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Zuclopenthixol (Clopixol, Cisordinol) - Drug Information

Zuclopenthixol is an antipsychotic medicine with a piperazine side chain that blocks postsynaptic dopaminergic brain receptors.

Dosage in Schizophrenia:
- Its acetate form is used for short-term acute treatment (initial treatment for acute psychosis or exacerbation of psychosis associated with schizophrenia)
- Decanoate injection is mainly intended for long-term management
- Tablets can be used in the initial or maintenance phase.

Zuclopenthixol Dose in Adults

Management of schizophrenia/ psychoses:

Dosage in the treatment of Acute psychosis:

Acute psychosis:

Initially, 10 to 50 mg/day is given in 2 to 3 divided doses
Then increase the dose by 10 to 20 mg every 2 to 3 days
The usual therapeutic range is 20 to 40 mg/day
The maximum dose is 100 mg/day

Maintenance therapy:

Target lowest effective dose
The usual maintenance dose is 20 to 40 mg/day. It can be given as a single dose
IM: Zuclopenthixol acetate:
Normal dose is 50 to 150 mg
It can be repeated in 2 to 3 day
The maximum dose given is no more than 400 mg or 4 injections should be given in the course of treatment.
Duration of treatment should exceed 2 weeks.

Shifting of patients from IM acetate to oral tablets:

Give a gap of 2 to 3 days after final injection before initiating oral therapy:
- 50 mg of acetate injection given every 2 to 3 days can be replaced with 20 mg daily of oral tablets
- 100 mg of acetate injection given every 2 to 3 days can be replaced with 40 mg daily of oral tablets
- 150 mg of acetate injection given every 2 to 3 days can be replaced with 60 mg daily of oral tablets

Long-term management of psychosis:

Zuclopenthixol decanoate:

Maintenance therapy:

Usual maintenance dose:
- It is given 150 to 300 mg Intramuscular given every 2 to 4 weeks
- Dose can be increased or reduced
- Frequent administration is needed in some patients.
- Maintain lowest effective dose.

Transfer of patients from oral tablets to IM decanoate:

Additional oral dosing, with subsequent tapering, might be required during the transition period.

≤20 mg daily of oral tablets can be replaced with 100 mg of decanoate injection every 2 weeks
25 to 40 mg daily of oral tablets can be replaced with 200 mg of decanoate injection every 2 weeks
50 to 75 mg daily of oral tablets can be replaced with 300 mg of decanoate injection every 2 weeks
>75 mg/day of oral tablets can be replaced with 400 mg of decanoate injection every 2 weeks

Shifting of patients from IM acetate to IM decanoate:

When starting maintenance therapy with decanoate, give initial dose concomitantly with final acetate injection:

50 mg of acetate injection every 48-72 hours can be replaced with 100 mg of decanoate injection every 2 weeks
100 mg of acetate injection every 48-72 hours can be replaced with 200 mg of decanoate injection every 2 weeks
150 mg of acetate injection every 48-72 hours can be replaced with 300 mg of decanoate injection every 2 weeks

Zuclopenthixol Dose in Children

Not recommended for use in Children.

Pregnancy Risk Factor: C

In animal reproduction studies, adverse events were observed.
Use of antipsychotics in the last trimester is associated with abnormal muscle movements (extrapyramidal signs [EPS]), and withdrawal symptoms in infants after delivery.
The symptoms of a newborn's illness include agitation, feeding disorder and hypotonia.
These effects can be self-limiting, or may require hospitalization.

Zuclopenthixol Dose in Renal Disease:

Manufacturer's labels do not contain any dosage adjustments (hasn't been studied).

Zuclopenthixol Dose in Liver Disease:

There are no dosage adjustments given in manufacturer's labeling.
Use cautiously as zuclopenthixol undergoes extensive hepatic metabolism.

Common Side Effects of Zuclopenthixol Include:

Central nervous system:
- Drowsiness
- Hypertonia
- Anxiety
- Insomnia
- Akathisia
- Extrapyramidal Reaction
- Dizziness
- Dystonia
Gastrointestinal:
- Xerostomia
Neuromuscular & Skeletal:
- Tremor
- Weakness
- Hypokinesia
Ophthalmic:
- Accommodation disturbance

Less Common Side Effects of Zuclopenthixol Include:

Cardiovascular:
- Tachycardia
- Orthostatic Hypotension
- Hypotension
- Palpitations
- Syncope
Central Nervous System:
- Agitation
- Depression
- Lack Of Concentration
- Headache
- Vertigo
- Amnesia
- Apathy
- Confusion
- Hallucination
- Tardive Dyskinesia
- Abnormal Dreams
- Abnormal Gait
- Malaise
- Pain
- Paresthesia
- Anorgasmia
Dermatologic:
- Diaphoresis
- Seborrhea
- Pruritus
- Pallor
Endocrine & Metabolic:
- Weight Gain
- Decreased Libido
- Weight Loss
- Menstrual Disease
- Increased Thirst
Gastrointestinal:
- Constipation
- Sialorrhea
- Anorexia
- Vomiting
- Nausea
- Increased Appetite
- Diarrhea
- Dyspepsia
Genitourinary:
- Urination Disorder
- Ejaculatory Disorder
Neuromuscular & skeletal:
- Myalgia
Ophthalmic:
- Visual disturbance

Contraindication to Zuclopenthixol Include:

Hypersensitivity to zuclopenthixol, Thioxanthenes, and any part of the formulation
Acute intoxication (ethanol, barbiturate or opioid)
CNS depression, coma
Subcortical brain injury suspected or confirmed
Circulatory collapse

Warnings and precautions

Modified cardiac conduction
- It could alter cardiac conduction. Life-threatening arrhythmias can be caused by therapeutic doses.
- Patients with QT prolongation should be avoided.
- Decanoate can have long-lasting adverse effects.
Anticholinergic effects
- It can cause constipation, xerostomia and blurred vision.
- Patients with reduced gastrointestinal motility, paralytic and ileus, urinary retentions, BPH, xerostomia, and visual impairments should be cautious.
- Zuclopenthixol's cholinergic blockade has been shown to be lower than other neuroleptics.
- Patients should be advised to immediately report any onset or worsening anticholinergic effects.
Blood dyscrasias
- Clinical trials and postmarketing reports involving antipsychotic use have shown leukopenia and neutropenia.
- Before initiation, take blood samples and continue to do so periodically.
Depression in the CNS:
- It can lead to CNS depression that can cause mental or physical impairments.
- Patients should be warned about driving or operating machinery that requires mental alertness.
- Aspiration/Esophageal dysmotility/Esophageal dysmotility
- Aspiration and esophageal dysmotility have been linked to antipsychotic use.
- Your risk of developing it increases as you age.
- Patients at high risk of aspiration pneumonia (ie Alzheimer disease) should be treated with caution, especially patients over 75 years.
Extrapyramidal symptoms
- It can cause extrapyramidal signs (EPS), such as pseudo-parkinsonism and acute dystonic reactions.
- Higher doses of antipsychotics and use of antipsychotics for men, younger patients, and males can increase the risk of dystonia.
- The following factors are associated with higher vulnerability to tardive dyskinesia: older age, female gender, postmenopausal status, previous brain damage, diabetes, alcoholism and Parkinson disease, pseudoparkinsonism symptoms, affective disorder (especially major depressive disorder), poor treatment response, high doses antipsychotics, and poor treatment.
- Stop treating tardive dyskinesia symptoms and signs.
Hyperglycemia
- Patients without a history of hyperglycemia have had cases of diabetic ketoacidosis.
- Before initiation, measure blood glucose and weight and check again periodically.
Hyperprolactinemia
- Increased prolactin levels are associated with the use of this drug
- Clinically significant hyperprolactinemia may require dosage adjustments or even stopping.
- Patients with breast cancer, prolactin-dependent tumors and pituitary tumors should be cautious.
- Hypogonadism and prolonged hyperprolactinemia can lead to decreased bone mineral density in males and females.
Neuroleptic malignant Syndrome (NMS):
- NMS can be caused by antipsychotic drugs, such as zuclopenthixol. Monitor for mental status changes and muscle rigidity.
- With the onset NMS, stop treating immediately
- Patients who have been treated with antipsychotic therapy for a second time have experienced recurrence.
Ocular:
- Similar drugs can be used to treat pigmentary retinopathy, corneal deposit, and photosensitivity.
Orthostatic hypotension
- It can lead to orthostatic hypotension
- Patients at high risk for this effect should be supervised.
Sexual dysfunction
- Reports of decreased libido and ejaculation failure, menstrual problems, erectile dysfunction (including rare priapism) have been made
- A dosage adjustment or complete discontinuation may be necessary for severe dysfunction.
- Discontinuation can cause effects that are irreversible.
Temperature regulation
- It is possible to have impaired core body temperature regulation
- Be aware of the dangers associated with exercise, heat, dehydration, or concomitant anticholinergic medication.
Venous thromboembolism, (VTE)
- VTE has been reported with antipsychotics. Ensure that you assess VTE risk prior to and during therapy.
Withdrawal syndrome
- When withdrawing from therapy, be careful
- Reduce slowly and be aware of withdrawal symptoms.
- An abrupt cessation of treatment can lead to (rarely) severe withdrawal symptoms, such as nausea, vomiting, and insomnia.
- Symptoms are usually felt within four days and disappear within one to two weeks.
Cardiovascular disease
- Patients with heart disease should be cautious.
Dementia
- Antipsychotics have a higher death rate than placebo for dementia-related psychosis in the elderly.
- The majority of deaths were caused by either infectious (eg pneumonia) or cardiovascular problems in nature.
- Elderly patients with dementia-related psychosis have a higher incidence of cerebrovascular adverse event (including fatalities).
- Zuclopenthixol has not been approved for elderly patients suffering from dementia or dementia-related psychosis.
Hepatic impairment
- Patients with hepatic impairment should be cautious; hepatic metabolism is affected.
Renal impairment
- Patients with impaired renal function should be cautious. This has not been tested.
Seizure disorder
Patients at high risk of seizures should be treated with caution

Zuclopenthixol (United States: Not available): Drug Interaction

Risk Factor C (Monitor therapy)
Acetylcholinesterase Inhibitors	May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors.
Acetylcholinesterase Inhibitors (Central)	May enhance the neurotoxic (central) effect of Antipsychotic Agents. Severe extrapyramidal symptoms have occurred in some patients.
Ajmaline	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Alcohol (Ethyl)	CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl).
Alizapride	May enhance the CNS depressant effect of CNS Depressants.
Amifampridine	Agents With Seizure Threshold Lowering Potential may enhance the neuroexcitatory and/or seizure-potentiating effect of Amifampridine.
Amphetamines	Antipsychotic Agents may diminish the stimulatory effect of Amphetamines.
Anticholinergic Agents	May enhance the adverse/toxic effect of other Anticholinergic Agents.
Botulinum Toxin-Containing Products	May enhance the anticholinergic effect of Anticholinergic Agents.
Brexanolone	CNS Depressants may enhance the CNS depressant effect of Brexanolone.
Brimonidine (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Cannabis	May enhance the CNS depressant effect of CNS Depressants.
Chloral Betaine	May enhance the adverse/toxic effect of Anticholinergic Agents.
Chlorphenesin Carbamate	May enhance the adverse/toxic effect of CNS Depressants.
CloBAZam	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
CNS Depressants	May enhance the adverse/toxic effect of other CNS Depressants.
CYP2D6 Inhibitors (Moderate)	May decrease the metabolism of CYP2D6 Substrates (High risk with Inhibitors).
CYP3A4 Inducers (Strong)	May decrease the serum concentration of Zuclopenthixol.
CYP3A4 Inhibitors (Moderate)	May increase the serum concentration of Zuclopenthixol.
Deutetrabenazine	May enhance the adverse/toxic effect of Antipsychotic Agents. Specifically, the risk for akathisia, parkinsonism, or neuroleptic malignant syndrome may be increased.
Dimethindene (Topical)	May enhance the CNS depressant effect of CNS Depressants.
Doxylamine	May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended.
Dronabinol	May enhance the CNS depressant effect of CNS Depressants.
Esketamine	May enhance the CNS depressant effect of CNS Depressants.
Gastrointestinal Agents (Prokinetic)	Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic).
Glucagon	Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased.
Guanethidine	Antipsychotic Agents may diminish the therapeutic effect of Guanethidine.
Haloperidol	QT-prolonging Agents (Indeterminate Risk - Avoid) may enhance the QTcprolonging effect of Haloperidol.
HydrOXYzine	May enhance the CNS depressant effect of CNS Depressants.
Imatinib	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Itopride	Anticholinergic Agents may diminish the therapeutic effect of Itopride.
Kava Kava	May enhance the adverse/toxic effect of CNS Depressants.
Lithium	May enhance the neurotoxic effect of Antipsychotic Agents. Lithium may decrease the serum concentration of Antipsychotic Agents. Specifically noted with chlorpromazine.
Lofexidine	May enhance the CNS depressant effect of CNS Depressants. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Lumefantrine	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Magnesium Sulfate	May enhance the CNS depressant effect of CNS Depressants.
Methylphenidate	Antipsychotic Agents may enhance the adverse/toxic effect of Methylphenidate. Methylphenidate may enhance the adverse/toxic effect of Antipsychotic Agents.
MetyroSINE	CNS Depressants may enhance the sedative effect of MetyroSINE.
MetyroSINE	May enhance the adverse/toxic effect of Antipsychotic Agents.
Mianserin	May enhance the anticholinergic effect of Anticholinergic Agents.
Minocycline	May enhance the CNS depressant effect of CNS Depressants.
Mirabegron	Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron.
Mirtazapine	CNS Depressants may enhance the CNS depressant effect of Mirtazapine.
Nabilone	May enhance the CNS depressant effect of CNS Depressants.
Nitroglycerin	Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption.
Panobinostat	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Peginterferon Alfa-2b	May decrease the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Peginterferon Alfa-2b may increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Perhexiline	CYP2D6 Substrates (High risk with Inhibitors) may increase the serum concentration of Perhexiline. Perhexiline may increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
QT-prolonging Agents (Highest Risk)	QT-prolonging Agents (Indeterminate Risk - Avoid) may enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
Quinagolide	Antipsychotic Agents may diminish the therapeutic effect of Quinagolide.
QuiNINE	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Ramosetron	Anticholinergic Agents may enhance the constipating effect of Ramosetron.
Rufinamide	May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced.
Selective Serotonin Reuptake Inhibitors	CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced.
Serotonin Modulators	May enhance the adverse/toxic effect of Antipsychotic Agents. Specifically, serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Exceptions: Nicergoline.
Tetrabenazine	May enhance the adverse/toxic effect of Antipsychotic Agents.
Tetrahydrocannabinol	May enhance the CNS depressant effect of CNS Depressants.
Tetrahydrocannabinol and Cannabidiol	May enhance the CNS depressant effect of CNS Depressants.
Thiazide and Thiazide-Like Diuretics	Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics.
Topiramate	Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate.
Trimeprazine	May enhance the CNS depressant effect of CNS Depressants.
Risk Factor D (Consider therapy modification)
Abiraterone Acetate	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible. When concurrent use is not avoidable, monitor patients closely for signs/symptoms of toxicity.
Anti-Parkinson Agents (Dopamine Agonist)	Antipsychotic Agents (First Generation [Typical]) may diminish the therapeutic effect of Anti-Parkinson Agents (Dopamine Agonist). Anti-Parkinson Agents (Dopamine Agonist) may diminish the therapeutic effect of Antipsychotic Agents (First Generation [Typical]). Management: Avoid concomitant therapy if possible and monitor for decreased effects of both agents when these combinations cannot be avoided. Atypical antipsychotics such as clozapine and quetiapine may be less likely to reduce the effects of antiParkinson agents.
Asunaprevir	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).
Blonanserin	CNS Depressants may enhance the CNS depressant effect of Blonanserin.
Buprenorphine	CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants.
Chlormethiazole	May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used.
CYP2D6 Inhibitors (Strong)	May decrease the metabolism of CYP2D6 Substrates (High risk with Inhibitors).
CYP3A4 Inhibitors (Strong)	May increase the serum concentration of Zuclopenthixol. Management: Consider zuclopenthixol dosage reduction with concomitant use of a strong CYP3A4 inhibitor (eg, ketoconazole) in poor CYP2D6 metabolizers or with strong CYP2D6 inhibitors (eg, paroxetine). Monitor for increased zuclopenthixol levels/toxicity.
Dacomitinib	May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Avoid concurrent use of dacomitinib with CYP2D6 subtrates that have a narrow therapeutic index.
Droperidol	May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Flunitrazepam	CNS Depressants may enhance the CNS depressant effect of Flunitrazepam.
HYDROcodone	CNS Depressants may enhance the CNS depressant effect of HYDROcodone. Management: Avoid concomitant use of hydrocodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Iohexol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iomeprol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iomeprol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Iopamidol	Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants.
Mequitazine	Antipsychotic Agents may enhance the arrhythmogenic effect of Mequitazine. Management: Consider alternatives to one of these agents when possible. While this combination is not specifically contraindicated, mequitazine labeling describes this combination as discouraged.
Methotrimeprazine	CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce adult dose of CNS depressant agents by 50% with initiation of concomitant methotrimeprazine therapy. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established.
Opioid Agonists	CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
OxyCODONE	CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Perampanel	May enhance the CNS depressant effect of CNS Depressants. Management: Patients taking perampanel with any other drug that has CNS depressant activities should avoid complex and high-risk activities, particularly those such as driving that require alertness and coordination, until they have experience using the combination.
Pramlintide	May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract.
Secretin	Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin.
Sodium Oxybate	May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to combined use. When combined use is needed, consider minimizing doses of one or more drugs. Use of sodium oxybate with alcohol or sedative hypnotics is contraindicated.
Suvorexant	CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended.
Tapentadol	May enhance the CNS depressant effect of CNS Depressants. Management: Avoid concomitant use of tapentadol and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug.
Zolpidem	CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol.
Risk Factor X (Avoid combination)
Aclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.
Amisulpride	Antipsychotic Agents may enhance the adverse/toxic effect of Amisulpride. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.
Azelastine (Nasal)	CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal).
Bromopride	May enhance the adverse/toxic effect of Antipsychotic Agents.
Bromperidol	May enhance the CNS depressant effect of CNS Depressants.
Cimetropium	Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium.
Eluxadoline	Anticholinergic Agents may enhance the constipating effect of Eluxadoline.
Glycopyrrolate (Oral Inhalation)	Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation).
Glycopyrronium (Topical)	May enhance the anticholinergic effect of Anticholinergic Agents.
Ipratropium (Oral Inhalation)	May enhance the anticholinergic effect of Anticholinergic Agents.
Levosulpiride	Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride.
Metoclopramide	May enhance the adverse/toxic effect of Antipsychotic Agents.
Orphenadrine	CNS Depressants may enhance the CNS depressant effect of Orphenadrine.
Oxatomide	May enhance the anticholinergic effect of Anticholinergic Agents.
Oxomemazine	May enhance the CNS depressant effect of CNS Depressants.
Paraldehyde	CNS Depressants may enhance the CNS depressant effect of Paraldehyde.
Piribedil	Antipsychotic Agents may diminish the therapeutic effect of Piribedil. Piribedil may diminish the therapeutic effect of Antipsychotic Agents. Management: Use of piribedil with antiemetic neuroleptics is contraindicated, and use with antipsychotic neuroleptics, except for clozapine, is not recommended.
Potassium Chloride	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride.
Potassium Citrate	Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate.
Revefenacin	Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin.
Sulpiride	Antipsychotic Agents may enhance the adverse/toxic effect of Sulpiride.
Thalidomide	CNS Depressants may enhance the CNS depressant effect of Thalidomide.
Tiotropium	Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium.
Umeclidinium	May enhance the anticholinergic effect of Anticholinergic Agents.

Monitor:

Mental health
Vital signs (as indicated by a doctor)
ECG for patients with QT prolongation, other cardiovascular disorders, or electrolyte disturbances
Weight, height, waist circumference, and BMI (baseline) at each visit for the first six months. Visits are made quarterly with stable antipsychotic medication.
CBC (as indicated by the doctor; patients with low WBC, or a history of drug-induced neutropenia/neutropenia should be monitored frequently in the first few months.
Electrolytes and liver function (yearly and as indicated by a physician)
Fasting plasma glucose level/ HbA
lipid panel (baseline, repeat every 2 years if LDL levels are normal; repeat every 6 month if LDL levels exceed 130 mg/dL).
Changes in menstruation, libido and development of galactorrhea (at each visit during the first 12 weeks following the antipsychotic's administration or until the dose becomes stable, then annually)
Parkinsonian signs or abnormal involuntary movements (baseline; continue weekly until dose stabilization for at least two weeks after introduction, and for at most 2 weeks following any significant dose increases).
Tightening of the teeth (every 6 to 12 months; high-risk patients, every 3 months).
Visual changes (inquire annually)
Ocular examinations (yearly for patients over 40 years old; every 2 years for younger patients).

How to administer Zuclopenthixol?

Intramuscular: Acetate or decanoate:

Apply the medication by injecting deeply into the gluteal area.
Two injection sites should be used for injection volumes exceeding 2 milliliters.
You can mix the decanoate and acetate formulations together in one syringe to administer the injections as a single dose.

Oral:

Tablets should be taken in divided doses of 2 to 3 tablets after initial dosing
It could switch to once-daily administration at night during maintenance treatment. It can be administered at night without regard for meals.

Mechanism of action of Zuclopenthixol:

Zuclopenthixol, a thioxanthene antipsychotic that also includes a piperazine side-chain, is called Zuclopenthixol.
It is closely related to fluphenazine. The cis(z]-clopenthixol active isomer is this neuroleptic.
It blocks brain receptors for postsynaptic dopaminergic D-1 and D-2 (D-1 & D-2).
It has a strong affinity for alpha-1 and 5-HT adrenergic receptors and a weaker affinity to histamine -receptors.

The start of actionAcetate injection: Sedation in 2 Hours

TimeAcetate injections: 2 - 3 Days

Distribution: V: 20 L/kg

Protein bindingAlmost 98%

Metabolism: Mainly Hepatic via N-dealkylation and sulfoxidation It is also subject to glucuronidation. The metabolites are inactive.

Eliminating half-lifeTerminal: Oral: Almost 20 Hours; Depot: 19 Days

Time to reach peak: Tablet: 4 hours; Acetate injection: 24 to 48 hours; Decanoate inject: 3-7 Days

Excretion: Mainly feces and urine (10%, minimal amount as unmodified drug).

International Brands of Zuclopenthixol:

Ciatyl-Z
Ciatyl-Z Acuphase
Ciatyl-Z Depot
Cisordinol
Cisordinol Acutard
Cisordinol Depot
Cisordinol-Acutard
Cisordinol-Acutard[inj.]
Clopixol
Clopixol Acuphase
Clopixol Acutard
Clopixol Depot
Klopiksol

Zuclopenthixol brands in Pakistan:

Zuclopenthixol [Inj 25 Mg/Ml]
Clopenia	Ipram International

Zuclopenthixol [Inj 50 Mg/Ml]
Clopenia	Ipram International
Clopixol	Lundbeck Pakistan (Pvt) Ltd.
Clopixol	Lundbeck Pakistan (Pvt) Ltd.
Xopixol	Genetics Pharmaceuticals
Xopixol Acuphase	Reko Pharmacal (Pvt) Ltd.

Zuclopenthixol [Inj 100 Mg/Ml]
Zucloact	Nabiqasim Industries (Pvt) Ltd.

Zuclopenthixol [Inj 200 Mg/Ml]
Xopixol La	Genetics Pharmaceuticals
Zuclodept	Nabiqasim Industries (Pvt) Ltd.

Zuclopenthixol [Inj Sr 200 Mg/Ml]
Clopixol	Lundbeck Pakistan (Pvt) Ltd.

Zuclopenthixol [Tabs 2 Mg]
Clopixol	Lundbeck Pakistan (Pvt) Ltd.
Zulpram	Ameer Pharma

Zuclopenthixol [Tabs 10 Mg]
Clopixol	Lundbeck Pakistan (Pvt) Ltd.
Zulpram	Ameer Pharma

Zuclopenthixol [Tabs 25 Mg]
Clopixol	Lundbeck Pakistan (Pvt) Ltd.
Zulpram	Ameer Pharma

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