flupentixol dihydrochloride: clinical use

Prescribing considerations

• Assess suicide risk and clinical deterioration, particularly after initiation or treatment changes.
• Identify cardiovascular, electrolyte and venous-thromboembolism risk factors.
• Use particular caution in older people and in hepatic or severe renal impairment.
• Avoid abrupt withdrawal; consider gradual discontinuation.
• Not recommended for children because clinical experience is lacking.
• The tablets contain lactose.

Contraindications and cautions

• Hypersensitivity to flupentixol or product excipients.
• Severe depression requiring hospital treatment or electroconvulsive therapy.
• Mania, excitement or marked overactivity.
• Circulatory collapse, coma or depressed consciousness from any cause, including intoxication.

Monitoring

• Mental state, suicidality and unusual behavioural change.
• Extrapyramidal symptoms, akathisia and tardive dyskinesia.
• Weight, appetite and glucose control where clinically relevant.
• Blood pressure and symptoms of venous thromboembolism.
• ECG and electrolytes where cardiac or QT-prolongation risk exists.
• Liver function and serum flupentixol levels when clinically indicated in hepatic impairment.

Clinical pharmacology

Flupentixol is a thioxanthene neuroleptic. Its precise antidepressant mechanism is undetermined. Presynaptic dopamine-receptor activity followed by postsynaptic aminergic receptor adaptation has been proposed. It is extensively metabolised by the liver and eliminated in urine and faeces.

Formulation and product differences

• This page concerns flupentixol dihydrochloride film-coated oral tablets.
• Flupentixol decanoate is a separate long-acting injection and is not interchangeable with the oral dihydrochloride product.
• The selected tablets contain lactose and are essentially sodium-free.

Tablet

Route: Oral

Strengths: 3 mg