Flupentixol decanoate(flupenthixol decanoate)20mg/mL oily solution in 1-mL and 2-mL ampoules; 1-mL and 2-mL syringes; 10-mL

vials

100mg/mL oily solution in 0.5-mL and 1-mL ampoules; 5-mL vials

200mg/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, hyperthy-

roidism, phaeochromocytoma, severe respiratory disease or if there are risk factors for stroke.

Biochemical and other tests

Blood pressure

Bodyweight

ECG

FBC

LFTs

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

TFTs

Dose

Test dose: 20mg to assess tolerability. Reduce test dose to 5 or 10mg if patient is elderly.

Maintenance dose: commence at least one week after test dose, usual dose range 50mg every 4

weeks up to 300mg every 2 weeks. Some patients may require up to 400mg weekly.

Intramuscular injection

Preparation and administration

1. Withdraw the required dose. The maximum volume to be administered at one site is 2mL.

Volumes >2mL 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 mixedin the same syringe.

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356 | Flupentixol decanoate

Technical information (continued )

pH Not relevant -- oily injection

Sodium content Nil

Storage Store below 25�C in original packaging.

Monitoring

Measure Frequency Rationale

Therapeuticimprovement

Periodically * To ensure that treatment is effective.

EPSEs During doseadjustment and every3 months

* Causes extrapyramidal symptoms, e.g. dystonias.

Renal function At least annually * As part of regular health check.

LFTs

Blood pressure

Blood glucose

Lipids (includingcholesterol, HDL, LDLand triglycerides)

Weight and obesity * As part of regular health check.* May cause weight gain* 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 seriousundesirable effects

Injection-related: Occasionally erythema, swelling or nodules have beenreported.Other: EPSEs, blurring of vision, "pulse, urinary incontinence and frequency.Dose-related postural #BP may occur, particularly in elderly patients. Weightgain.

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

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Flupentixol decanoate | 357

Additional information (continued )

Significantinteractions

* 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 ofoverdose

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 beappropriate.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 isknown.

Risk rating: GREEN Score ¼ 2Lower-risk product: Risk-reduction strategies should be considered.

This assessment is based on the full range of preparation and administration options described in themonograph. 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 acid15mg/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.

358 | Flupentixol decanoate | Folic acid