Formulary
Zuclopenthixol: Indications, Dosing, Side Effects and Interactions
Zuclopenthixol clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Zuclopenthixol: Indications, Dosing, Side Effects and Interactions
Zuclopenthixol clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Schizophrenia and other psychoses**
- **Adult** (By Mouth): Initially 20-30 mg daily in divided doses, increased if necessary up to 150 mg daily; usual maintenance 20-50 mg daily (max. per dose 40 mg), for debilitated patients, use elderly dose.
- **Elderly** (By Mouth): Initially 5-15 mg daily in divided doses, increased if necessary up to 150 mg daily; usual maintenance 20-50 mg daily (max. per dose 40 mg).
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 zuclopenthixol Hyperthyroidism; hypothyroidism
Contraindications
Apathetic states; CNS depression; comatose states; phaeochromocytoma; withdrawn states
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 zuclopenthixol Frequency not known Anxiety; appetite abnormal; asthenia; concentration impaired; depression; diarrhoea; dyspnoea; eye disorders; fever; flatulence; gait abnormal; gastrointestinal discomfort; glucose tolerance impaired; headaches; hepatic disorders; hot flush; hyperacusia; hyperhidrosis; hyperlipidaemia; hypothermia; malaise; memory loss; myalgia; nasal congestion; nausea; neuromuscular dysfunction; pain; palpitations; paraesthesia; photosensitivity reaction; reflexes increased; seborrhoea; sexual dysfunction; skin reactions; sleep disorders; speech disorder; syncope; thirst; thrombocytopenia; tinnitus; urinary disorders; venous thromboembolism; vertigo; vision disorders; vulvovaginal dryness; weight decreased; withdrawal syndrome
Interactions
**Other interactions (5):**
- In common with other antipsychotics, zuclopenthixol enhances the response to alcohol, the effects of barbiturates and other CNS depressants.
- Zuclopenthixol may potentiate the effects of general anaesthetics and anticoagulants and prolong the action of neuromuscular blocking agents.
- Concomitant use of zuclopenthixol and drugs known to cause QT prolongation or cardiac arrhythmias, such as tricyclic antidepressants or other antipsychotics should be avoided.
- Drugs known to cause electrolyte disturbances such as thiazide diuretics (hypokalemia) and drugs known to increase the plasma concentration of zuclopenthixol should also be used with caution as they...
- Since zuclopenthixol is partly metabolised by CYP2D6 concomitant use of drugs known to inhibit this enzyme may lead to higher than expected plasma concentrations of zuclopenthixol, increasing the...
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 dose reduction of half the recommended dose.
Renal impairment
Caution in renal failure. M Dose adjustments Use half normal dose in renal failure. M
Medicinal forms
Tablet,Drops
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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