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Pipotiazine Palmitate) Depot Injection

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Pipotiazine Palmitate) Depot Injection Head of Medicines Management Trust Head Office 99 Waverley Rd St Albans, Herts AL3 5TL 27 October 2014 Dear Colleagues Discontinuation of Piportil (pipotiazine palmitate) Depot Injection You may have received a letter (attached) from Sanofi-Aventis Ltd about the global withdrawal of Piportil depot injection in March 2015. This is due to a global shortage of the active pharmaceutical ingredient pipotiazine palmitate. Unfortunately there is no generic or other branded product of pipotiazine palmitate depot injection available in UK. All patients currently receiving pipotiazine palmitate depot injection will therefore need to be reviewed and switched to an alternative treatment before March 2015. No new patients should be initiated on pipotiazine palmitate. The choice of alternative will be a clinical decision by the prescriber in conjunction with the patient. Please consider the following steps if switching to another conventional / typical antipsychotic depot injection. • Full drug history This can assist decision making for the alternative antipsychotic depot injection. • Dose interval and patient compliance The pharmacokinetics of the preparation influences its dose interval. BNF1 states (according to response): Pipotiazine palmitate and haloperidol decanoate are 4 weekly Flupentixol decanoate varies from 2 – 4 weekly, but can be weekly Fluphenazine decanoate varies from 14 – 35 days Zuclopenthixol decanoate varies from 1 – 4 weekly Patient compliance may need to be considered. • Test dose A test dose consisting of a small dose of the active drug in a small volume of oil, tests the patient’s sensitivity to the drug, the base oil and EPSEs. It is usually tested at least 5 – 7days prior to the first dose of the antipsychotic depot injection, please refer the BNF1 for more details. Please note the oil base in pipotiazine is palmitate whereas those in other suggested alternative preparations is decanoate. Test doses should be given in depot clinics where adrenaline is available in the event of an anaphylactic reaction occurring. • Equivalent doses of depot antipsychotics (Adapted from BNF1) These equivalences are intended only as an approximate guide; individual dosage instructions should also be checked; patients should be carefully monitored after any change in medication Antipsychotic drug Dose (mg) Interval Flupentixol decanoate 40 2 weeks Fluphenazine decanoate 25 2 weeks Haloperidol (as decanoate) 100 4 weeks Pipotiazine palmitate 50 4 weeks Zuclopenthixol decanoate 200 2 weeks Important These equivalences must not be extrapolated beyond the maximum dose for the drug • Choice of conventional / typical antipsychotics depot (Adapted from BNF1) There is no clear-cut division in the use of the conventional antipsychotics, but zuclopenthixol may be suitable for the treatment of agitated or aggressive patients whereas flupentixol can cause over-excitement in such patients. Zuclopenthixol decanoate may be more effective in preventing relapses than other conventional antipsychotic depot preparations. The incidence of extrapyramidal reactions is similar for the conventional antipsychotics. • How to switch2 The general consensus for switching antipsychotic depot injections is to initiate the new / switched depot on the day that the previous depot injection is due. This allows for a smooth switch over and helps minimise the risk of overlapping the two drugs involved. However, please note the test dose will need to be administered at least 5 -7 days prior to the initiation, please refer to the BNF1. • Monitor mental state and side effects closely during and after switching It is important to monitor the patient closely for any signs of relapse or potential drug related side-effects during and after the switching period, so that the dose and dosage interval of the switched antipsychotic depot injection can be reviewed according to response. Reference: 1. British National Formulary (BNF) 68th Edition (Section 4.2.2) 2. Psychotropic Drug Directory 2014 – Stephen Bazire (Section 2.2) Please do not hesitate to call one of the Medicines Management Team if you have any questions. Yours sincerely Janet Janet Howell Head of Medicines Management .
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