Schizophrenia zuclopenthixol

A 73-year-old woman with diabetes mellitus and schizophrenia was given haloperidol 8 mg/day instead of zuclopenthixol she also took levomepromazine 75 mg at night 10 days later she was found unconscious with a rectal temperature of 31.5° C (546). A few weeks later, she had two further episodes, first with olanzapine 10 mg/day (rectal temperature 31.7° C) and then with thioridazine 40 mg/day (rectal temperature 34° C). She was therefore given dixyrazine 150 mg/day and alimemazine 20 mg at night, and had no more episodes of hypothermia. 

A 66-year-old man with schizophrenia took zuclopenthixol 10 mg tds for 18 days and developed a mild leukopenia (2.9 x 109/1) and thrombocytopenia (109 x 109/1). He was asymptomatic, with no evidence of infection or a bleeding tendency. Zuclopenthixol was withdrawn, without any change in the rest of his drug therapy (glibenclamide 5 mg tds, biperiden 2 mg bd, oxazepam 10 mg tds, dipyridamole 75 mg tds, and ranitidine 150 mg/day). The leukocyte and platelet counts rose over the next 5 days. 

Coutinho E, Fenton M, Quraishi S. Zuclopenthixol decanoate for schizophrenia and ofher serious menfal illnesses. Cochrane Dafabase Sysf Rev 2000 (2) CD001164. 

Fenton M, Coutinho ES, Campbell C. Zuclopenthixol acetate in the treatment of acute schizophrenia and similar serious mental illnesses. Cochrane Database Syst Rev 2000 (2) CD000525. 

Haloperidol, zuclopenthixol, fluphenazine, flupentixol and pipothiazine are available as depot intramuscular injections for maintenance treatment of patients with schizophrenia and other chronic psychotic disorders. Provided the patient is willing to agree to have depot injections, usually by a community psychiatric nurse at intervals of 2-4 weeks, the need to take tablets two or three times a day is removed. Poor compliance with oral medication is the most common cause of admission to hospital with a relapse of schizophrenia. A reduced initial dose of the depot medication should be given, with a review for unwanted effects after 5-10 days. 

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