flupentixol decanoate: clinical use

Prescribing considerations

• Confirm stabilisation and tolerability on oral therapy before using the selected depot product.
• Review cardiac history, QT-risk medicines, electrolyte disturbances and cardiovascular risk.
• Use particular caution in hepatic or renal impairment, epilepsy, Parkinson's disease, severe respiratory disease and older or frail people.
• Assess venous-thromboembolism risk and avoid unnecessary concurrent antipsychotics.
• Consider suicide risk, particularly during clinical change or early recovery.

Contraindications and cautions

• Hypersensitivity to flupentixol or an excipient.
• Circulatory collapse, coma or depressed consciousness, including from alcohol, barbiturate or opioid intoxication.
• The product is not recommended for excitable or acutely agitated patients.

Monitoring

• Clinical response, sedation, hypotension and extrapyramidal or tardive movement disorders.
• Weight, glucose control and other relevant metabolic measures.
• ECG and electrolytes when cardiac or QT-prolongation risks are present.
• Signs of venous thromboembolism, neuroleptic malignant syndrome and prolactin-related effects.
• Full blood count if persistent infection or other features of blood dyscrasia develop.
• Liver function and serum concentrations where clinically indicated in hepatic impairment.

Clinical pharmacology

Flupentixol is a thioxanthene antipsychotic with dopamine D1- and D2-receptor antagonism. Esterification with decanoic acid makes it lipophilic. After deep intramuscular injection from an oil vehicle, it diffuses slowly and undergoes enzymatic release of active flupentixol. It is highly protein-bound, extensively metabolised by the liver and excreted mainly in faeces.

Formulation and product differences

• The selected Low Volume product is a concentrated, clear yellowish oily solution containing fractionated coconut oil.
• It is intended for deep intramuscular administration and must not be given intravenously.
• It may be mixed in the same syringe with other products in the Depixol injection range, but not with other injection fluids.
• Ampoules should be protected from light and stored within the product's stated temperature conditions.