FGA Depot·Psychiatry - Depot Antipsychotics

Flupentixol decanoate

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

Authority requiredPBSDEPOT Q2-4WFluanxol DepotS4+1

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At a glance

Max Dose

400 mg/week

Half-life

17 Days

Caution: Activation

HIGH

High risk: EPS Risk

CRITICAL

Cautions

Avoid / Cautions

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

Where it stands

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 Uniquely activating and alerting, making it excellent for withdrawn, apathetic patients, but terrible for agitated ones.

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). Maintenance ceiling up to Australian approved max (100–400 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

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

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