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Typical Antipsychotic (Thioxanthene) — Also Used as Low-dose Antidepressant Pregnancy: UK SPC §4.6, verbatim. PREGNANCY: 'As the safety of this drug during pregnancy has not been established, use during pregnancy, especially the first and last trimesters, should be avoided, unless the expected benefit to the patient outweighs the potential risk to the foetus. Neonates exposed to antipsychotics (including Depixol) during the third trimester of pregnancy are at risk of adverse reactions including extrapyramidal and/or withdrawal symptoms that may vary in severity and duration following delivery. There have been reports of agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, or feeding disorder. Consequently, newborns should be monitored carefully. Animal studies have shown reproductive toxicity.' BREAST-FEEDING: 'Flupentixol is excreted into the breast milk. If the use of Depixol is considered essential, nursing mothers should be advised to stop breast-feeding.' FERTILITY: 'In humans, adverse events such as hyperprolactinaemia, galactorrhoea, amenorrhoea, libido decreased, erectile dysfunction and ejaculation failure have been reported… These events may have a negative impact on female and/or male sexual function and fertility. If clinical significant hyperprolactinaemia, galactorrhoea, amenorrhoea or sexual dysfunctions occur, a dose reduction (if possible) or discontinuation should be considered. The effects are reversible on discontinuation.'

Flupentixol

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

Flupentixol is a first-generation (thioxanthene) antipsychotic; oral formulations are used for schizophrenia and related psychoses, and at low dose for depression.

Adult dose

Dose: 1 to 3 tablets twice daily — that is 3 mg to 9 mg twice daily with the 3 mg tablet (product: Depixol Tablets 3mg)
Route: Oral — UK SPC §4.2: 'The tablets are swallowed with water.'
Frequency: Twice daily, titrated to the individual patient. §4.2: 'It is recommended that commencement of treatment and increase in dosage should be carried out under close supervision. As with all antipsychotic drugs, the dose of Depixol should be titrated to the needs of each patient.'
Max: Maximum 18 mg (6 tablets) per day — UK SPC §4.2, verbatim: 'Adults 1 - 3 tablets twice daily to a maximum of 18 mg (6 tablets) per day.'
VERBATIM §4.2 (Posology, Adults) — 'Adults 1 - 3 tablets twice daily to a maximum of 18 mg (6 tablets) per day. It is recommended that commencement of treatment and increase in dosage should be carried out under close supervision. As with all antipsychotic drugs, the dose of Depixol should be titrated to the needs of each patient. When transferring patients from oral to depot antipsychotic treatment, the oral medication should not be discontinued immediately, but gradually withdrawn over a period of several days after administering the first injection.' The dose is expressed in the SPC as a tablet count; the strength is pinned by the product name (Depixol Tablets 3mg) and confirmed internally by the maximum line (6 tablets = 18 mg), so 1-3 tablets twice daily is 3-9 mg twice daily. OLDER PATIENTS (§4.2): 'In accordance with standard medical practice, initial dosage may need to be reduced to a quarter or half the normal starting dose in the frail or older patients.' CHILDREN (§4.2): 'Flupentixol is not recommended for use in children due to lack of clinical experience' — hence paedDose is null. WITHDRAWAL (§4.4): 'Acute withdrawal symptoms, including nausea, vomiting, sweating and insomnia have been described after abrupt cessation of antipsychotic drugs. Recurrence of psychotic symptoms may also occur, and the emergence of involuntary movement disorders (such as akathisia, dystonia and dyskinesia) has been reported. Therefore, gradual withdrawal is usually advisable.' EXTRAPYRAMIDAL EFFECTS (§4.8): 'Extrapyramidal reactions may occur, especially in the early phase of treatment. In most cases these side effects can be satisfactorily controlled by reduction of dosage and/or use of antiparkinsonian drugs. The routine prophylactic use of antiparkinsonian drugs is not recommended. Antiparkinsonian drugs do not alleviate tardive dyskinesia and may aggravate them. Reduction in dosage or, if possible, discontinuation of flupentixol therapy is recommended. In persistent akathisia a benzodiazepine or propranolol may be useful.' DIABETES (§4.4): flupentixol 'may modify insulin and glucose responses calling for adjustment of the antidiabetic therapy in diabetic patients'. NOT SOURCED HERE: the page also lists a Depixol depot regimen (intramuscular, every 2-4 weeks) and a low-dose Fluanxol antidepressant regimen; neither product's SPC is in this bundle, so no depot or antidepressant dose is published above. Fetch those SPCs separately before publishing them.

Dose adjustments

Renal

UK SPC §4.2, verbatim: 'Patients with reduced renal function — Flupentixol has not been studied in renal impairment. Increased cerebral sensitivity to antipsychotics has been noted in severe renal impairment (see section 4.4).' No dose reduction figure is given. §4.4 lists renal failure among the conditions in which 'caution should be exercised'.

Hepatic

UK SPC §4.2, verbatim: 'Patients with reduced hepatic function — Flupentixol has not been studied in hepatic impairment. It is extensively metabolised by the liver and particular caution should be used in this situation and serum level monitoring is advised (see section 4.4).' No dose reduction figure is given. §4.4 also lists liver disease among the conditions requiring caution.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 (§4.3)
  • Circulatory collapse (§4.3)
  • Depressed level of consciousness due to any cause, e.g. intoxication with alcohol, barbiturates or opiates (§4.3)
  • Coma (§4.3)
  • 'Not recommended for excitable or agitated patients' (§4.3, verbatim)
  • Not a contraindication but a §4.4 caution list — liver disease; cardiac disease or arrhythmias; severe respiratory disease; renal failure; epilepsy and conditions predisposing to epilepsy (e.g. alcohol withdrawal or brain damage); Parkinson's disease; narrow angle glaucoma; prostatic hypertrophy; hypothyroidism; hyperthyroidism; myasthenia gravis; phaeochromocytoma; and patients who have shown hypersensitivity to thioxanthenes or other antipsychotics
  • Not a contraindication but a §4.4 QT caution: use with caution in susceptible individuals (hypokalaemia, hypomagnesaemia or genetic predisposition) and in patients with a history of cardiovascular disorders such as QT prolongation, significant bradycardia (<50 beats per minute), recent acute myocardial infarction, uncompensated heart failure or cardiac arrhythmia

Side effects

  • Very common: somnolence, akathisia, hyperkinesia, hypokinesia (nervous system); dry mouth (gastrointestinal)
  • Common, nervous system: tremor, dystonia, dizziness, headache, disturbance in attention
  • Common, psychiatric: insomnia, depression, nervousness, agitation, decreased libido; uncommon: confusional state
  • Common, metabolic: increased appetite, weight increased; uncommon: decreased appetite; rare: hyperglycaemia, abnormal glucose tolerance
  • Common, gastrointestinal: salivary hypersecretion, constipation, vomiting, dyspepsia, diarrhoea; uncommon: abdominal pain, nausea, flatulence
  • Common, cardiac: tachycardia, palpitations; rare: electrocardiogram QT prolonged. Uncommon, vascular: hypotension, hot flush; not known: venous thromboembolism
  • Common, eye: accommodation disorder, abnormal vision; uncommon: oculogyration
  • Common, skin: hyperhidrosis, pruritus; uncommon: rash, photosensitivity reaction, dermatitis
  • Common, musculoskeletal: myalgia; uncommon: muscle rigidity. Common, renal and urinary: micturition disorder, urinary retention. Common, respiratory: dyspnoea
  • Uncommon to rare, nervous system: tardive dyskinesia, dyskinesia, parkinsonism, speech disorder, convulsion; very rare: neuroleptic malignant syndrome (hyperthermia, muscle rigidity, fluctuating consciousness, instability of the autonomous nervous system)
  • Rare, blood: thrombocytopenia, neutropenia, leukopenia, agranulocytosis; rare, immune: hypersensitivity, anaphylactic reaction; rare, endocrine: hyperprolactinaemia
  • Uncommon, hepatobiliary: abnormal liver function test; very rare: jaundice
  • Not known: suicidal ideation and suicidal behaviour — §4.8 opens 'Cases of suicidal ideation and suicidal behaviours have been reported during flupentixol therapy or early after treatment discontinuation'
  • Not known: neonatal drug withdrawal syndrome after third-trimester exposure (§4.8, §4.6)
  • §4.8: 'The majority of undesirable effects are dose dependent. The frequency and severity are most pronounced in the early phase of treatment and decline during continued treatment.' The §4.8 table is truncated at 'Reproductive system…', so the list above is incomplete

Monitoring

  • Close supervision at initiation and at every dose increase — §4.2: 'It is recommended that commencement of treatment and increase in dosage should be carried out under close supervision'
  • Serum level monitoring in hepatic impairment — §4.2: 'It is extensively metabolised by the liver and particular caution should be used in this situation and serum level monitoring is advised'
  • Blood counts if infection develops — §4.4: 'Blood dyscrasias, including thrombocytopenia, have been reported rarely. Blood counts should be carried out if a patient develops signs of persistent infection'
  • Glycaemic control in diabetes — §4.4: flupentixol 'may modify insulin and glucose responses calling for adjustment of the antidiabetic therapy in diabetic patients'
  • QT interval in susceptible patients — §4.4: 'flupentixol may cause QT prolongation. Persistently prolonged QT intervals may increase the risk of malignant arrhythmias', so use with caution in patients with hypokalaemia, hypomagnesaemia, genetic predisposition or a cardiovascular history
  • Venous thromboembolism risk — §4.4: 'all possible risk factors for VTE should be identified before and during treatment with Depixol and preventive measures undertaken'
  • Watch for neuroleptic malignant syndrome — §4.4: hyperthermia, muscle rigidity, fluctuating consciousness, autonomic instability; treatment is discontinuation of the neuroleptic plus symptomatic and supportive measures, with dantrolene and bromocriptine possibly helpful; 'Symptoms may persist for more than a week after oral neuroleptics are discontinued and somewhat longer when associated with the depot forms of the drugs'
  • Extrapyramidal effects, especially early in treatment (§4.8), managed by dose reduction and/or antiparkinsonian drugs; routine prophylactic antiparkinsonian drugs are not recommended
  • Newborns exposed in the third trimester — §4.6: 'newborns should be monitored carefully' for extrapyramidal and/or withdrawal symptoms
  • Consider dose reduction or discontinuation if clinically significant hyperprolactinaemia, galactorrhoea, amenorrhoea or sexual dysfunction occurs (§4.6)

Clinical monograph

How it works

It antagonises postsynaptic dopamine D2 receptors, reducing dopaminergic overactivity associated with psychotic symptoms.

Prescribing in practice

  • It can cause extrapyramidal side effects and, rarely, neuroleptic malignant syndrome, which requires immediate discontinuation and urgent treatment.
  • Avoid in overactive or excited patients because it can have an alerting effect that may worsen agitation.
  • Antipsychotics increase the risk of QT prolongation and, in elderly patients with dementia, of stroke and death.

Monitoring

Monitor for extrapyramidal symptoms, metabolic effects and, where indicated, ECG and prolactin during treatment.

Counselling the patient

  • Report muscle stiffness, tremor, restlessness or high fever.
  • May cause drowsiness; take care with driving until effects are known.
  • Continue treatment as prescribed and do not stop suddenly.

Evidence & guidelines

First-generation antipsychotics are established treatments for schizophrenia, with efficacy and extrapyramidal risk well characterised.

Reference: NICE CG178 (Psychosis and Schizophrenia); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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