Flupenthixol decanoate (depot) for schizophrenia or other similar psychotic disordersBy continuing to browse this site wwirkung haldol depot wirkung to us using cookies as described in About Cookies. Long-acting depot injections of drugs such as flupenthixol decanoate are extensively used as a means of long-term maintenance treatment for schizophrenia. To evaluate the effects of haldol depot wirkung decanoate in comparison with haldol depot wirkung, oral antipsychotics and other depot neuroleptic preparations for people with schizophrenia and other severe mental illnesses, in terms of clinical, social and economic outcomes. We identified relevant trials by searching the Cochrane Schizophrenia Group Trials Register in March manfaat hormon steroid then for this update version, a search was run in April References of all identified studies were inspected for further trials.
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By continuing to browse this site you agree to us using cookies as described in About Cookies. Long-acting depot injections of drugs such as flupenthixol decanoate are extensively used as a means of long-term maintenance treatment for schizophrenia.
To evaluate the effects of flupenthixol decanoate in comparison with placebo, oral antipsychotics and other depot neuroleptic preparations for people with schizophrenia and other severe mental illnesses, in terms of clinical, social and economic outcomes. We identified relevant trials by searching the Cochrane Schizophrenia Group Trials Register in March and then for this update version, a search was run in April References of all identified studies were inspected for further trials.
We contacted relevant pharmaceutical companies, drug approval agencies and authors of trials for additional information. All randomised controlled trials that focused on people with schizophrenia or other similar psychotic disorders where flupenthixol decanoate had been compared with placebo or other antipsychotic drugs were included. All clinically relevant outcomes were sought.
Review authors independently selected studies, assessed trial quality and extracted data. Analysis was by intention-to-treat. We presented scale data only for those tools that had attained prespecified levels of quality.
The review currently includes 15 randomised controlled trials with participants. No trials compared flupenthixol decanoate with placebo. One small study compared flupenthixol decanoate with an oral antipsychotic penfluridol.
Ten studies in total compared flupenthixol decanoate with other depot preparations, though not all studies reported on all outcomes of interest. In the current state of evidence, there is nothing to choose between flupenthixol decanoate and other depot antipsychotics.
From the data reported in clinical trials, it would be understandable to offer standard dose rather than the high dose depot flupenthixol as there is no difference in relapse. However, data reported are of low or very low quality and this review highlights the need for large, well-designed and reported randomised clinical trials to address the effects of flupenthixol decanoate. Schizophrenia is a severe mental illness that affects thinking and perception. It often develops in early adult-hood and can have a lifelong impact on not only the mental well-being of the sufferer, but their social and general functioning.
Worldwide around 15 people per , are diagnosed with schizophrenia every year. The mainstay of treatment for schizophrenia is antipsychotic drugs. Antipsychotics are usually given as tablets by mouth orally. However, people with mental illness often have difficulties with accepting medication compliance.
Their illness affects their thinking, which can erode their understanding of their illness and they often do not see the need for treatment. Taking antipsychotics can also have unpleasant side effects. Oral medication requires regular self-administration otherwise effectiveness is reduced and the risk of relapse is high.
A solution to poor compliance is depot medication where medication is given by injection and is slowly released over a period of weeks. For people with schizophrenia it was hoped to be able to maintain care in the community with regular injections administered by community psychiatric nurses. Initial enthusiasm and the favourable results of clinical trials gave rise to the extensive use of depots as a means of long-term treatment.
Flupenthixol decanoate is one of the most widely used depot antipsychotics in the UK. This review looks at the effectiveness of depot flupenthixol decanoate in comparison with no active treatment placebo , oral antipsychotics and other depot preparations for people with schizophrenia and other severe mental illnesses. An electronic search for relevant trials was carried out in Fifteen trials with participants could be included. All evidence from these trials was rated by the authors to be low or very low quality.
Currently, from the data reported, there is nothing to choose between depot flupenthixol decanoate and other depot or oral antipsychotics.
There was some evidence that it would be understandable to offer a standard dose rather than the high dose depot flupenthixol as there is no difference in relapse.
Overall, this review highlights the lack of evidence based information available for the review question and the need for large, well-designed and reported randomised clinical trials to address the medical, social, personal and economic effects of flupenthixol decanoate. Dijelom je dokazano kako je razumljivo ponuditi standardnu dozu flupentiksol dekanoat depoa prije nego visoku dozu, s obzirom kako nema nikakve razlike u relapsu. Dekanonian flupentyksolu w postaci depot w schizofrenii lub innych podobnych chorobach psychicznych.
Low, moderate and high risks calculated from included studies. All studies rated as an 'unclear' risk of bias due to lack of description of randomisation. The schizophrenic disorders are characterised in general by fundamental and characteristic distortions of thinking and perception, and by inappropriate and blunted affect International Classification of Diseases, ICD, WHO.
The illness often runs a chronic course with acute exacerbations and often partial remissions. The risk of death from all causes is 1.
In the Global Burden of Disease Study , mental illness and behavioural disorders accounted for 7. Disabilities experienced by people with schizophrenia are only partly due to recurrent episodes or continuing symptoms. Other factors that play a part are unpleasant side effects of treatment, social adversity and isolation, poverty and homelessness. Continuing prejudice, stigma and social exclusion associated with the diagnosis continue to play a major part Sartorius ; Thornicroft Experiencing a relapse of schizophrenia often lowers a person's level of social functioning and quality of life Curson Prevention of such episodes is therefore crucial from a clinical point of view as well as having enormous financial implications.
For example, within the UK, a Department of Health burden of disease analysis indicated that schizophrenia accounted for 5. Inpatient care accounted for The mainstay of treatment for schizophrenia are antipsychotic drugs Dencker Also called neuroleptics, they are generally regarded as highly effective, especially in controlling such symptoms as hallucinations and fixed false beliefs delusions Kane They also seem to reduce the risk of acute relapse.
Problems with adherence to treatment are common throughout medicine Haynes Those who suffer from long-term illnesses where treatments may have uncomfortable side effects Kane , cognitive impairments David and erosion of insight may be especially prone to be unreliable at taking medication.
Depot antipsychotic injections, developed in the s, mainly consist of an ester of the active drug held in an oily suspension. This is injected intramuscularly and released into the body slowly so may only need to be given every one to six weeks.
It was hoped to be able to maintain people in the community with regular injections administered by community psychiatric nurses, sometimes in clinics set up for this purpose Barnes Initial enthusiasm and the favourable results of clinical trials Hirsch gave rise to the extensive use of depots as a means of long-term maintenance treatment.
Flupentixol is a neuroleptic of the thioxanthene group. It exists in two geometric isomers, the cis Z and trans E forms of which only the cis Z -flupenthixol is pharmacologically active.
Flupenthixol decanoate is produced by esterification of cis Z -flupentixol with decanoic acid. Flupenthixol decanoate is usually given intramuscularly every two to four weeks. It is slowly released from the depot site, with a half-life of three to eight days Jorgensen The decanoate ester is then rapidly hydrolysed intracellularly to release the active cis Z -flupenthixol, with only traces of decanoate remaining in the bloodstream Jorgensen The serum T max for intramuscular flupenthixol decanoate is three to five days Jorgensen Flupenthixol has no active metabolites Jorgensen a.
Steady state is reached in about three months of administration Saikia Flupenthixol antagonizes dopamine binding primarily at D1, D2, D3 and with less affinity at D4 receptors; it also affects serotonin binding at 5-HT 2A and 5-HT 2C receptors as well as noradrenaline binding at 1-adrenergic receptors Glaser Flupenthixol is a powerful antagonist of both D1 and D2 dopamine receptors, though it is no more potent a neuroleptic than other agents e.
It blocks prolactin inhibitory factor PIF , resulting in an increase in pituitary prolactin secretion Fielding Flupentixol has no affinity for cholinergic muscarine receptors, only slight antihistaminergic properties and no alpha2 adrenoreceptor blocking properties. The pharmacological profile of flupenthixol has definite similarities to atypical antipsychotics and can be described as at least partially atypical Arnt ; Bandelow ; Glaser Flupenthixol is also said to resemble tricyclic antidepressants in some of its actions, though not in anticholinergic activity Kato Antipsychotic drugs are usually given orally Aaes-Jorgenson , but compliance with medication given by this route is likely to be poor and, certainly, is difficult to quantify.
Since development in the s, depot antipsychotics have been used in maintenance treatment for people with schizophrenia for whom relapse prevention is indicated. Since the introduction of atypical antipsychotics, there has been a fall in the use of depot medications, as only one atypical antipsychotic medication risperidone was available in depot form.
But non-adherence to oral antipsychotic medications continues to be a major problem. Olanzapine, risperidone and paliperidone in their depot forms olanzapine pamoate, risperdal consta and paliperidone palmitate respectively have been available. The NICE Guideline on schizophrenia March , in its 'promoting recovery' section promotes the use of depot antipsychotics after an acute episode if acceptable to the patient and to avoid covert non-adherence NICE Guideline: CGS 82 Schizophrenia update Flupenthixol in its depot form has been extensively used for maintenance and relapse prevention in schizophrenia.
Individuals are reported to show an improvement in mood when used in maintenance treatment Carney ; Chowdhury and also in treatment of relapses Johnson ; Wistedt Flupenthixol decanoate has shown to have better tolerance and less side effects as compared to fluphenazine decanoate Johnson ; Pinto ; Wistedt These might be due to the 'partial atypical' properties of flupenthixol and also resembling tricyclic antidepressants in some of its actions.
At four-weekly doses, flupenthixol decanoate could not keep psychotic symptoms in check as compared to haloperidol decanoate nor was there any conclusive evidence of anti-depressant properties, and the authors have commented that two-weekly dosing might be more appropriate Eberhard A month prospective comparison of standard dose verus half dose flupenthixol decanoate for maintenance treatment indicated that a dose reduction had increased relapse significantly Johnson Flupenthixol decanoate is one of the most widely used depots in the UK.
We included relevant randomised controlled trials which were at least single-blind blind raters. Where a trial was described as 'double-blind', but it was only implied that the study was randomised, we included these trials in a sensitivity analysis. If there was no substantive difference within primary outcomes see Types of outcome measures when these 'implied randomisation' studies were added, then we included these in the final analysis.
If there was a substantive difference, we only used clearly randomised trials and described the results of the sensitivity analysis in the text. We excluded quasi-randomised studies, such as those allocating by using alternate days of the week. Randomised cross-over studies were included in this review but we only used data up to the point of the first cross-over because of the instability of the problem behaviours and the likely carry-over effects of all treatments.
People with schizophrenia or other similar psychotic disorders e. There is no clear evidence that the schizophrenia-like psychoses are caused by fundamentally different disease processes or require different treatment approaches Carpenter