Typical Antipsychotic (Thioxanthene) — Oral and Depot Formulations Pregnancy: Use only if benefit outweighs risk — neonatal EPS and withdrawal risk. Depot cannot be reversed if adverse effects occur.

Zuclopenthixol

Brand names: Clopixol (oral/depot), Acuphase (short-acting IM — 72h)

Adult dose

Dose: Acute agitation (Acuphase IM): 50–150mg IM (max 150mg per injection; 400mg total course; maximum 2 injections). Oral maintenance: 20–30mg daily in divided doses; maximum 150mg daily. Depot (Clopixol decanoate): 200–500mg IM every 2–4 weeks.

Route: IM (Acuphase — acute); Oral (maintenance); IM depot (long-term)

Frequency: Acuphase: single injection repeated at 24–72h if needed (max 2 doses); Oral: divided doses; Depot: every 2–4 weeks

Max: 150mg daily oral; 400mg total Acuphase course; 600mg per depot injection

Acuphase (zuclopenthixol acetate) is a short-acting IM formulation for acute agitation — onset 2h, duration 72h. NOT the same as zuclopenthixol decanoate depot (which lasts 2–4 weeks). Must not be given to drug-naive patients, only those already established on antipsychotics. Used for acutely disturbed patients who need sustained sedation for 72h without repeated injections.

Paediatric dose

Route: IM / Oral

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 in severe renal impairment.

Hepatic

Use with caution in hepatic impairment — reduce dose.

Clinical pearls

Acuphase is NOT a rapid tranquilliser for truly acute emergencies (onset 2h) — use IM lorazepam or IM haloperidol for immediate sedation; Acuphase is for sustained control over 24–72h
Only give Acuphase to patients with a known response to antipsychotics — never in antipsychotic-naive patients (unpredictable EPSE and NMS risk)
EPSE antidote: procyclidine 5–10mg IM/IV for acute dystonia; propranolol or low-dose diazepam for akathisia
Depot injections: mark injection date and due date clearly — missed depot injections can lead to rapid relapse

Contraindications

CNS depression, coma
Alcohol or barbiturate intoxication
Drug-naive patients (Acuphase only)
Phaeochromocytoma
Hypersensitivity to thioxanthenes

Side effects

Sedation (therapeutically useful with Acuphase)
EPSE — dystonia, parkinsonism, akathisia, tardive dyskinesia
QTc prolongation
Hyperprolactinaemia
Orthostatic hypotension
NMS (rare)
Weight gain
Injection site pain and nodules (depot)

Interactions

CNS depressants — additive sedation
QT-prolonging drugs — additive
Lithium — increased neurotoxicity risk
Antihypertensives — additive hypotension

Monitoring

ECG (QTc)
EPSE assessment (AIMS scale)
Prolactin if symptomatic
Weight and metabolic parameters
Injection site (depot)

Reference: BNFc; BNF 90; NICE CG178 (Psychosis and Schizophrenia); NICE NG10 (Violence and Aggression). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways