ZUCLOPENTHIXOL DEPOT BNF GUIDANCE

In blue I have highlighted the side effects Elizabeth is experiencing on the above drug which was prescribed at maximum level of 400mg now reduced to a still high dosage of 300mg. Below is taken from BNF Guidelines, link of which was sent to me when I contacted NICE recently to find out their recommendations on the withdrawal of the above depot. It is horrifying to note that NICE do not have any recommendations. The depot is being withdrawn by 50mg at a time following a review at every six weeks by ENFIELD COMMUNITY REHAB TEAM whose RC is Dr Ilyas Mirza. Elizabeth has just had a review from Dr Ahmad from the Community MH Team resulting in the reduction of 50mg bringing it down to 300mg. It is shocking to see so many terrible side effects that my daughter is suffering right now on this prescription but because of the fact that this is contraindicated to CNS she is having to go through agonising pain of withdrawal without any support and then all she wants is to be left alone as she recognises that she has been abused – she sees the depot as abuse. The question needs to be asked as to why she was ever put on it in the first place when although she took herself off Risperidone in one go cold turkey she was suffering terrible side effects on this and just look what Risperidone and Paliperidone causes in cases of autism which Elizabeth (not me) recognises as being HER condition. We await to hear the verdict from the Maudsley on diagnosis but one thing is for sure they can no longer pin the unscientific label of “paranoid schizophrenia” on my daughter and I await answers to my query on what is the correct diagnosis and I am not going to allow anything or anybody to cover this up.

I last spoke to Beatrice Awudu who completed the Discharge Note stating only physical conditions and I was told to contact Runa Bhoobun next but the question needs to be asked as to why this Discharge Notice did not come from Suffolk Ward itself rather than from the Home Treatment Team nurses. It is no wonder why my daughter does not feel well right now with this prescription in mind.

ZUCLOPENTHIXOL

Indications and dose

Schizophrenia and other psychoses

By mouth Unfortunately the guidance needed is on the depot

  • For Adult
    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.
  • For Elderly
    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).

Contra-indications

Apathetic states; CNS depression; comatose states; phaeochromocytoma; withdrawn states Yes this explains why Elizabeth is being taken off it.

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) (in adults); photosensitisation (may occur with higher dosages); prostatic hypertrophy (in adults); severe respiratory disease; susceptibility to angle-closure glaucoma This is not looking good as it would appear that certain doctors have ruined my daughter’s physical health by their enormous prescriptions of antipsychotic drugs without a second thought to not doing harm to the patient.

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. AWAITED – Appointment recently cancelled by Inhealth private clinic referred to by NHS due to covid.

Elderly

In adults

Prescription potentially inappropriate (STOPP criteria):

  • 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) I cannot understand why quetiapine and clozapine are in brackets. Quetiapine caused Akathisia and Clozapine NMS, and other extrapyramidal symptoms.

  • 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).

See also Prescribing in the elderly.

For ZUCLOPENTHIXOL

Hyperthyroidism; hypothyroidism

Interactions

Individual interactants:

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; 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; embolism and thrombosis; neuroleptic malignant syndrome (discontinue—potentially fatal) Already had that on Clozapine which is why I took her off it.

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.

For ZUCLOPENTHIXOL

Frequency not known

Anxiety; appetite abnormal; asthenia; concentration impaired; depressiondiarrhoeadyspnoea; eye disorders; fever; flatulence; gait abnormalgastrointestinal discomfort; glucose tolerance impairedheadaches; hepatic disorders; hot flush; hyperacusiahyperhidrosis; hyperlipidaemiahypersalivation; hypothermia; malaise; memory lossmyalgianasal congestion; nausea; neuromuscular dysfunction; pain; palpitations; paraesthesiaphotosensitivity reaction; reflexes increased; seborrhoea; sexual dysfunctionskin reactions; sleep disorders; speech disorder; syncope; thirst; thrombocytopenia; tinnitus; urinary disorders; vertigo; vision disorders; vulvovaginal dryness; weight decreased; withdrawal syndrome

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

Dose adjustments

Halve dose in renal failure; smaller starting doses used in severe renal impairment because of increased cerebral sensitivity.

Monitoring requirements

For all ANTIPSYCHOTIC DRUGS

Monitoring of patient parameters

It is advisable to monitor prolactin concentration at the start of therapy, at 6 months, and then yearly. Patients taking antipsychotic drugs not normally associated with symptomatic hyperprolactinaemia should be considered for prolactin monitoring if they show symptoms of hyperprolactinaemia (such as breast enlargement and galactorrhoea).

Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year.

In children

Regular clinical monitoring of endocrine function should be considered when children are taking an antipsychotic drug known to increase prolactin levels; this includes measuring weight and height, assessing sexual maturation, and monitoring menstrual function.

Treatment cessation

For all ANTIPSYCHOTIC DRUGS

There is a high risk of relapse if medication is stopped after 1–2 years. Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse. Patients should be monitored for 2 years after withdrawal of antipsychotic medication for signs and symptoms of relapse.

Prescribing and dispensing information

For all ANTIPSYCHOTIC DRUGS

Patient decision aid

In adults

Antipsychotic medicines for treating agitation, aggression and distress in people living with dementia. National Institute for Health and Care Excellence. June 2018.

www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/shared-decision-making

Patient and carer advice

For all ANTIPSYCHOTIC DRUGS

As photosensitisation may occur with higher dosages, patients should avoid direct sunlight.

Driving and skilled tasks

Drowsiness may affect performance of skilled tasks (e.g. driving or operating machinery), especially at start of treatment; effects of alcohol are enhanced.

Medicinal forms

There can be variation in the licensing of different medicines containing the same drug.

Tablet, Oral dropsBack to top 

Related Treatment Summaries

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