Clopixol

Oral Zuclopenthixol (dihydrochloride)

• Schizophrenia and other chronic psychotic disorders.
• Acute bipolar mania (clinically accepted off-label use).

Zuclopenthixol Acetate (IM, short‑acting)

• Acute psychosis with severe agitation or aggression.
• Acute mania and severe behavioral disturbances in psychiatric emergencies.

Zuclopenthixol Decanoate (Depot IM, long‑acting)

• Maintenance treatment of schizophrenia and paranoid psychoses, especially in patients with poor adherence to oral therapy.
• Long-term management of aggressive or violent behavior associated with psychotic disorders.

রেজিস্টার্ড চিকিৎসকের নির্দেশনা অনুযায়ী ঔষধ সেবন করুন।

Oral (Zuclopenthixol Hydrochloride)

• Starting dose (Adults): 10–20 mg/day in divided doses.
• Titration: Increase by 10–20 mg every 2–3 days based on clinical response.
• Maintenance: 20–60 mg/day; maximum 100 mg/day in divided doses.
• Elderly: Start at 25–50% of the adult dose; titrate more slowly with close monitoring.

IM Short-acting (Zuclopenthixol Acetate)

• Used for rapid sedation in acute psychotic agitation.
• Initial dose: 50–150 mg IM; may be repeated after 2–3 days if necessary.
• Maximum total dose: 400 mg/week; not intended for continuous or maintenance therapy.

IM Depot (Zuclopenthixol Decanoate)

• Initial dose: 100–200 mg IM; overlap with oral therapy for 1–2 weeks during initiation.
• Maintenance: 200–500 mg every 2–4 weeks.
• Maximum dose: 600 mg per injection; some patients may require up to 600 mg weekly based on clinical response.

Special Populations

• Children: Not recommended for use in individuals under 18 years of age.
• Hepatic Impairment: Use with caution; monitor liver function tests regularly.
• Renal Impairment: No specific dosage adjustment required, but close clinical monitoring is advised.

রেজিস্টার্ড চিকিৎসকের নির্দেশনা অনুযায়ী ঔষধ সেবন করুন।

Zuclopenthixol is a typical thioxanthene antipsychotic that antagonizes dopamine D₁ and D₂ receptors, plus α₁-adrenergic and 5-HT₂ receptors, with minor histamine H₁ antagonism. By blocking dopamine transmission in limbic and mesolimbic pathways, it reduces psychotic symptoms. α₁ blockade contributes sedation and hypotension, while D₂ blockade underlies extrapyramidal effects and prolactin elevation.

• Absorption: Oral bioavailability ~49%; peak plasma levels in 3–6 hours
• Distribution: High protein binding (~98%); large volume of distribution
• Metabolism: Primarily hepatic via CYP2D6 and CYP3A4 enzymes
• Elimination: Mostly excreted in feces via bile; less than 10% in urine
• Half-life:
• Oral: ~20 hours
• Acetate (IM): 48–72 hours (peak); short-term
• Decanoate (IM): Half-life ~19 days; steady release over weeks

• Pregnancy: Category C. Use only if potential benefits justify potential risks. Neonates may experience extrapyramidal symptoms or withdrawal if exposed in the third trimester.
• Lactation: Excreted in breast milk in small amounts. Breastfeeding is not recommended unless benefits outweigh potential risks; monitor infants for sedation or feeding problems.

• Class: Typical antipsychotic (first-generation antipsychotic)
• Subclass: Thioxanthene derivative

• Hypersensitivity to zuclopenthixol or any of its components
• Comatose states or severe CNS depression
• Existing QT interval prolongation or arrhythmia
• Severe hypotension or circulatory collapse
• Acute alcohol, barbiturate, or opioid intoxication
• Parkinson’s disease (relative contraindication)

• Risk of neuroleptic malignant syndrome (NMS): monitor for fever, rigidity, confusion
• Extrapyramidal symptoms (EPS): including dystonia, akathisia, and tardive dyskinesia
• Sedation and orthostatic hypotension: increased fall risk in elderly
• QT prolongation: caution with cardiac disease or electrolyte imbalance
• Metabolic effects: weight gain, hyperglycemia, and lipid changes possible
• Hematologic risks: rare cases of leukopenia, neutropenia, or agranulocytosis
• Seizure threshold may be lowered
• Hyperprolactinemia: menstrual irregularities, galactorrhea, sexual dysfunction

Common:

• Drowsiness, sedation
• Dry mouth, constipation
• Dizziness, fatigue
• Extrapyramidal symptoms (tremor, rigidity)
• Orthostatic hypotension
• Increased salivation

Less Common/Rare:

• Tardive dyskinesia
• Neuroleptic malignant syndrome
• Weight gain, hyperglycemia
• QT prolongation, arrhythmia
• Agranulocytosis, leukopenia
• Elevated liver enzymes
• Photosensitivity reactions

• CNS depressants (alcohol, benzodiazepines, opioids): enhanced sedation
• QT-prolonging drugs (e.g., antiarrhythmics, macrolides): increased cardiac risk
• CYP2D6 and CYP3A4 inhibitors (e.g., fluoxetine, erythromycin): may increase plasma levels
• Antihypertensives: additive hypotensive effect
• Levodopa and dopamine agonists: antagonistic effects
• Lithium: increased risk of neurotoxicity

• Long-acting injection forms emphasized in clinical guidelines for non-adherent schizophrenia patients
• Ongoing monitoring recommendations include ECG (QT interval), metabolic screening, and CBC during long-term use
• Not FDA-approved in the U.S. but widely used internationally

• Tablets: Store below 25°C in a dry place, protected from light
• Acetate/Decanoate Injections: Store at 15–30°C; do not freeze; protect from light
• Use aseptic technique when drawing from vials; discard unused portions after opening