Zuclopenthixol

CLINICAL USE

Antipsychotic for schizophrenia and other psychoses

DOSE IN NORMAL RENAL FUNCTION

Schizophrenia and paranoid psychoses: Oral: 20–30 mg daily in divided doses; maximum 150 mg daily Maintenance:

20 to 50 : mg daily Deep IM: 200–500 mg every 1–4 weeks Maximum: 600 mg weekly Acute psychoses: (Clopixol Acuphase) Deep IM: 50–150 mg, repeated if required after 2–3 days Maximum 400 mg per course

PHARMACOKINETICS

Molecular weight : 401 (443 as acetate), (473.9 as hydrochloride), (555.2 as decanoate)

%Protein binding : 98

%Excreted unchanged in urine : Minimal (

10 to 20

% unchanged drug and metabolites)

Volume of distribution (L/kg) :

10 to 20 :

half-life – normal/ESRD (hrs) : 20–24

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Start with 50% of the dose and titrate slowly

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD : Not dialysed. Dose as in GFR <10 mL/min

HD : Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux : Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD : Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effects

Analgesics: increased risk of convulsions with tramadol; enhanced hypotensive and sedative effects with opioids

Anti-arrhythmics: increased risk of ventricular arrhythmias with anti- arrhythmics that prolong the QT interval

Antidepressants: increased level of tricyclics

Anti-epileptics: anticonvulsant effect antagonised

Antimalarials: avoid concomitant use with artemether/lumefantrine

Antipsychotics: avoid concomitant use of clozapine with depot preparations in case of neutropenia

Antivirals: concentration possibly increased with ritonavir Anxiolytics and hypnotics: increased sedative effects

Sibutramine: increased risk of CNS toxicity – avoid concomitant use Avoid concomitant use with drugs that prolong the QT interval

ADMINISTRATION

Reconstition

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Route

Oral, IM

Rate of Administration

–

Comments

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OTHER INFORMATION

May cause hypotension and excessive sedation Increased CNS sensitivity in renally impaired patients – start with small doses as can accumulate Peak levels occur 3–6 hours after oral administration .the liver. It can be used in renal failure at normal doses with caution.

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