Adult: As flupentixol decanoate: In patients who have not received prior depot antipsychotics: Administer an initial test dose of 20 mg via deep IM inj, may be followed by 20-40 mg after 4-10 days, according to response. Subsequent doses are individualised and titrated at Max increments of ≤20 mg, according to patient’s response and tolerability. Other patients may be adequately maintained on 20-40 mg every 2-4 weeks. Usual dose: Between 50 mg every 4 weeks and 300 mg every 2 weeks up to Max 400 mg weekly. Dosage recommendations may vary among countries and individual products (refer to specific product guidelines). Elderly: As flupentixol decanoate: Initial dose may require reduction to 1/4 or 1/2 of the usual starting dose.
Oral Depression
Adult: For cases with or without anxiety: As flupentixol dihydrochloride: Initially, 1 mg daily as a single dose in the morning. May be increased to 2 mg daily after 1 week according to response, up to Max 3 mg daily in divided doses. Discontinue treatment if no response after 1 week at Max dose. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines). Elderly: For cases with or without anxiety: As flupentixol dihydrochloride: Initially, 0.5 mg daily as a single dose in the morning. May increase dose to 1 mg daily after 1 week according to response, up to Max 1.5 mg daily in divided doses. Discontinue treatment if no response after 1 week at Max dose. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Oral Psychoses, Schizophrenia
Adult: As flupentixol dihydrochloride: Initially, 3-9 mg bid, adjusted according to response. Max: 18 mg daily. Dosage and treatment recommendations may vary between countries (refer to specific product guidelines). Elderly: As flupentixol dihydrochloride: Initial dose may require reduction to 1/4 or 1/2 of the usual starting dose. Dose must be adjusted according to individual response. Dosage and treatment recommendations may vary between countries (refer to specific product guidelines).
What are the brands available for Flupentixol in Malaysia?
Suspected or established subcortical brain damage, depressed level of consciousness due to any cause (e.g. alcohol intoxication, barbiturates, opiates), severe depression requiring electroconvulsive therapy or hospitalisation, states of excitement or overactivity including mania, cerebrovascular or renal insufficiency, severe CV disease or circulatory collapse, liver damage, comatose states.
Special Precautions
Patient with decreased gastrointestinal motility, paralytic ileus, urinary retention, benign prostatic hyperplasia, xerostomia, visual problems (e.g. narrow angle glaucoma), myasthenia gravis, Parkinson's disease, phaeochromocytoma, hypothyroidism, hyperthyroidism, history of or at risk for cerebrovascular accident; at risk for seizures (including those with a history of seizures, brain damage, head trauma, alcoholism, or concurrent treatment with medications which may reduce seizure threshold). Patients undergoing surgery. Avoid use in patients with underlying QT prolongation, those taking QT-prolonging medications, or drugs that may cause polymorphic ventricular tachycardia. Avoid abrupt withdrawal in patients receiving maintenance treatment. Not approved for use in elderly with dementia or dementia-related psychosis. Not recommended for use in excitable, overactive, or manic patients. Renal and hepatic impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Altered cardiac conduction, anticholinergic effects (e.g. constipation, xerostomia, blurred vision, urinary retention), bloody dyscrasias (e.g. agranulocytosis, neutropenia, leucopenia, granulocytopenia), extrapyramidal symptoms (e.g. pseudoparkinsonism, acute dystonic reactions, akathisia, tardive dyskinesia), VTE, NMS, diabetic ketoacidosis, esophageal dysmotility, aspiration, orthostatic hypotension, falls, impaired core body temperature regulation, increased prolactin levels, withdrawal symptoms (following abrupt discontinuation). Rarely, lens opacity. Cardiac disorders: Tachycardia, palpitations. Eye disorders: Abnormal vision, accommodation disorder. Gastrointestinal disorders: Vomiting, salivary hypersecretion, diarrhoea, dyspepsia. General disorders and administration site conditions: Asthenia, fatigue. Investigations: Increased weight. Metabolism and nutrition disorders: Increased appetite. Musculoskeletal and connective tissue disorders: Myalgia. Nervous system disorders: Headache, dizziness, somnolence, disturbance in attention, tremor, dystonia, hyperkinesia, hypokinesia. Psychiatric disorders: Agitation, insomnia, depression, nervousness. Renal and urinary disorders: Micturition disorder. Reproductive system and breast disorders: Decreased libido. Respiratory, thoracic and mediastinal disorders: Dyspnoea. Skin and subcutaneous tissue disorders: Pruritus, hyperhidrosis. Potentially Fatal: Arrhythmias, suicidal thoughts or attempts, cerebrovascular events (in elderly patients with dementia-related psychosis).
Patient Counseling Information
This drug may cause sedation or blurred vision if affected, do not drive or operate machinery.
Monitoring Parameters
Correct electrolyte abnormalities prior to initiation of treatment. Monitor ECG; CBC, vital signs (e.g. blood pressure, temperature, pulse), electrolytes, renal function, LFTs, TSH, fall risk (as clinically indicated); lipid panel, fasting plasma glucose level/HbA1c (4 months after initiation and annually thereafter). Assess for signs and symptoms of tardive dyskinesia; extrapyramidal symptoms. Perform ocular examination (as clinically indicated). Monitor weight, height, and BMI every visit for the 1st 6 months, then quarterly thereafter; mental status and alertness; hyperprolactinaemia symptoms (e.g. changes in menstruation, libido, erectile dysfunction). Evaluate for personal and family history of metabolic syndrome (e.g. diabetes, dyslipidaemia, CV disease, obesity, hypertension).
Overdosage
Symptoms: Somnolence, coma, extrapyramidal symptoms, convulsions, hypotension, shock, hyper- or hypothermia, ECG changes, QT prolongation, torsade de pointes, cardiac arrest, ventricular arrhythmias. Management: Symptomatic and supportive treatment. May consider administration of activated charcoal or perform gastric lavage after oral ingestion. May give anticholinergic antiparkinson drugs for extrapyramidal symptoms; benzodiazepines for agitation, convulsions, or excitement; norepinephrine in IV saline drip for shock.
Drug Interactions
May potentiate the effects of other CNS depressants, general anaesthetics, and anticoagulants. May prolong the action of neuromuscular blocking agents. May increase the anticholinergic effects of atropine and other drugs with anticholinergic properties. Increased risk of extrapyramidal effects (e.g. tardive dyskinesia) with metoclopramide, piperazine, or antiparkinsonian drugs. Increased risk of neurotoxicity with lithium or sibutramine. May enhance the cardiac depressant effects of quinidine. May increase the absorption of corticosteroids and digoxin. May enhance the hypotensive effect of vasodilator antihypertensive including α-blockers (e.g. doxazosin) or methyldopa. Increases in QT interval may be exacerbated when co-administered with other drugs known to significantly increase QT interval including class Ia and III antiarrhythmics (e.g. amiodarone, dofetilide, quinidine, sotalol), certain antipsychotics (e.g. thioridazine), certain macrolides (e.g. erythromycin), certain quinolone antibiotics (e.g. moxifloxacin), certain antihistamines, cisapride, lithium, drugs known to cause electrolyte disturbances (e.g. thiazide diuretics), and drugs known to increase the serum concentration of flupentixol. May antagonise the effects of epinephrine and other sympathomimetic agents. May reverse the antihypertensive effects of guanethidine, possibly clonidine, and other similar adrenergic-blocking agents. May impair the effect of levodopa, adrenergic agents, and anticonvulsants. May inhibit the metabolism of TCAs.
Food Interaction
May enhance the effect of alcohol.
Action
Description: Mechanism of Action: Flupentixol is a non-sedating, thioxanthene-derivative antipsychotic. It inhibits the postsynaptic dopamine receptors in the central nervous system (CNS), leading to the inhibition of dopamine-mediated effects. Synonym(s): Flupenthixol. Onset: Oral: Within 1-2 weeks (schizophrenia). IM depot: 24-72 hours. Duration: IM depot: 2-4 weeks. Pharmacokinetics: Absorption: Readily absorbed from the gastrointestinal tract. Bioavailability: Approx 40% (oral). Time to peak plasma concentration: 3-8 hours (oral); 4-7 days (IM depot). Distribution: Widely distributed in the body. Crosses the blood-brain barrier and enters breast milk (low concentrations). Volume of distribution: Approx 14.1 L/kg. Plasma protein binding: Approx 99%. Metabolism: Extensively metabolised in the liver via sulfoxidation, side chain N-dealkylation, and glucuronic acid conjugation into inactive metabolites. Excretion: Mainly via faeces (as metabolites); urine (small amounts). Elimination half-life: Approx 35 hours (oral); 3 weeks (IM depot).
Chemical Structure
Flupentixol Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5281881, Flupentixol. https://pubchem.ncbi.nlm.nih.gov/compound/cis-Flupentixol. Accessed July 28, 2025.
Storage
Store between 15-30°C. Protect the inj from light.
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