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Typical Antipsychotic (Thioxanthene) — Also Used as Low-dose Antidepressant Pregnancy: Use only if benefit outweighs risk. Depot cannot be withdrawn rapidly if adverse effects occur in pregnancy.

Flupentixol

Brand names: Depixol (depot), Fluanxol (oral low-dose antidepressant)

Adult dose

Dose: Schizophrenia / psychosis (oral): 3–9mg daily in divided doses (start 3mg BD); maximum 18mg daily. Depot (Depixol): 20–40mg IM every 2–4 weeks initially; maintenance 20–400mg every 2–4 weeks. Depression / anxiety (low dose Fluanxol): 0.5–1mg OD in morning; maximum 3mg daily.
Route: Oral / IM depot
Frequency: Twice daily (oral antipsychotic); once daily morning (low-dose antidepressant); every 2–4 weeks (depot)
Max: 18mg daily (oral antipsychotic); 400mg per depot injection; 3mg daily (antidepressant dose)
At low doses (0.5–3mg/day) flupentixol has antidepressant and anxiolytic properties — used in mixed anxiety/depression when other antidepressants have failed. Activating at low doses (dopamine agonism at low concentrations) — may worsen agitation if used at antipsychotic doses in agitated patients. Depixol depot lasts 2–4 weeks.

Paediatric dose

Route: Oral / IM
Frequency: As per indication
Max: Not applicable
Not licensed under 18 years. Seek specialist child and adolescent psychiatry opinion.

Dose adjustments

Renal

Use with caution — start at lower doses.

Hepatic

Reduce dose in hepatic impairment.

Clinical pearls

  • Dual action: at antipsychotic doses acts as D2 blocker (typical antipsychotic); at low doses (0.5–3mg) acts as an antidepressant — dopamine agonism at presynaptic autoreceptors enhances dopamine transmission
  • Fluanxol (0.5–3mg) is licenced for depression in adults — consider when other antidepressants have failed, especially in apathetic, withdrawn presentations
  • EPSE antidote: procyclidine 5–10mg IM/IV (acute dystonia)
  • Activating effect at low doses: do not use in agitated or manic patients — flupentixol may worsen agitation

Contraindications

  • Excitement or overactivity (low-dose activating effect may worsen)
  • Mania
  • CNS depression
  • Hypersensitivity to thioxanthenes

Side effects

  • EPSE (dose-dependent)
  • Activating/agitating at low doses (paradoxical in some patients)
  • QTc prolongation
  • Hyperprolactinaemia
  • Weight gain
  • Tardive dyskinesia (long-term)
  • Injection site pain (depot)

Interactions

  • QT-prolonging drugs — additive
  • CNS depressants — additive sedation
  • Lithium — enhanced neurotoxicity

Monitoring

  • EPSE assessment
  • QTc (ECG)
  • Prolactin if symptomatic
  • Weight and metabolic parameters
  • Depot injection site and schedule

Reference: BNFc; BNF 90; NICE CG178 (Psychosis and Schizophrenia). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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