Formulary
Flupentixol decanoate: Indications, Dosing, Side Effects and Interactions
Flupentixol decanoate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Flupentixol decanoate: Indications, Dosing, Side Effects and Interactions
Flupentixol decanoate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Maintenance in schizophrenia and other psychoses**
- **Adult** (By Deep Intramuscular Injection): Test dose 20 mg, dose to be injected into the upper outer buttock or lateral thigh, then 20-40 mg after at least 7 days, then 20-40 mg every 2-4 weeks, adjusted according to response, usual maintenance dose 50 mg every 4 weeks to 300 mg every 2 weeks; maximum 400 mg per week.
- **Elderly** (By Deep Intramuscular Injection): Dose is initially quarter to half adult dose.
Cautions
For all antipsychotic drugs Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes (may raise blood glucose); epilepsy; history of jaundice; myasthenia gravis; Parkinson's disease (may be exacerbated); photosensitisation (may occur with higher dosages); prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma Cautions, further information Cardiovascular disease An ECG may be required, particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: for all antipsychotics (other than quetiapine and clozapine) in patients with parkinsonism or Lewy Body Disease (risk of severe extrapyramidal symptoms) in behavioural and psychological symptoms of dementia (BPSD), unless symptoms are severe and other non-pharmacological treatments have failed (increased risk of stroke) for use as a hypnotic, unless sleep disorder is due to psychosis or dementia (risk of confusion, hypotension, extrapyramidal side-effects, and falls) in patients prone to falls (may cause gait dyspraxia, parkinsonism) if prescribed a phenothiazine (other than prochlorperazine for nausea, vomiting, or vertigo; chlorpromazine for relief of persistent hiccups; levomepromazine as an antiemetic in palliative care) as first-line treatment (sedative, significant antimuscarinic (anticholinergic) toxicity in older people, and safer and more efficacious alternatives exist) if prescribed an antipsychotic drug with moderate or marked antimuscarinic effects (e.g. chlorpromazine, clozapine, flupenthixol, fluphenazine, pipothiazine, promazine, and zuclopenthixol) in patients with a history of prostatism or urinary retention (high risk of urinary retention) Cautions For flupentixol decanoate An alternative antipsychotic may be necessary if symptoms such as aggression or agitation appear; hyperthyroidism; hypothyroidism; phaeochromocytoma; when transferring from oral to depot therapy, the dose by mouth should be reduced gradually
Contraindications
Children; CNS depression; comatose states; excitable patients; overactive patients
Side effects
For all antipsychotic drugs Common or very common Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; fatigue; galactorrhoea; gynaecomastia; hyperglycaemia; hyperprolactinaemia; hypersalivation; hypotension (dose-related); insomnia; leucopenia; movement disorders; muscle rigidity; neutropenia; parkinsonism; postural hypotension (dose-related); QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased Uncommon Agranulocytosis; confusion; neuroleptic malignant syndrome (discontinue-potentially fatal) Rare or very rare Sudden death; withdrawal syndrome neonatal Side-effects, further information For depot antipsychotics-side-effects may persist until the drug has been cleared from its depot site. Overdose Phenothiazines cause less depression of consciousness and respiration than other sedatives. Hypotension, hypothermia, sinus tachycardia, and arrhythmias may complicate poisoning. For details on the management of poisoning see Antipsychotics under Emergency treatment of poisoning . Side-effects For flupentixol decanoate Common or very common Appetite abnormal; asthenia; concentration impaired; depression; diarrhoea; dyspnoea; gastrointestinal discomfort; headache; hyperhidrosis; myalgia; nervousness; palpitations; sexual dysfunction; skin reactions; urinary disorder; vision disorders Uncommon Flatulence; hot flush; nausea; oculogyration; photosensitivity reaction; speech disorder Rare or very rare Glucose tolerance impaired; jaundice; thrombocytopenia Frequency not known Suicidal behaviours; venous thromboembolism Side-effects, further information Side-effects may persist until the drug has been cleared from its depot site.
Interactions
**Severe interactions:**
- Relevant classes include: class Ia and III antiarrhythmics (e.g.
**Other interactions (9):**
- In common with other antipsychotics, flupentixol enhances the response to alcohol the effects of barbiturates and other CNS depressants.
- Flupentixol may potentiate the effects of general anaesthetics and anticoagulants and prolong the action of neuromuscular blocking agents.
- Combined use of antipsychotics and lithium or sibutramine has been associated with an increased risk of neurotoxicity.
- Antipsychotics may enhance the cardiac depressant effects of quinidine; the absorption of corticosteroids and digoxin.
- The hypotensive effect of vasodilator antihypertensive agents such as hydralazine and -blockers (e.g.
- Drugs known to cause electrolyte disturbances such as thiazide diuretics (hypokalaemia) and drugs known to increase the plasma concentration of flupentixol should also be used with caution as they...
Pregnancy
For all antipsychotic drugs Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress.
Breast feeding
For all antipsychotic drugs There is limited information available on the short- and long-term effects of antipsychotic drugs on the breast-fed infant. Animal studies indicate possible adverse effects of antipsychotic medicines on the developing nervous system. Chronic treatment with antipsychotic drugs whilst breast-feeding should be avoided unless absolutely necessary. Phenothiazine derivatives are sometimes used in breast-feeding women for short-term treatment of nausea and vomiting.
Hepatic impairment
Manufacturer advises caution-monitor serum drug concentration. Dose adjustments Manufacturer advises initiate at low dose orally to check for tolerability before switching to depot formulation.
Renal impairment
Caution in renal failure (increased risk of cerebral sensitivity). M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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