Clopixol Depot

Indications

Zuclopenthixol Decanoate is a long-acting (depot) antipsychotic injection used for the maintenance treatment of schizophrenia and other long-term psychotic illnesses, especially in people who find it hard to take tablets every day. It helps prevent relapse of symptoms such as hallucinations, delusions and disturbed thinking.

How It Works

Zuclopenthixol blocks dopamine receptors (mainly D1 and D2) in the brain. Too much dopamine activity is linked to psychotic symptoms; blocking it calms these symptoms. The decanoate form is dissolved in oil and released slowly from the muscle, so one injection works for 2 to 4 weeks.

Dosage and Administration

It is given only by a doctor or nurse as a deep injection into a large muscle (usually the buttock or thigh), typically every 2 to 4 weeks. The dose is set and adjusted by the psychiatrist according to the person's response and side effects, as prescribed. Doses are lower in older people. Do not miss scheduled injections.

Interactions

• Alcohol, sleeping pills, strong painkillers and other sedating medicines: increased drowsiness.
• Medicines that affect heart rhythm (QT prolongation), such as Amiodarone, Quinidine, Sotalol, some antibiotics (Erythromycin, Moxifloxacin) and Methadone: risk of dangerous heart rhythm.
• Levodopa and other Parkinson's medicines: effects may be reduced.
• Lithium: higher risk of nerve side effects.
• Tricyclic antidepressants and medicines for high blood pressure: effects may increase.
• Metoclopramide and Piperazine: increased risk of movement side effects.

Contraindications

• Allergy to Zuclopenthixol or thioxanthenes.
• Coma, severe drowsiness or alcohol, barbiturate or opioid poisoning.
• Phaeochromocytoma (an adrenal tumour).
• Severe blood disorders or bone marrow depression.

Side Effects

Common side effects include drowsiness, dry mouth, constipation, blurred vision, weight gain, dizziness on standing, and movement problems such as stiffness, tremor, restlessness (akathisia) and abnormal muscle movements. Long-term use can cause tardive dyskinesia (involuntary movements of the face or body). Raised prolactin may cause breast swelling, milk discharge or missed periods.

Get urgent medical help if there is high fever with muscle stiffness, sweating and confusion (neuroleptic malignant syndrome), fainting or a fast or irregular heartbeat, fits, a painful swollen leg or sudden breathlessness (possible blood clot), or signs of serious infection.

Pregnancy and Lactation

Use in pregnancy only if the doctor decides it is clearly needed. Babies exposed late in pregnancy may have movement problems or withdrawal symptoms after birth. Small amounts pass into breast milk; discuss breastfeeding with the doctor.

Precautions and Warnings

Use with care in heart disease, epilepsy, Parkinson's disease, liver or kidney disease, glaucoma, enlarged prostate, and in older people. Elderly people with dementia have a higher risk of stroke and death with antipsychotics. It may cause drowsiness; avoid driving until you know how it affects you. Avoid getting overheated or dehydrated.

Overdose

An overdose may cause severe drowsiness, coma, low blood pressure, severe movement problems, fits, abnormal heart rhythm and low body temperature. This needs emergency hospital care.

Therapeutic Class

Typical antipsychotic; thioxanthene; long-acting depot injection.

Storage

Store below 25°C, protected from light. Do not freeze. Handled by the clinic or hospital as directed on the pack, out of the reach of children.