Flupentixol

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Flupentixol
Flupenxitol Wiki Str.png
Flupentixol3Dan.gif
Clinical data
Trade namesDepixol, Fluanxol
AHFS/Drugs.comMicromedex Detailed Consumer Information
Pregnancy
category
  • C
Routes of
administration
Oral, IM (including a depot)
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only)
  • CA: ℞-only
  • UK: POM (Prescription only)

  • Rx-only
Pharmacokinetic data
Bioavailability40-55% (Oral)[2]
MetabolismGut wall, hepatic[1]
Elimination half-life35 hours[2]
ExcretionRenal (negligible)[3]
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
E number{{#property:P628}}
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Chemical and physical data
FormulaC23H25F3N2OS
Molar mass434.5219 g/mol
3D model (JSmol)
 ☒N☑Y (what is this?)  (verify)

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. In addition to single drug preparations, it is also available as flupentixol/melitracen—a combination product containing both melitracen (a tricyclic antidepressant) and flupentixol.

Flupentixol is not approved for use in the US. It is, however, approved for use in the UK,[4] Australia,[5] Canada, Russian Federation,[6] South Africa, New Zealand, Philippines 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 suffer frequent relapses of illness, though it is also commonly given as a tablet. There however is little evidence to support its use for this indication.[4][7]

Flupentixol is also used in low doses as an antidepressant.[4][8][9][10][11][12][13]

Adverse effects

Adverse effect incidence[2][4][5][14][15]

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
  • Hyperprolactinaemia and its complications such as: (acutely)
- Sexual dysfunction
- Amenorrhoea — cessation of menstrual cycles
- Gynaecomastia — enlargement of breast tissue in males
- Galactorrhoea — the expulsion of breast milk that's not related to breastfeeding or pregnancy
and if the hyperprolactinaemia 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
- Neutropaenia — 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.
- Hyperthermia
- Muscle rigidity
- Rhabdomyolysis
- Autonomic instability (e.g. tachycardia, diarrhoea, 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.
  • Hypotension
  • Confusional state
  • Seizures
  • Mania
  • Hypomania
  • Depression
  • Hot flush
  • Anergia
  • Appetite changes
  • Weight changes
  • Hyperglycaemia — high blood glucose (sugar) levels
  • Abnormal glucose tolerance
  • Pruritus — itchiness
  • Rash
  • Dermatitis
  • Photosensitivity — sensitivity to light
  • Oculogyration
  • 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
  • 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

Interactions

It should be not used concomitantly with medications known to prolong the QTc interval (e.g. 5-HT3 antagonists, tricyclic antidepressants, citalopram, etc.) as this may lead to an increased risk of QTc interval prolongation.[15][2] Neither should it be given concurrently with lithium (medication) as it may increase the risk of lithium toxicity and neuroleptic malignant syndrome.[4][5][15] It should not be given concurrently with other antipsychotics due to the potential for this to increase the risk of side effects, especially neurological side effects such as neuroleptic malignant syndrome.[4][5][15] It should be avoided in patients on CNS depressants such as opioids, alcohol and barbiturates.[15]

Contraindications

It should not be given in the following disease states:[2][4][5][15]

Pharmacology

Binding profile[16]

Protein cis-flupentixol trans-flupentixol
5-HT1A 8028 -
5-HT2A 87.5 (HFC) -
5-HT2C 102.2 (RC) -
mAChRs[17] Neg. Neg.
D1 3.5 474 (MB)
D2 0.35 120
D3 1.75 162.5
D4 66.3 >1000
H1 0.86 5.73

Acronyms used:
HFC - Human frontal cortex receptor
MB - Mouse brain receptor
RC - Cloned rat receptor

Its antipsychotic effects are likely caused by D2 and/or 5-HT2A antagonism, whereas its antidepressant effects at lower doses may be mediated by preferential D2/D3 autoreceptor blockade, resulting in increased postsynaptic activation.

Society and culture

The combination of flupenthixol and melitracen is banned by Indian regulatory body.[18]

References

  1. Jann, MW; Ereshefsky, L; Saklad, SR (July–August 1985). "Clinical pharmacokinetics of the depot antipsychotics". Clinical Pharmacokinetics. 10 (4): 315–333. doi:10.2165/00003088-198510040-00003. PMID 2864156.
  2. 2.0 2.1 2.2 2.3 2.4 "Depixol Tablets 3mg - Summary of Product Characteristics (SPC)". electronic Medicines Compendium. Lundbeck Ltd. 27 December 2012. Retrieved 20 October 2013.
  3. "Antipsychotic drugs: clinical pharmacokinetics of potential candidates for plasma concentration monitoring". Clinical Pharmacokinetics. 13 (2): 65–90. doi:10.2165/00003088-198713020-00001. PMID 2887326.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Template:Cite isbn
  5. 5.0 5.1 5.2 5.3 5.4 Template:Cite isbn
  6. "Fluanxol® (flupentixol) Tablets Registration Certificate". Russian State Register of Medicinal Products. Retrieved 29 July 2014.
  7. Shen, X; Xia, J; Adams, CE (Nov 14, 2012). Shen, Xiaohong, ed. "Flupenthixol versus placebo for schizophrenia". Cochrane database of systematic reviews (Online). 11: CD009777. doi:10.1002/14651858.CD009777.pub2. PMID 23152280.
  8. Robertson MM, Trimble MR (May 1981). "The antidepressant action of flupenthixol". The Practitioner. 225 (1355): 761–3. PMID 7291129.
  9. Pöldinger W, Sieberns S (1983). "Depression-inducing and antidepressive effects of neuroleptics. Experiences with flupenthixol and flupenthixol decanoate". Neuropsychobiology. 10 (2–3): 131–6. doi:10.1159/000117999. PMID 6674820.
  10. Johnson DA (January 1979). "A double-blind comparison of flupenthixol, nortriptyline and diazepam in neurotic depression". Acta Psychiatrica Scandinavica. 59 (1): 1–8. doi:10.1111/j.1600-0447.1979.tb06940.x. PMID 369298.
  11. Young JP, Hughes WC, Lader MH (May 1976). "A controlled comparison of flupenthixol and amitriptyline in depressed outpatients". British Medical Journal. 1 (6018): 1116–8. doi:10.1136/bmj.1.6018.1116. PMC 1639983. PMID 773506.
  12. Fujiwara J, Ishino H, Baba O, Hanaoka M, Sasaki K (August 1976). "Effect of flupenthixol on depression with special reference to combination use with tricyclic antidepressants. An uncontrolled pilot study with 45 patients". Acta Psychiatrica Scandinavica. 54 (2): 99–105. doi:10.1111/j.1600-0447.1976.tb00101.x. PMID 961463.
  13. Tam W, Young JP, John G, Lader MH (March 1982). "A controlled comparison of flupenthixol decanoate injections and oral amitriptyline in depressed out-patients". The British Journal of Psychiatry : the Journal of Mental Science. 140 (3): 287–91. doi:10.1192/bjp.140.3.287. PMID 7093597.
  14. Bostwick, JR; Guthrie, SK; Ellingrod, VL (January 2009). "ntipsychotic-induced hyperprolactinemia". Pharmacotherapy. 29 (1): 64–73. doi:10.1592/phco.29.1.64. PMID 19113797.
  15. 15.0 15.1 15.2 15.3 15.4 15.5 "FLUANXOL® DEPOT FLUANXOL® CONCENTRATED DEPOT". TGA eBusiness Services. Lundbeck Australia Pty Ltd. 28 June 2013. Retrieved 20 October 2013.
  16. Roth, BL; Driscol, J (12 January 2011). "PDSP Ki Database". Psychoactive Drug Screening Program (PDSP). University of North Carolina at Chapel Hill and the United States National Institute of Mental Health. Retrieved 20 October 2013.
  17. Golds PR, Przyslo FR, Strange PG (March 1980). "The binding of some antidepressant drugs to brain muscarinic acetylcholine receptors". British Journal of Pharmacology. 68 (3): 541–9. doi:10.1111/j.1476-5381.1980.tb14570.x. PMC 2044199. PMID 7052344.
  18. "Central Government prohibits combination of Flupenthixol and Melitracen". PharmaTutor. 24 July 2014. Retrieved 12 August 2014.

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