Flupentixol

When ATH:
N05AF01

Characteristics flupentyksola

From the group of neuroleptic thioxanthene.

Pharmacological action flupenthixol

Neuroleptic, antipsychotic, anxiolytic, antidepressant, sedation.

Application flupenthixol

Pills (at a dose of 3 mg): depression of mild to moderate severity, combined with anxiety, asthenia and lack of initiative; chronic neurotic disorders with anxiety, Depression and apathy; psychosomatic disorders with asthenic manifestations; acute and situationally caused anxiety and emotional stress state, that do not require a sedative / hypnotic effect (especially if you suspect, that the patient is at risk of abuse of tranquilizers).

Pills (dose 3 mg, and more), drops (4-40 Mg /), depot: psychotic states with a predominance of hallucinatory symptoms, paranoid delusions and thought disorders, accompanied by apathy, and anergy autism.

Drops (at a dose of 40-150 mg / day): acute and chronic psychosis, resistant to therapy (including schizophrenia); alcohol withdrawal syndrome.

Flupentixol – Contraindications

Hypersensitivity, acute alcohol intoxication and other means, CNS depressants (barbiturates, opioid analgesics), coma, neuroleptic malignant syndrome, central hyperthermia history, state of excitement and hyperactivity, blood dyscrasias, bone marrow depression, collapse, pheochromocytoma, pregnancy, lactation.

Restrictions on the use flupenthixol

Convulsions; progressive liver disease; diseases of the cardiovascular system (incl. arrhythmia, severe hypotension, orthostatic dysregulation of the blood circulation); brain damage, incl. trunk (Parkinson's disease); respiratory disorders, associated with acute infectious diseases, asthma, emphysema; glaucoma, incl. closure, or predisposition to it; symptomatic prostatic hypertrophy (the risk of urinary retention); violation of emptying the bladder with formation of residual urine; gastric ulcer and duodenal ulcer (possible deterioration); Reye syndrome (increased risk of hepatotoxic effects); alcoholism (may increase CNS depression); renal failure, prolaktinzavisimye tumor, stenosis of the gastrointestinal tract.

Application flupenthixol during pregnancy and breastfeeding

When pregnancy is possible, if the effect of therapy outweighs the potential risk to the fetus (Experiments on animals showed embryotoxic and teratogenic effects, studies in humans have not been conducted). At the time of treatment should stop breastfeeding (pharmacologically similar phenothiazines increase the risk of tardive dyskinesia and, perhaps, sleepiness in the baby).

Side effects flupenthixol

On the part of the central nervous system and sensory organs: at a dose of less than 3 mg / day - Insomnia, drowsiness, anxiety, extrapyramidal disorder (less 5%); at higher doses - extrapyramidal disorders (akathisia - 18%, Parkinsonism - 8%, tremor - 7% (for depot formulations - 16%), gipokineziya - 5%), Insomnia - 9%, fatigue - 5%, Depression - 4% (for depot forms), anxiety - 3%, Parez akkomodacii - 3%, drowsiness, dizziness - 2%; other than that - early and late dyskinesia, provocation epileptiform seizures, glaucoma attacks, dystonic reactions (especially in children and young adults), tardive dystonia, dyskinesia, caused by the abolition of the drug, deposition of opaque substances in the lens and cornea, retinopathy, swelling of the nasal mucosa; in rare cases - neuroleptic malignant syndrome (hyperthermia, muscle rigidity, disturbance of consciousness, vascular dystonia - lability of blood pressure, tachycardia, increased sweating) which can be fatal.

Cardio-vascular system: hypotension - 1,5% (at a dose above 40 mg / day), hemodyscrasia (agranulocytosis et al.) - Less 1%, thrombosis - I 0,1%, cardiac conduction disturbances, tachycardia, orthostatic dysregulation of the blood circulation.

From the digestive tract: hyperptyalism (4%), nausea (2%), dry mouth (2%), constipation (2%), diarrhea (1%), paralytic ileus, cholestasis, in some cases - jaundice, transient changes in liver function tests.

With the genitourinary system: urinary retention, menstrual disorders, sexual disorders (reduced sexual potency).

For the skin: discolouration of the skin (more often in women, long-term therapy in high doses), toxic and allergic skin reactions, photosensitivity.

Other: weight gain, increased appetite, decreased sweating, breast enlargement (women and men), unusual secretion of milk.

Interaction flupenthixol

It enhances the effect of alcohol and other means, CNS depressants (for narcosis, barbiturates, opioid analgesics), anticholinergics, and anticholinergic effects of antihistamines and antidiskineticheskih. Enhances or extends (mutually) sedative and anticholinergic effect of tricyclic antidepressants, Maprotiline, MAO inhibitors (including furazolidone, procarbazine, selegiline), trazodona. It weakens the hypotensive effect of guanethidine, clonidine and alpha-methyldopa, effect of dopamine receptor agonists (bromocriptine, amantadin, levodopa). In combination with the possible suppression of amphetamine stimulating effect of amphetamine on the central nervous system and anti-psychotic action thioxanthenes. Caffeine reduces the effect of neuroleptics. Can inhibit peripheral vasoconstrictor effect of dopamine, ephedrine, metaraminola, methoxamine, phenylephrine. The simultaneous use of adrenaline (epinephrine) It is leading to a sharp drop in blood pressure, with metoclopramide, bromocriptine, alizapridom and piperazine - increased risk of extrapyramidal disorders. In combination with bromocriptine may increase the concentration of prolactin in the serum, with drugs, having ototoxic properties, - Masking the symptoms of ototoxicity, with means, causing photosensitivity - strengthening the photosensitizing effect. Increases (mutually) the concentration of propranolol, tricyclic antidepressants, lithium preparations serum, while the use of drugs lithium may develop neurotoxic symptoms. Increasing the concentration of phenytoin plasma. Barbiturates, carbamazepine accelerates metabolism of neuroleptics. Antacids and adsorbents antidiarrheal drugs can inhibit the absorption of thioxanthenes ingestion.

Overdose flupenthixol

Symptoms: severe breathing problems, cardiopalmus, drowsiness, coma, extrapyramidal disorder, pupillary constriction, convulsions, hypotension, unusual excitement, tired or severe weakness, shock, Hypo- or hyperthermia.

Treatment: gastric lavage and the appointment of a sorbent, if flupentixol appointed interior, monitoring vital functions, symptomatic and supportive therapy. In convulsions - diazepam, extrapyramidal disorders - biperidena.

Dosing and Administration flupenthixol

Inside, / m.

Inside. Pills. Depression and anxiety disorders: the initial dose - 1 mg 1 once a day in the morning or 0,5 mg 2 once a day, if necessary through 1 weeks, increase the dose to a maximum daily - 3 mg, razdelennoy 2-3 accepts; with no effect dose 3 mg / day therapy canceled. Psychotic conditions: the initial dose - 5-15 mg / day in 2-3 hours, if necessary - up 40 mg / day; maintenance - 5-20 mg 1 once a day in the morning.

Drops. Psychotic conditions: 4-16 Mg / (1-4 Drops per day) 2-3 hours, if necessary - up 40 mg / day (10 drops per day). Acute and chronic psychosis, resistant to therapy: Dose set individually; 40-150 Mg 4 times a day at the beginning of therapy, then - 1-3 times a day.

/ M, deep in the buttock. Depot: 20-200 Mg every 2-4 weeks, during exacerbation - up 400 mg every 1-2 weeks, followed by a gradual decrease to a maintenance dose - 20-200 mg every 2-4 weeks.

The transition from the oral forms at a depot formulation is carried out under the scheme: oral daily dose (mg) x 4 = Single dose (mg) depot / m 1 once every 2 Sun; in the first week after injection should continue taking oral dosage forms in small doses.

Precautions

Caution should be used in children (Safety and efficacy have not been determined). Elderly patients should be prescribed a lower starting dose and gradually carry out their correction.

The emergence of extrapyramidal disorders requires a reduction of dose and destination antiparkinsonian. If signs of tardive dyskinesia or dystonia, neuroleptic malignant syndrome should be abolished flupentixol therapy and prescribe supportive and symptomatic treatment.

When long-term therapy, particularly with high doses, careful monitoring and assessment of patients with the aim of supporting the timely correction of the dose or discontinuation of therapy: blood count and determination of leukocyte (in severe agranulocytosis flupentixol should be abolished), definition of the function of the liver, Urine bilirubin, and other bile pigments (with the appearance of jaundice or flu-like symptoms), Ophthalmic Research.

Caution should be exercised with any surgical, dental treatment or emergency treatment.

Do not expose unprotected skin to solar radiation.

Patients, which previously were appointed long-acting antipsychotics, the use of depot should start with a test dose - 5-20 mg, and be closely monitored for their condition within 5-10 days.

Upon the termination of long-term maintenance therapy is recommended to reduce the dose gradually, within a few weeks. In the case of previous therapy with antipsychotic drugs with sedative effects of their intake should be stopped gradually.

During treatment should abandon the use of alcoholic beverages, refrain from activities potentially hazardous activities, require attention and speed of mental and motor responses.

Cautions

Solution for injection (depot) should not be mixed with other. solution for injection (except klopiksol-akufaz a co-injection).