Flupentixol decanoate

FGA Depot·Psychiatry - Depot Antipsychotics

Maintenance treatment of Schizophrenia, especially in patients with prominent negative symptoms (apathy, withdrawal)

Authority requiredPBSDEPOT Q2-4WFluanxol DepotS4+1

Max Dose

40 mg/week

Half-life

17 Days

Activation

HIGH

EPS Risk

CRITICAL

Rapid Summary

Overview

First-Generation Antipsychotic (FGA) depot. Extremely potent D2 antagonist. Uniquely activating and alerting, making it excellent for withdrawn, apathetic patients, but terrible for agitated ones.

Maximum Dose

Max 40 mg/week (Usually dosed 20-40 mg every 2-4 weeks).

Clinical Focus

High risk of severe EPS. Often exacerbates anxiety or agitation if given to the wrong patient type.

Bottom Line

Flupentixol decanoate is a depot thioxanthene antipsychotic for maintenance treatment of schizophrenia, but causes extrapyramidal effects and depression can emerge, and effects persist for weeks after injection.

Formulation & Access

Brand Names

Fluanxol Depot

Parenteral

Ampoules (20 mg/1 mL). Thin oil suspension.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Maintenance treatment of Schizophrenia, especially in patients with prominent negative symptoms (apathy, withdrawal).

Clinical Place

The direct opposite of Zuclopenthixol (Clopixol). Clopixol puts you to sleep; Fluanxol wakes you up.

Quick reference

Class & Role

FGA Depot — First-Generation Antipsychotic (FGA) depot.

Route / Formulation

Ampoules (20 mg/1 mL). Thin oil suspension. (Fluanxol Depot)

Usual Dose & Max

IM 20-40 mg every 2 to 4 weeks. Deep gluteal injection (Z-Track method). Max 40 mg/week (Usually dosed 20-40 mg every 2-4 weeks).

Key Indication Doses

Schizophrenia Maintenance: IM 20-40 mg every 2 to 4 weeks. Deep gluteal injection (Z-Track method). Elderly / Frail: Start with 10-20 mg every 4 weeks. Highly sensitive to EPS.

Best Uses

Avoid / Cautions

Severely agitated or hyperactive patients, Parkinson's disease, severe CNS depression. Pregnancy Category C.

Key Risks

Neurological: Severe Extrapyramidal Side Effects (Parkinsonism, acute dystonia, severe akathisia). HIGH — Insomnia, agitation, over-stimulation. Cardiovascular: QTc prolongation, mild tachycardia. Endocrine: Hyperprolactinemia.

Key Interactions

Avoid concurrent QTc prolonging drugs. CYP2D6 inhibitors (Paroxetine) spike Flupentixol levels.

Monitoring

Monitor for akathisia (pacing/restlessness). If the patient complains of severe anxiety post-injection, it is likely akathisia. Treat with Propranolol. Baseline ECG (QTc check).

Clinical Pearl

Flupentixol and Zuclopenthixol are sister drugs. Remember: Flupentixol = Fly (Activating/Energy). Zuclopenthixol = Zzz (Sleeping/Sedating). Choose the depot based on whether the patient is withdrawn or aggressive.

Access

Authority requiredFluanxol Depot

Brand: Fluanxol Depot
PBS status: Authority required