Flupentixol (INN), also known as flupenthixol (former BAN), marketed under brand names such as Depixol and Fluanxol is a typical antipsychotic drug of the thioxanthene class. It was introduced in 1965 by Lundbeck. In addition to single drug preparations, it is also available as flupentixol/melitracen—a combination product containing both melitracen (a tricyclic antidepressant) and flupentixol (marketed as Deanxit). Flupentixol is not approved for use in the United States. It is, however, approved for use in the UK, Australia, Canada, Russian Federation, South Africa, New Zealand, Philippines, Iran, Germany, and various other countries.
Medical uses
Flupentixol's main use is as a long-acting injection given once in every two or three weeks to individuals with schizophrenia who have poor compliance with medication and have frequent relapses of illness, though it is also commonly given as a tablet. There is little formal evidence to support its use for this indication but it has been in use for over fifty years.
Flupentixol is also used in low doses as an antidepressant. There is tentative evidence that it reduces the rate of deliberate self-harm, among those who self-harm repeatedly.
Adverse effects
Adverse effect incidence
Common (>1% incidence) adverse effects include
Extrapyramidal side effects such as: (which usually become apparent soon after therapy is begun or soon after an increase in dose is made) Muscle rigidity Hypokinesia Hyperkinesia Parkinsonism Tremor Akathisia Dystonia Dry mouth Constipation Hypersalivation – excessive salivation Blurred vision Diaphoresis – excessive sweating Nausea Dizziness Somnolence Restlessness Insomnia Overactivity Headache Nervousness Fatigue Myalgia Hyperprolactinemia and its complications such as: (acutely) Sexual dysfunction Amenorrhea – cessation of menstrual cycles Gynecomastia – enlargement of breast tissue in males Galactorrhea – the expulsion of breast milk that's not related to breastfeeding or pregnancy and if the hyperprolactinemia persists chronically, the following adverse effects may be seen: Reduced bone mineral density leading to osteoporosis (brittle bones) Infertility Dyspepsia – indigestion Abdominal pain Flatulence Nasal congestion Polyuria – passing more urine than usual
Uncommon (0.1–1% incidence) adverse effects include
Fainting
Palpitations
Rare (<0.1% incidence) adverse effects include
Blood dyscrasias (abnormalities in the cell composition of blood), such as: Agranulocytosis – a drop in white blood cell counts that leaves one open to potentially life-threatening infections Neutropenia – a drop in the number of neutrophils (white blood cells that specifically fight bacteria) in one's blood Leucopenia – a less severe drop in white blood cell counts than agranulocytosis Thrombocytopenia – a drop in the number of platelets in the blood. Platelets are responsible for blood clotting and hence this leads to an increased risk of bruising and other bleeds Neuroleptic malignant syndrome – a potentially fatal condition that appear to result from central D2 receptor blockade. The symptoms include: Hyperthermia Muscle rigidity Rhabdomyolysis Autonomic instability (e.g. tachycardia, diarrhea, diaphoresis, etc.) Mental status changes (e.g. coma, agitation, anxiety, confusion, etc.)
Unknown incidence adverse effects include
Jaundice
Abnormal liver function test results
Tardive dyskinesia – an often incurable movement disorder that usually results from years of continuous treatment with antipsychotic drugs, especially typical antipsychotics like flupenthixol. It presents with repetitive, involuntary, purposeless and slow movements; TD can be triggered by a fast dose reduction in any antipsychotic. Hypotension Confusional state Seizures Mania Hypomania Depression Hot flush Anergia Appetite changes Weight changes Hyperglycemia – high blood glucose (sugar) levels Abnormal glucose tolerance Pruritus – itchiness Rash Dermatitis Photosensitivity – sensitivity to light Oculogyric crisis Accommodation disorder Sleep disorder Impaired concentration Tachycardia QTc interval prolongation – an abnormality in the electrical activity of the heart that can lead to potentially fatal changes in heart rhythm (only in overdose or <10 ms increases in QTc) Torsades de pointes Miosis – constriction of the pupil of the eye Paralytic ileus – paralysis of the bowel muscles leading to severe constipation, inability to pass wind, etc. Mydriasis Glaucoma