Clopixol Depot

/ Lundbeck

Adults: Dosage and interval between injections should be individually adjusted according to the condition of the patient. This in order to achieve a maximum suppression of psychotic symptoms with a minimum of side effects.
Zuclopenthixol decanoate 200 mg/ml
In the maintenance treatment the dosage range would normally be 200-400 mg (1-2 ml) every second to fourth week.
A few patients may need higher doses or shorter intervals between doses.
Injection volumes exceeding 2ml (400 mg) should be distributed between two injection sites.
If volumes larger than 2-3 ml of the 200 mg/ml solution are required the more concentrated solution (zuclopenthixol decanoate 500 mg/ml) should be preferred.
Treatment is usually started with 100 mg. One week later, or when symptoms recur (but not more than 4 weeks later) a second injection of 100-200 mg or more is given.
Zuclopenthixol decanoate 500 mg/ml
250-500 mg (½ml – 1 ml) every one to four weeks, depending on the response.
When changing the medication from oral zuclopenthixol or zuclopenthixol acetate i.m. to maintenance treatment with zuclopenthixol decanoate the following guidelines should be used:
1) Change from oral zuclopenthixol to zuclopenthixol decanoate
x mg p.o. daily corresponds to 8x mg decanoate every 2 weeks.
x mg p.o. daily corresponds to 16x mg decanoate every 4 weeks.
Oral zuclopenthixol should be continued during the first week after the first injection but in diminishing dosage.
2) Change from zuclopenthixol acetate to zuclopenthixol decanoate
Concomitantly with the (last) injection of zuclopenthixol acetate (100 mg), 200-400 mg (1-2 ml) of zuclopenthixol decanoate 200 mg/ml should be given intramuscularly and repeated every 2nd week.
Higher doses or shorter intervals may be needed.
Zuclopenthixol acetate and zuclopenthixol decanoate can be mixed in a syringe and given as one injection (co-injection).
Patients being transferred from other depot preparations should receive a dose in the ratio of 200 mg zuclopenthixol decanoate equivalent to 25 mg fluphenazine decanoate, to 40 mg cis(Z)-flupentixol decanoate, or to 50 mg
haloperidol decanoate.
Subsequent doses of zuclopenthixol decanoate and interval between injections should be adjusted to the response of the patient.
Elderly: Elderly patients should receive dosages in the lower end of the dosage range.
Children: Clopixol Depot is not recommended for use in children due to lack of clinical experience.
Reduced renal function: Clopixol Depot can be given in usual doses to patients with reduced renal function.
Reduced liver function: Careful dosing and, if possible, a serum level determination is advisable.
Method of administration: Clopixol Depot is administered by intramuscular injection into the upper outer quadrant of the gluteal region. Injection volumes exceeding 2 ml should be distributed between 2 injection sites. Local tolerability is good.
Note: As with all oily injections it is important to ensure by aspiration before injection, that inadvertent intravascular entry does not occur.

Clopixol Depot Injection is a depot neuroleptic preparation designed for the maintenance treatment of acute and chronic schizophrenia and other paranoid psychoses, especially where compliance with oral medication is a problem.

Hypersensitivity to the active substance or to any of the excipients.
Circulatory collapse, depressed level of consciousness due to any cause (e.g. intoxication with alcohol, barbiturates or opiates), coma.

The possibility of development of neuroleptic malignant syndrome (hyperthermia, muscle rigidity, fluctuating consciousness, instability of the autonomous nervous system) exists with any neuroleptic.
The risk is possibly greater with the more potent agents. Patients with pre-existing organic brain syndrome, mental retardation and opiate and alcohol abuse are over-represented among fatal cases.
See prescribing information for full details.

Extrapyramidal reactions may occur, especially during the first few days after an injection and in the early phase of treatment. In most cases these side effects can be satisfactorily controlled by reduction of dosage and/or use of antiparkinsonian drugs. The routine prophylactic use of antiparkinsonian
drugs is not recommended. Antiparkinsonian drugs do not alleviate tardive dyskinesia and may aggravate them. Reduction in dosage or, if possible, discontinuation of zuclopenthixol therapy is recommended. In persistent akathisia a benzodiazepine or propranolol may be useful.
See prescribing information for full details.