zuclopenthixol decanoate: clinical use

Prescribing considerations

• Confirm the decanoate depot product; do not confuse it with short-acting zuclopenthixol acetate.
• Establish previous antipsychotic response and tolerability before prolonged depot exposure.
• Review cardiac, neurological, hepatic, renal, respiratory, endocrine and thromboembolic risk factors.
• Use extra caution in frail older adults, who are more susceptible to sedation, hypotension, confusion and temperature disturbance.
• Avoid routine antipsychotic polypharmacy and review interacting medicines, particularly QT-prolonging or myelosuppressive agents.

Contraindications and cautions

• Hypersensitivity to zuclopenthixol decanoate or an excipient.
• Circulatory collapse.
• Depressed consciousness from any cause, including alcohol, barbiturate or opioid intoxication.
• Coma.

Monitoring

• Clinical response, relapse symptoms and adverse effects after injections.
• Extrapyramidal symptoms, akathisia and tardive dyskinesia.
• Sedation, postural symptoms, weight and metabolic risk, including glucose control where relevant.
• Pulse, ECG and electrolytes when cardiac or QT-risk factors are present.
• Blood-cell abnormalities when clinically indicated, especially with infection symptoms or myelosuppressive treatment.
• Liver function and serum zuclopenthixol concentrations where hepatic impairment makes this appropriate.
• Prolactin-related, sexual and reproductive adverse effects.
• Venous-thromboembolism risk before and during treatment.

Clinical pharmacology

Zuclopenthixol is a dopamine D1/D2 receptor antagonist with alpha-adrenergic, serotonergic and slight antihistaminic activity. Following deep intramuscular administration, active zuclopenthixol is released gradually from the decanoate depot.

Formulation and product differences

• Clopixol Injection is supplied as a 200 mg/mL oily solution in ampoules and a multidose vial presentation.
• Clopixol Conc. Injection is a 500 mg/mL concentrated oily solution supplied in ampoules.
• Both contain thin vegetable oil and must not be confused with zuclopenthixol acetate injection.
• They may be mixed in one syringe with products in the Clopixol injection range but not with other injection fluids.