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Home , Phenothiazine, Pipotiazine

Depot Discontinuation

Pipotiazine depot is to be discontinued in March 2015. Therefore patients will need to be switched to an alternative depot before the supplies are exhausted.

The equivalent dose of Pipotiazine depot 50mg/week to other depots is:

Antipsychotic depot Maudsley Guidelines BNF Equivalent Dose Equivalent dose depot 25mg/week 50mg/week depot 75mg/week Pipotiazine 50mg/month = NB pipotiazine 50mg/month = haloperidol depot haloperidol depot 75mg/month 100mg/month depot 500mg/week 400mg/week depot 50mg/week 60mg/week *pipotiazine depot 10mg/week = consta 12.5mg/week = depot 12.5mg/week

Unfortunately Pipotiazine belongs to group 2 of the class and there are no other depots available on the UK market from this group.

Recommendation

To switch a patient to a different antipsychotic depot when the next dose of Pipotiazine is due and stop the Pipotiazine. The drug choice should be based on the side effect of the medicines below and the history of response by the patient to previous .

Example switch - Pipotiazine 100mg/month to Fluphenazine depot

Give test dose of 12.5mg Fluphenazine depot when dose of Pipotiazine was due 7 days later give 25mg dose. In one month’s time give 50mg then continue on 50mg monthly thereafter.

Drug Extrapyramidal Cardiac Weight Prolactin Sedation Anticholinergic side effects gain Zuclopenthixol xxx x xx xx xx xx depot Fluphenazine xxx xx x xxx xx xx depot Haloperidol xxx xx x xxx x x depot Flupentixol xx x/o xx xx x xx depot Pipotiazine xx xx xx xxx xx Xx depot Paliperidone x 0 xx xxx x X depot x/o x x/0 0 0 0 depot (adapted from Maudsley Prescribing Guidelines 11th ed and Psychotropic Drug Directory 2014) 0 – no effect, x – min effect, xx – moderate effect, xxx – major effect Michael Dixon Pharmacist 23.10.14

Chemical Structure of Zuclopenthixol

Chemical Structure of Pipotiazine

Chemical Structure of Fluphenazine

Chemical Structure of Flupentixol

Chemical Structure of Haloperidol