l DRUG ACTION Loxapine is a dopamine D2 and serotonin 5-
HT2A receptor antagonist. It also binds to noradrenergic,
histaminergic, and cholinergic receptors.
Rapid control of mild-to-moderate agitation in patients
with schizophrenia or bipolar disorder (specialist
▶ Adult: 9.1 mg as a single dose, followed by 9.1 mg after
2 hours if required, alternatively 4.5 mg as a single
dose, followed by 4.5 mg after 2 hours if required, lower
dose may be given if more appropriate or if the higher
of hypotension . elderly patients (especially those with
dementia-related psychosis). hypovolaemia—risk of
l CAUTIONS Bronchodilator treatment should be available
for treatment of possible severe respiratory side-effects
(bronchospasm). history of extrapyramidal symptoms . risk factors for hypoventilation
l INTERACTIONS → Appendix 1: loxapine
▶ Common or very common Fatigue .taste altered .throat
▶ Uncommon Bronchospasm . oculogyration .restlessness
▶ Frequency not known Dry eye . hypertension . syncope . vision blurred
l PREGNANCY Manufacturer advises use only if potential
l BREAST FEEDING Manufacturer advises to avoid for
48 hours after dose (express and discard milk produced
during this time)—present in milk in animal studies.
l MONITORING REQUIREMENTS Manufacturer advises to
observe patient during the first hour after each dose for
signs and symptoms of bronchospasm.
l DIRECTIONS FOR ADMINISTRATION Manufacturer advises
remove pull-tab and wait for green light to turn on
(product must be used within 15 minutes of pulling tab);
instruct patient to inhale through mouthpiece and then
hold breath briefly. When green light turns off, this
indicates the dose has been delivered.
l PRESCRIBING AND DISPENSING INFORMATION Educational
risk minimisation materials are available for health care
Adasuve ® 4.5 mg inhalation powder may be difficult to
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Loxapine 9.1 mg Adasuve 9.1mg/dose inhalation powder | 1 dose P £58.30 (Hospital only)
▶ Adult: Initially 75 mg daily in divided doses, then
increased in steps of 25 mg every week, adjusted
according to response; maximum 300 mg per day
▶ Elderly: Initially 15–30 mg daily in divided doses, then
increased in steps of 25 mg every week, adjusted
according to response; maximum 300 mg per day
Short-term adjunctive management of severe anxiety,
psychomotor agitation, and violent or dangerously
▶ Adult: Initially 15–30 mg daily in 2 divided doses,
adjusted according to response, larger dose to be taken
▶ Elderly: Initially 5–10 mg daily in 2 divided doses,
adjusted according to response, larger dose to be taken
l CONTRA-INDICATIONS CNS depression . comatose states . phaeochromocytoma
l INTERACTIONS → Appendix 1: phenothiazines
l HEPATIC IMPAIRMENT Can precipitate coma;
phenothiazines are hepatotoxic.
l RENAL IMPAIRMENT Avoid in renal impairment.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
CAUTIONARY AND ADVISORY LABELS 2
▶ Pericyazine (Non-proprietary)
Pericyazine 2 mg per 1 ml Pericyazine 10mg/5ml oral solution | 100 ml P £82.80 DT = £82.80
CAUTIONARY AND ADVISORY LABELS 2
▶ Pericyazine (Non-proprietary)
Pericyazine 2.5 mg Pericyazine 2.5mg tablets | 84 tablet P £27.90 DT = £27.90
Pericyazine 10 mg Pericyazine 10mg tablets | 84 tablet P £72.00 DT = £72.00
▶ Adult: Initially 2 mg daily, adjusted according to
response, then increased in steps of 2–4 mg at intervals
of not less than 1 week; usual dose 2–20 mg daily
▶ Elderly: Initially 1 mg daily, adjusted according to
response, increased in steps of 2–4 mg at intervals of
not less than 1 week; usual dose 2–20 mg daily
388 Mental health disorders BNF 78
Monosymptomatic hypochondriacal psychosis | Paranoid
▶ Adult: Initially 4 mg daily, adjusted according to
response, then increased in steps of 2–4 mg at intervals
of not less than 1 week; maximum 16 mg per day
▶ Elderly: Initially 2 mg daily, adjusted according to
response, increased in steps of 2–4 mg at intervals of
not less than 1 week; maximum 16 mg per day
congenital QT prolongation . phaeochromocytoma
l INTERACTIONS → Appendix 1: pimozide
overactivity . urinary disorders . vision blurred
▶ Uncommon Dysarthria .face oedema . oculogyric crisis . skin reactions
l HEPATIC IMPAIRMENT Manufacturer advises caution.
Dose adjustments Start with small doses in severe renal
impairment because of increased cerebral sensitivity.
▶ ECG monitoring Following reports of sudden unexplained
death, an ECG is recommended before treatment. It is also
recommended that patients taking pimozide should have
an annual ECG (if the QT interval is prolonged, treatment
should be reviewed and either withdrawn or dose reduced
under close supervision) and that pimozide should not be
given with other antipsychotic drugs (including depot
preparations), tricyclic antidepressants or other drugs
which prolong the QT interval, such as certain
antimalarials, antiarrhythmic drugs and certain
antihistamines and should not be given with drugs which
cause electrolyte disturbances (especially diuretics).
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension
CAUTIONARY AND ADVISORY LABELS 2
▶ Orap (Eumedica Pharmaceuticals)
Pimozide 4 mg Orap 4mg tablets | 100 tablet P £40.31 DT =
Schizophrenia and other psychoses | Mania
▶ Adult: 12.5 mg twice daily for 7 days, dose to be
adjusted at intervals of 4–7 days according to response;
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Adult: 12.5–25 mg 2–3 times a day
Short-term adjunctive management of severe anxiety
▶ Adult: 15–20 mg daily in divided doses; maximum
Nausea and vomiting, acute attack
▶ Adult: Initially 20 mg, then 10 mg after 2 hours
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Adult: 12.5 mg as required, to be followed if necessary
Nausea and vomiting, prevention
▶ Adult: 5–10 mg 2–3 times a day
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Adult: 12.5 mg as required, to be followed if necessary
Prevention and treatment of nausea and vomiting
▶ Child 1–11 years (body-weight 10 kg and above):
250 micrograms/kg 2–3 times a day
▶ Child 12–17 years: 5–10 mg up to 3 times a day if
▶ Child 2–4 years: 1.25–2.5 mg up to 3 times a day if
▶ Child 5–11 years: 5–6.25 mg up to 3 times a day if
▶ Child 12–17 years: 12.5 mg up to 3 times a day if required
▶ Adult: 5 mg 3 times a day, increased if necessary to
30 mg daily in divided doses, dose to be increased
gradually, then reduced to 5–10 mg daily, dose is
Nausea and vomiting in previously diagnosed migraine
▶ BY MOUTH USING BUCCAL TABLET
▶ Child 12–17 years: 3–6 mg twice daily, tablets to be
placed high between upper lip and gum and left to
▶ Adult: 3–6 mg twice daily, tablets to be placed high
between upper lip and gum and left to dissolve
DOSE EQUIVALENCE AND CONVERSION
▶ Doses are expressed as prochlorperazine maleate or
mesilate; 1 mg prochlorperazine maleate : 1 mg
▶ With intramuscular use in children Injection not licensed for
▶ With buccal use in children Buccastem M ® tablets not
GENERAL CAUTIONS Elderly . hypotension (more likely
after intramuscular injection)
▶ With systemic use Hypothyroidism (in adults)
l INTERACTIONS → Appendix 1: phenothiazines
▶ Rare or very rare Glucose tolerance impaired . hyperglycaemia . hyponatraemia . SIADH
▶ Frequency not known Photosensitivity reaction . skin
▶ With buccal use Blood disorder. hepatic disorders
▶ With buccal use Oral disorders
congestion .respiratory depression
▶ With oral use Atrioventricular block . autonomic
dysfunction . cardiac arrest. consciousness impaired .
BNF 78 Psychoses and schizophrenia 389
SIDE-EFFECTS, FURTHER INFORMATION Acute dytonias are
more common with potent first-generation antipsychotics.
The risk is increased in men, young adults, children,
antipsychotic-naïve patients, rapid dose escalation, and
abrupt treatment discontinuation.
l HEPATIC IMPAIRMENT Manufacturer advises avoid.
Dose adjustments Start with small doses in severe renal
impairment because of increased cerebral sensitivity.
l DIRECTIONS FOR ADMINISTRATION
▶ With buccal use Buccal tablets are placed high between
upper lip and gum and left to dissolve.
▶ With buccal use Patients or carers should be given advice on
how to administer prochlorperazine buccal tablets.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 2
▶ Prochlorperazine (Non-proprietary)
Prochlorperazine maleate 5 mg Stemetil 5mg tablets |
28 tablet P £1.98 DT = £0.73 | 84 tablet P £5.94
Prochlorperazine mesilate 12.5 mg per 1 ml Stemetil 12.5mg/1ml
solution for injection ampoules | 10 ampoule P £5.23 DT = £5.23
CAUTIONARY AND ADVISORY LABELS 2
▶ Prochlorperazine (Non-proprietary)
Prochlorperazine maleate 3 mg Prochlorperazine 3mg buccal
tablets | 50 tablet P £50.27 DT = £37.23
▶ Buccastem (Alliance Pharmaceuticals Ltd)
Prochlorperazine maleate 3 mg Buccastem M 3mg tablets |
CAUTIONARY AND ADVISORY LABELS 2
Prochlorperazine mesilate 1 mg per 1 ml Stemetil 5mg/5ml syrup
Schizophrenia with predominantly negative symptoms
▶ Adult: 200–400 mg twice daily; maximum 800 mg per
▶ Elderly: Lower initial dose to be given, increased
gradually according to response
Schizophrenia with mainly positive symptoms
▶ Adult: 200–400 mg twice daily; maximum 2.4 g per day
▶ Elderly: Lower initial dose to be given, increased
gradually according to response
l CONTRA-INDICATIONS CNS depression . comatose states . phaeochromocytoma
l CAUTIONS Aggressive patients (even low doses may
aggravate symptoms). agitated patients (even low doses
may aggravate symptoms). excited patients (even low
l INTERACTIONS → Appendix 1: sulpiride
▶ Common or very common Breast abnormalities
▶ Uncommon Hypersalivation . muscle tone increased . orgasm abnormal
▶ Rare or very rare Oculogyric crisis
Dose adjustments Start with small doses in severe renal
impairment because of increased cerebral sensitivity.
l MONITORING REQUIREMENTS Sulpiride does not affect
blood pressure to the same extent as other antipsychotic
drugs and so blood pressure monitoring is not mandatory
l PRESCRIBING AND DISPENSING INFORMATION Flavours of
oral liquid formulations may include lemon and aniseed.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
CAUTIONARY AND ADVISORY LABELS 2
Sulpiride 40 mg per 1 ml Sulpiride 200mg/5ml oral solution sugar
free sugar-free | 150 ml P £31.00 DT = £31.00
CAUTIONARY AND ADVISORY LABELS 2
Sulpiride 200 mg Sulpiride 200mg tablets | 30 tablet P £8.70
Sulpiride 400 mg Sulpiride 400mg tablets | 30 tablet P £23.50
Sulpiride 200 mg Dolmatil 200mg tablets | 100 tablet P £6.00
Sulpiride 400 mg Dolmatil 400mg tablets | 100 tablet P £19.00
Schizophrenia and other psychoses | Short-term
adjunctive management of psychomotor agitation,
excitement, and violent or dangerously impulsive
▶ Adult: Initially 5 mg twice daily, daily dose may be
increased by 5 mg after 1 week. If necessary, dose may
be further increased in steps of 5 mg at intervals of
3 days. When satisfactory control has been achieved,
reduce gradually until an effective maintenance level
▶ Elderly: Initially up to 2.5 mg twice daily, daily dose
may be increased by 5 mg after 1 week. If necessary,
dose may be further increased in steps of 5 mg at
intervals of 3 days. When satisfactory control has been
achieved, reduce gradually until an effective
maintenance level has been established
Short-term adjunctive management of severe anxiety
▶ Adult: 2–4 mg daily in divided doses, increased if
▶ Elderly: Up to 2 mg daily in divided doses, increased if
▶ Adult: 2–4 mg daily in divided doses; maximum 6 mg
l CONTRA-INDICATIONS CNS depression . comatose states . phaeochromocytoma
l INTERACTIONS → Appendix 1: phenothiazines
l SIDE-EFFECTS Alertness decreased . anxiety . appetite
related). skin reactions .thrombocytopenia . urinary
hesitation . vision blurred . withdrawal syndrome
SIDE-EFFECTS, FURTHER INFORMATION Extrapyramidal
symptoms are more frequent at doses exceeding 6mg daily.
Acute dystonias are more common with potent first
generation antipsychotics. The risk is increased in men,
young adults, children, antipsychotic-naïve patients, rapid
dose escalation, and abrupt treatment discontinuation.
l HEPATIC IMPAIRMENT Manufacturer advises avoid.
Dose adjustments Start with small doses in severe renal
impairment because of increased cerebral sensitivity.
l MONITORING REQUIREMENTS Trifluoperazine does not
affect blood pressure to the same extent as other
antipsychotic drugs and so blood pressure monitoring is
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 2
▶ Trifluoperazine (Non-proprietary)
Trifluoperazine (as Trifluoperazine hydrochloride)
200 microgram per 1 ml Trifluoperazine 1mg/5ml oral solution
sugar free sugar-free | 200 ml P £112.25 DT = £112.25
Trifluoperazine (as Trifluoperazine hydrochloride) 1 mg per
1 ml Trifluoperazine 5mg/5ml oral solution sugar free sugar-free |
150 ml P £25.50–£27.00 DT = £27.00
CAUTIONARY AND ADVISORY LABELS 2
▶ Trifluoperazine (Non-proprietary)
Trifluoperazine (as Trifluoperazine hydrochloride)
1 mg Trifluoperazine 1mg tablets | 112 tablet P £59.12–£99.80
Trifluoperazine (as Trifluoperazine hydrochloride)
5 mg Trifluoperazine 5mg tablets | 112 tablet P £134.89–
Schizophrenia and other psychoses
▶ Adult: Initially 20–30 mg daily in divided doses,
increased if necessary up to 150 mg daily; usual
maintenance 20–50 mg daily (max. per dose 40 mg), for
debilitated patients, use elderly dose
▶ Elderly: Initially 5–15 mg daily in divided doses,
increased if necessary up to 150 mg daily; usual
maintenance 20–50 mg daily (max. per dose 40 mg)
l CAUTIONS Hyperthyroidism . hypothyroidism
l INTERACTIONS → Appendix 1: zuclopenthixol
l HEPATIC IMPAIRMENT Can precipitate coma.
Monitoring Consider serum-level monitoring in patients
Dose adjustments Halve dose in renal failure; smaller
starting doses used in severe renal impairment because of
increased cerebral sensitivity.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 2
Zuclopenthixol (as Zuclopenthixol dihydrochloride) 2 mg Clopixol
2mg tablets | 100 tablet P £3.14 DT = £3.14
Zuclopenthixol (as Zuclopenthixol dihydrochloride)
10 mg Clopixol 10mg tablets | 100 tablet P £8.06 DT = £8.06
Zuclopenthixol (as Zuclopenthixol dihydrochloride)
25 mg Clopixol 25mg tablets | 100 tablet P £16.13 DT = £16.13
Short-term management of acute psychosis | Short-term
management of mania | Short-term management of
exacerbation of chronic psychosis
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Adult: 50–150 mg, then 50–150 mg after 2–3 days if
required, (1 additional dose may be needed 1–2 days
after the first injection); maximum cumulative dose
400 mg in 2 weeks and maximum 4 injections;
maximum duration of treatment 2 weeks—if
maintenance treatment necessary change to an oral
antipsychotic 2–3 days after last injection, or to a
longer acting antipsychotic depot injection given
concomitantly with last injection of zuclopenthixol
acetate; to be administered into the gluteal muscle or
▶ Elderly: 50–100 mg, then 50–100 mg after 2–3 days if
required, (1 additional dose may be needed 1–2 days
after the first injection); maximum cumulative dose
400 mg in 2 weeks and maximum 4 injections;
maximum duration of treatment 2 weeks—if
maintenance treatment necessary change to an oral
antipsychotic 2–3 days after last injection, or to a
longer acting antipsychotic depot injection given
concomitantly with last injection of zuclopenthixol
acetate; to be administered into the gluteal muscle or
When prescribing, dispensing, or administering, check
that this is the correct preparation—this preparation is
usually used in hospital for an acute episode and should
not be confused with depot preparations which are
usually used in the community or clinics for maintenance
Zuclopenthixol acetate has been confused with
zuclopenthixol decanoate; care must be taken to ensure
the correct drug is prescribed and dispensed.
l CONTRA-INDICATIONS CNS depression . comatose states . phaeochromocytoma
l CAUTIONS Hyperthyroidism . hypothyroidism
l INTERACTIONS → Appendix 1: zuclopenthixol
BNF 78 Psychoses and schizophrenia 391
l HEPATIC IMPAIRMENT Can precipitate coma.
Dose adjustments Start with small doses in severe renal
impairment because of increased cerebral sensitivity.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Clopixol Acuphase (Lundbeck Ltd)
Zuclopenthixol acetate 50 mg per 1 ml Clopixol Acuphase
50mg/1ml solution for injection ampoules | 5 ampoule P £24.21
ANTIPSYCHOTICS › FIRST-GENERATION
Maintenance in schizophrenia and other psychoses
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Adult: Test dose 20 mg, dose to be injected into the
upper outer buttock or lateral thigh, then 20–40 mg
after at least 7 days, then 20–40 mg every 2–4 weeks,
adjusted according to response, usual maintenance
dose 50 mg every 4 weeks to 300 mg every 2 weeks;
▶ Elderly: Dose is initially quarter to half adult dose
l CAUTIONS An alternative antipsychotic may be necessary
from oral to depot therapy, the dose by mouth should be
l INTERACTIONS → Appendix 1: flupentixol
▶ Rare or very rare Glucose tolerance impaired . hyperglycaemia . jaundice .thrombocytopenia
▶ Frequency not known Suicidal tendencies
SIDE-EFFECTS, FURTHER INFORMATION Side-effects may
persist until the drug has been cleared from its depot site.
l HEPATIC IMPAIRMENT Manufacturer advises caution—
monitor serum drug concentration.
Dose adjustments Manufacturer advises initiate at low
dose orally to check for tolerability before switching to
Dose adjustments Start with small doses in severe renal
impairment because of increased cerebral sensitivity.
l MONITORING REQUIREMENTS Treatment requires careful
monitoring for optimum effect.
l DIRECTIONS FOR ADMINISTRATION In general not more
than 2–3mL of oily injection should be administered at
any one site. Correct injection technique (including use of
z-track technique) and rotation of injection sites are
essential. When initiating therapy with sustained-release
preparations of conventional antipsychotics, patients
should first be given a small test-dose as undesirable sideeffects are prolonged.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Flupentixol decanoate 20 mg per 1 ml Depixol 40mg/2ml solution
for injection ampoules | 10 ampoule P £25.39 DT = £25.39
Depixol 20mg/1ml solution for injection ampoules |
10 ampoule P £15.17 DT = £15.17
Flupentixol decanoate 100 mg per 1 ml Depixol Conc 100mg/1ml
solution for injection ampoules | 10 ampoule P £62.51 DT =
Flupentixol decanoate 200 mg per 1 ml Depixol Low Volume
200mg/1ml solution for injection ampoules | 5 ampoule P £97.59
Flupentixol decanoate 20 mg per 1 ml Psytixol 40mg/2ml solution
for injection ampoules | 10 ampoule P £25.38 DT = £25.39
Psytixol 20mg/1ml solution for injection ampoules | 10 ampoule P £15.16 DT = £15.17
Flupentixol decanoate 100 mg per 1 ml Psytixol 50mg/0.5ml
solution for injection ampoules | 10 ampoule P £34.12 DT =
Psytixol 100mg/1ml solution for injection ampoules | 10 ampoule P £62.50 DT = £62.51
Flupentixol decanoate 200 mg per 1 ml Psytixol 200mg/1ml
solution for injection ampoules | 5 ampoule P £97.58 DT = £97.59
Fluphenazine decanoate 23-Jul-2018
Maintenance in schizophrenia and other psychoses
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Adult: Test dose 12.5 mg, dose to be administered into
the gluteal muscle, then 12.5–100 mg after 4–7 days,
then 12.5–100 mg every 14–35 days, adjusted
▶ Elderly: Test dose 6.25 mg, dose to be administered
into the gluteal muscle, then 12.5–100 mg after
4–7 days, then 12.5–100 mg every 14–35 days,
adjusted according to response
mouth should be reduced gradually
l INTERACTIONS → Appendix 1: phenothiazines
SIDE-EFFECTS, FURTHER INFORMATION Side-effects may
persist until the drug has been cleared from its depot site
392 Mental health disorders BNF 78
l HEPATIC IMPAIRMENT Manufacturer advises caution; avoid
l RENAL IMPAIRMENT Manufacturer advises caution. Avoid
Dose adjustments Start with small doses of antipsychotic
drugs in severe renal impairment because of increased
l MONITORING REQUIREMENTS Treatment requires careful
monitoring for optimum effect.
l DIRECTIONS FOR ADMINISTRATION In general not more
than 2–3 mL of oily injection should be administered at
any one site. Correct injection technique (including use of
z-track technique) and rotation of injection sites are
essential. When initiating therapy with sustained-release
preparations of conventional antipsychotics, patients
should first be given a small test-dose as undesirable sideeffects are prolonged.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Sesame oil
Fluphenazine decanoate 25 mg per 1 ml Modecate 50mg/2ml
solution for injection ampoules | 5 ampoule P £22.22
Modecate 25mg/1ml solution for injection ampoules | 10 ampoule P £22.55 DT = £22.55
Fluphenazine decanoate 100 mg per 1 ml Modecate Concentrate
100mg/1ml solution for injection ampoules | 5 ampoule P £43.73
Modecate Concentrate 50mg/0.5ml solution for injection ampoules | 10 ampoule P £44.73
Haloperidol decanoate 18-May-2018
Maintenance in schizophrenia and schizoaffective
disorder [in patients currently stabilised on oral
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Adult: Initially 25–150 mg every 4 weeks, initial dose
should be based on previous daily dose of oral
haloperidol (10–15 times the daily dose of oral
haloperidol is recommended), adjusted in steps of up
to 50 mg every 4 weeks if required, adjustment of the
dosing interval may be required, depending on
individual patient response; usual maintenance
50–200 mg every 4 weeks (max. per dose 300 mg every
4 weeks), dose to be administered into gluteal muscle,
the individual benefit-risk should be assessed when
considering doses above 200 mg every 4 weeks, if
supplementation with oral haloperidol is required, the
combined total dose of haloperidol from both
formulations must not exceed the corresponding
maximum oral haloperidol dose of 20 mg per day
▶ Elderly: Initially 12.5–25 mg every 4 weeks, increased if
necessary to 25–75 mg every 4 weeks, adjustment of
the dosing interval may be required, depending on
individual patient response, dose to be administered
into gluteal muscle, doses above 75 mg every 4 weeks
should only be considered in patients who have
tolerated higher doses and after reassessment of the
individual benefit-risk, if supplementation with oral
haloperidol is required, the combined total dose of
haloperidol from both formulations must not exceed
the corresponding maximum oral haloperidol dose of
5 mg per day, or the previously administered oral
haloperidol dose in patients who have received longterm treatment with oral haloperidol
DOSE EQUIVALENCE AND CONVERSION
▶ A range of equivalent doses is quoted in the literature;
the consensus is that 2 mg per day of oral haloperidol is
approximately equivalent to 15 mg per week of
haloperidol decanoate depot injection.
When prescribing, dispensing or administering, check
that this is the correct preparation—this preparation is
used for maintenance treatment and should not be used
for the rapid control of an acute episode.
with Lewy bodies . history of torsade de pointes . history of
ventricular arrhythmia . Parkinson’s disease . progressive
supranuclear palsy . QT-interval prolongation .recent
acute myocardial infarction . uncompensated heart failure . uncorrected hypokalaemia
l CAUTIONS Bradycardia . electrolyte disturbances (correct
from oral to depot therapy, the dose by mouth should be
l INTERACTIONS → Appendix 1: haloperidol
▶ Common or very common Depression . hypersalivation . muscle complaints . sexual dysfunction
▶ Uncommon Eye disorders . headache . neuromuscular
dysfunction . vision disorders
disorders .restlessness .rhabdomyolysis . SIADH . skin
reactions .temperature regulation disorders . thrombocytopenia .trismus . weight decreased
SIDE-EFFECTS, FURTHER INFORMATION Haloperidol is a less
l PREGNANCY Manufacturer advises it is preferable to
avoid—moderate amount of data indicate no malformative
or fetal/neonatal toxicity, however there are isolated case
reports of birth defects following fetal exposure, mostly in
combination with other drugs; reproductive toxicity
l HEPATIC IMPAIRMENT Manufacturer advises caution.
Dose adjustments Manufacturer advises halve initial dose
and then adjust if necessary with smaller increments and
l RENAL IMPAIRMENT Manufacturer advises use with
Dose adjustments Manufacturer advises consider lower
initial dose in severe impairment and then adjust if
necessary with smaller increments and at longer intervals.
▶ Manufacturer advises perform ECG before treatment
initiation and assess need for further ECGs during
treatment on an individual basis.
▶ Manufacturer advises monitor electrolytes before
treatment initiation and periodically during treatment.
l DIRECTIONS FOR ADMINISTRATION In general not more
than 2–3 mL of oily injection should be administered at
any one site. Correct injection technique (including use of
z-track technique) and rotation of injection sites are
essential. When initiating therapy with sustained-release
BNF 78 Psychoses and schizophrenia 393
preparations of conventional antipsychotics, patients
should first be given a small test-dose as undesirable sideeffects are prolonged.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Benzyl alcohol, sesame oil
▶ Haldol decanoate (Janssen-Cilag Ltd)
Haloperidol (as Haloperidol decanoate) 50 mg per 1 ml Haldol
Decanoate 50mg/1ml solution for injection ampoules | 5 ampoule P £19.06 DT = £19.06
Haloperidol (as Haloperidol decanoate) 100 mg per 1 ml Haldol
Decanoate 100mg/1ml solution for injection ampoules | 5 ampoule P £25.26 DT = £25.26
Maintenance in schizophrenia and paranoid psychoses
▶ BY DEEP INTRAMUSCULAR INJECTION
▶ Adult: Test dose 100 mg, dose to be administered into
the upper outer buttock or lateral thigh, followed by
200–500 mg after at least 7 days, then 200–500 mg
every 1–4 weeks, adjusted according to response,
higher doses of more than 500mg can be used; do not
▶ Elderly: A quarter to half usual starting dose to be used
When prescribing, dispensing, or administering, check
that this is the correct preparation—this preparation is
used for maintenance treatment and should not be used
for the short-term management of an acute episode.
Zuclopenthixol decanoate has been confused with
zuclopenthixol acetate; care must be taken to ensure the
correct drug is prescribed and dispensed.
l CONTRA-INDICATIONS Children . CNS depression . comatose states . phaeochromocytoma
l CAUTIONS Hyperthyroidism . hypothyroidism . QT interval
prolongation . when transferring from oral to depot
therapy, the dose by mouth should be reduced gradually
l INTERACTIONS → Appendix 1: zuclopenthixol
SIDE-EFFECTS, FURTHER INFORMATION Side-effects may
persist until the drug has been cleared from its depot site.
l HEPATIC IMPAIRMENT Can precipitate coma.
Dose adjustments Start with small doses in severe renal
impairment because of increased cerebral sensitivity.
l MONITORING REQUIREMENTS Treatment requires careful
monitoring for optimum effect.
l DIRECTIONS FOR ADMINISTRATION In general not more
than 2–3 mL of oily injection should be administered at
any one site. Correct injection technique (including use of
z-track technique) and rotation of injection sites are
essential. When initiating therapy with sustained-release
preparations of conventional antipsychotics, patients
should first be given a small test-dose as undesirable sideeffects are prolonged.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Zuclopenthixol decanoate 200 mg per 1 ml Clopixol 200mg/1ml
solution for injection ampoules | 10 ampoule P £31.51 DT =
Zuclopenthixol decanoate 500 mg per 1 ml Clopixol Conc
500mg/1ml solution for injection ampoules | 5 ampoule P £37.18
ANTIPSYCHOTICS › SECONDGENERATION
l DRUG ACTION Amisulpride is a selective dopamine
receptor antagonist with high affinity for mesolimbic D2
Acute psychotic episode in schizophrenia
▶ Adult: 400–800 mg daily in 2 divided doses, adjusted
according to response; maximum 1.2 g per day
Schizophrenia with predominantly negative symptoms
l INTERACTIONS → Appendix 1: amisulpride
l BREAST FEEDING Avoid—no information available.
l RENAL IMPAIRMENT No information available if eGFR less
Dose adjustments Halve dose if eGFR 30–60 mL/minute/
l MONITORING REQUIREMENTS Amisulpride does not affect
blood pressure to the same extent as other antipsychotic
drugs and so blood pressure monitoring is not mandatory
l PRESCRIBING AND DISPENSING INFORMATION Flavours of
oral liquid formulations may include caramel.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
CAUTIONARY AND ADVISORY LABELS 2
▶ Amisulpride (Non-proprietary)
Amisulpride 100 mg per 1 ml Amisulpride 100mg/ml oral solution
sugar free sugar-free | 60 ml P £87.48 DT = £49.44
394 Mental health disorders BNF 78
Amisulpride 100 mg per 1 ml Solian 100mg/ml oral solution sugarfree | 60 ml P £33.76 DT = £49.44
CAUTIONARY AND ADVISORY LABELS 2
▶ Amisulpride (Non-proprietary)
Amisulpride 50 mg Amisulpride 50mg tablets | 60 tablet P £19.74 DT = £6.02
Amisulpride 100 mg Amisulpride 100mg tablets | 60 tablet P £39.48 DT = £8.73
Amisulpride 200 mg Amisulpride 200mg tablets | 60 tablet P £66.00 DT = £13.71
Amisulpride 400 mg Amisulpride 400mg tablets | 60 tablet P £132.00 DT = £42.05
Amisulpride 50 mg Solian 50 tablets | 60 tablet P £22.76 DT =
Amisulpride 100 mg Solian 100 tablets | 60 tablet P £35.29 DT
Amisulpride 200 mg Solian 200 tablets | 60 tablet P £58.99 DT
Amisulpride 400 mg Solian 400 tablets | 60 tablet P £117.97
l DRUG ACTION Aripiprazole is a dopamine D2 partial
agonist with weak 5-HT1a partial agonism and 5-HT2A
Maintenance of schizophrenia in patients stabilised with
oral aripiprazole (CYP2D6 poor metabolisers)
▶ Adult: 300 mg every month, to be injected into the
gluteal or deltoid muscle, minimum of 26 days between
injections, treatment with 10–20 mg oral aripiprazole
daily should be continued for 14 consecutive days after
Maintenance of schizophrenia in patients stabilised with
▶ Adult: 400 mg every month, to be injected into the
gluteal or deltoid muscle, minimum of 26 days between
injections, treatment with 10–20 mg oral aripiprazole
daily should be continued for 14 consecutive days after
▶ Adult: 10–15 mg once daily; usual dose 15 mg once
daily (max. per dose 30 mg once daily)
Treatment and recurrence prevention of mania
▶ Adult: 15 mg once daily, increased if necessary up to
Control of agitation and disturbed behaviour in
▶ Adult: Initially 5.25–15 mg for 1 dose, alternatively
usual dose 9.75 mg for 1 dose, followed by 5.25–15 mg
after 2 hours if required, maximum 3 injections daily;
maximum daily combined oral and parenteral dose
DOSE ADJUSTMENTS DUE TO INTERACTIONS
▶ With oral use Manufacturer advises double the dose with
concurrent use of potent inducers of CYP3A4.
Manufacturer advises reduce dose by half with concurrent
use of potent inhibitors of CYP3A4 or CYP2D6.
▶ With intramuscular use For dose adjustments due to
concurrent use of interacting drugs—consult product
When prescribing, dispensing, or administering, check
that the correct preparation is used—the preparation
usually used in hospital for the rapid control of an acute
episode (solution for injection containing aripiprazole
7.5 mg/mL) should not be confused with depot
preparations (aripiprazole 400-mg vial with solvent),
which are usually used in the community or clinics for
l CONTRA-INDICATIONS CNS depression . comatose state . phaeochromocytoma
GENERAL CAUTIONS Cerebrovascular disease . elderly
▶ With intramuscular use when transferring from oral to depot
therapy, the dose by mouth should be reduced gradually
l INTERACTIONS → Appendix 1: aripiprazole
▶ Uncommon Depression . hiccups . hyperglycaemia . sexual
disorder.thrombocytopenia . urinary incontinence . weight decreased
l PREGNANCY Use only if potential benefit outweighs risk.
l BREAST FEEDING Manufacturer advises avoid—present in
l HEPATIC IMPAIRMENT Manufacturer advises caution in
severe impairment (oral treatment preferred to
intramuscular administration; limited information
▶ Aripiprazole does not affect blood pressure to the same
extent as other antipsychotic drugs and so blood pressure
monitoring is not mandatory for this drug.
▶ With intramuscular use Treatment requires careful
monitoring for optimum effect.
l DIRECTIONS FOR ADMINISTRATION
▶ With oral use Orodispersible tablets should be placed on the
tongue and allowed to dissolve, or be dispersed in water
▶ With intramuscular use Correct injection technique
(including the use of z-track technique) and rotation of
injection sites are essential.
▶ With oral use Patients or carers should be given advice on
how to administer aripiprazole orodispersible tablets.
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