixol levels or effect (or "side-effects):

anaesthetics-general ("hypotensive effect), artemether with lumefantrine,
clozapine ("risk of agranulocytosis), myelosuppressive drugs, ritonavir,
sibutramine.
Flupentixol may "risk of ventricular arrhythmias with the following drugs:
antiarrhythmics, antidepressants-tricyclic, atomoxetine, methadone.
Flupentixol may #effect of the following drugs (lowers convulsive threshold):
barbiturates, carbamazepine, ethosuximide, oxcarbazepine, phenytoin,
primidone, valproate.

Action in case of
overdose

Treat EPSE with anticholinergic antiparkinsonian drugs.

If agitation or convulsions occur treat with benzodiazepines.
If the patient is in shock treatment with metaraminol or noradrenaline may be
appropriate.
Adrenaline must not be given (may further #BP).

Counselling

Advise patients not to drink alcohol, especially at beginning of treatment.

May impair alertness so do not drive or operate machinery until susceptibility is
known.

Risk rating: GREEN

Score 2
Lower-risk product: Risk-reduction strategies should be considered.

This assessment is based on the full range of preparation and administration options described in the
monograph. These may not all be applicable in some clinical situations.

Bibliography
SPC Depixol (accessed 15 October 2007).
NICE (2009). Clinical Guideline 82: Core interventions in the treatment and management of schizophrenia
in primary and secondary care (update). London: National Institute for Health and Clinical Excellence.
http://guidance.nice.org.uk/CG82 (accessed 1 October 2009).

Folic acid
15 mg/mL solution in 1-mL ampoules
*

Folic acid is a member of the vitamin B group.

It is used to treat folate-deficient megaloblastic anaemias, usually due to poor nutrition,

pregnancy, or antiepileptic drugs.

It is used to prevent folate deficiency in renal dialysis patients or chronic haemolytic states.