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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by jasmineneroli on May 22, 2005, at 20:55:06
My sister in the UK is currently being treated with Flupenthixol Deconoate injections every two weeks. I'm not sure of the dosage. As far as I know, her dx is panic disorder, social phobia/anxiety and treatment resistant depression of the dysthymic, withdrawn, flat-effect type.
I would like some feedback on the appropriateness of this treatment, because the only info I can find on this drug is its use for maintenance in Schizophrenia, or other psychotic disorders and for cocaine addiction.
At no time time have I ever known my sister to be psychotic. (I live in Canada).
I'm concerned about TD or other extra-pyramidal effects. I'm also concerned about other health implications.She is having regular blood tests, mainly to check hepatic functioning, I believe.
I don't think that it is a commonly used drug in Canada...I thought I knew them all!!
I'm aware of the use of AP's for T R Depression, but in my experience the common ones used are Zyprexa or Risperdal. Why would her doctor choose this route?
Should I have any concerns? Any advice I can pass on to her?? She lives with my elderly parents, who really don't understand any of this, and follow what the medical profession say as "golden". They don't ask questions. I had to insist she was assessed by a psychiatrist in the first place, because I was alarmed by her behaviour when I was last in the UK, visiting.
Appreciate your input, everyone.
Jas
Posted by Phillipa on May 22, 2005, at 21:44:40
In reply to Flupenthixol deconoate inject. questions - Ed UK, posted by jasmineneroli on May 22, 2005, at 20:55:06
Is that the same as prolixin? Fondly, Phillipa
Posted by med_empowered on May 23, 2005, at 3:29:50
In reply to Re: Flupenthixol deconoate inject. questions - Ed UK » jasmineneroli, posted by Phillipa on May 22, 2005, at 21:44:40
hey! I'm not Ed but I hope I can help a little. In the US, this medicine is sold as Navane, and its in a subgroup of phenothiazenes (the same antipsychotic group that contains Thorazine and Mellaril). From what I understand, virtually **all** the antipsychotics, old and new, have been used at some point to treat non-psychotic illnesses, including depression, anxiety, and general "neurotic" behavior. The problem, obviously, is that anti-psychotics are pretty hardcore in terms of side-effects, especially the old ones. According to what I could find online, the doses of this medicine used for non-psychotic depression are pretty small. That said, your sister still runs the risk of movement disorders like Tardive Dyskinesia and reactions such as akathisia (restlessness accompanied by increased motor activity). One thing that concerns me is that she's getting the depot injection form--do you know why her doc is doing this? Depot injections seem to increase the risk of some side effects. I'd seriously recommend trying to get your sister another doctor. According to the American Psychiatric Association 1980 taskforce on Tardive Dyskinesia, about 20% of patients will develop TD after 5 years of exposure to a neuroleptic (this lumps all the old anti-psychotics together, including Navane). Other estimates run more along the lines of 30%, possibly higher; the per year incidence of TD with old drugs is estimated at 3-5%/per year. Women get it more often than men, and the very old and the very young develop it more often than others. In comparison, the newer antipsychotics have a TD risk of .5-1%/year. Ideally, anti-psychotics used for depression should be withdrawn as soon as possible. Good luck!
Posted by xbunny on May 23, 2005, at 7:33:07
In reply to Flupenthixol deconoate inject. questions - Ed UK, posted by jasmineneroli on May 22, 2005, at 20:55:06
Hi there (sorry Im not Ed either ;) )
For the other posters, flupenthixol has the brand names depixol and fluanxol. It is not navane or prolixin, though is a phenothiazine also.
> I'm aware of the use of AP's for T R Depression, but in my experience the common ones used are Zyprexa or Risperdal. Why would her doctor choose this route?
Here in the UK low dose flupenthixol (the 1mg fluanxol tables) is also listed as an antidepressant. The dose for depression is less than 3mg per day I think. Im not sure why the dr would choose to use the injectable version. Perhaps your sister has trouble taking her meds regularly or the doctor doesnt know about the tablets. They are a pretty uncommon prescription im told, according to my CPN Im the only person in my local catchment area who takes the tablets! here is drug info which includes flupenthixol as an antidepressant
http://www.mindmelt.co.uk/trickcyclists/pocket_psych/BNF/antidepressants/flupentixol.htm
Note the bit in dose, if flupenthixol is gonna work it usually does so within a week.Personally I find flupenthixol a very good drug, though I do get psychosis also. I find it boosts my mood, increases concentration and motivation and decreases sensory disturbances. I take 6mg - 9mg a day in tablets. I dont find it of much use for anxiety though as its not really sedating enough.
EPS and other common antipsychotics side effects are likely with flupenthixol as is excitement and insomnia (it tends to be an activating and stimulating drug).
Regards, Bunny
Posted by Larry Hoover on May 23, 2005, at 7:33:37
In reply to Re: Flupenthixol deconoate inject. questions - Ed, posted by med_empowered on May 23, 2005, at 3:29:50
> One thing that concerns me is that she's getting the depot injection form--do you know why her doc is doing this? Depot injections seem to increase the risk of some side effects.
One thing not known in all of this is the patient's ability to comply with care. Remembering to take the meds is a big part of getting the desired effect from the meds.
That's one argument for depo injections that I have to say is a strong one. Guaranteed med compliance.
Apart from that one criterion, I agree that other (newer) meds would be preferred, by a substantial margin.
Lar
Posted by xbunny on May 23, 2005, at 7:40:28
In reply to Re: Flupenthixol deconoate inject. questions - Ed, posted by xbunny on May 23, 2005, at 7:33:07
> For the other posters, flupenthixol has the brand names depixol and fluanxol. It is not navane or prolixin, though is a phenothiazine also.
whoops its not a phenothiazine its just lumped in with them cos its a 'old' antipsychotic lol
Posted by med_empowered on May 23, 2005, at 8:30:36
In reply to Re: Flupenthixol deconoate inject. questions - Ed, posted by xbunny on May 23, 2005, at 7:40:28
hi! I'm not really a fan of depot injections...they kind of take away the "free will" aspect of treatment that I think is highly, highly important, especially when the person involved is **not** floridly psychotic and an obvious risk to him/herself and/or others. Besides, at least one atypical--Risperdal--is currently available in depot form. I think Zyprexa is as well, but I'm not entirely sure. A lot of patients "fail to comply" because the side effects from a given drug or drug combo are simply intolerable...given that, depot injections seem to both violate the patient's free will and the doctor's duty to **improve** the quality of life for those they treat.
Posted by ed_uk on May 23, 2005, at 9:11:27
In reply to Flupenthixol deconoate inject. questions - Ed UK, posted by jasmineneroli on May 22, 2005, at 20:55:06
Hi J,
Lots of people have answered lol! It's probably a good thing because I've got an exam tomorrow!
Yes, flupenthixol injection is sold as Depixol in the UK.
>I would like some feedback on the appropriateness of this treatment, because the only info I can find on this drug is its use for maintenance in Schizophrenia, or other psychotic disorders and for cocaine addiction.
It *might* be appropriate if other treatments have been tried and have not been effective. I can't really say much more because I don't know what other treatments she's already been on.
>her dx is panic disorder, social phobia/anxiety and treatment resistant depression of the dysthymic, withdrawn, flat-effect type.
Has she tried Nardil?
>I'm aware of the use of AP's for T R Depression, but in my experience the common ones used are Zyprexa or Risperdal.
Seroquel and Solian are also sometimes used.
>Why would her doctor choose this route?
Perhaps he thought she wouldn't take the tablets. As med pointed out, there is sometimes a good reason for not taking the tablets!
>Should I have any concerns?
I would be concerned if flupenthixol injection was being used for depression/anxiety in cases where other potentially safer treatments had not been tried. Extra-pyramidal side effects are common with flupenthixol eg. pseudo-parkinsonism, dystonia, akathisia, tardive dyskinesia.
Kind regards,
Ed.PS. Sorry for the quick reply, I have to get back to studying!
Posted by ed_uk on May 23, 2005, at 17:53:01
In reply to Flupenthixol deconoate inject. questions - Ed UK, posted by jasmineneroli on May 22, 2005, at 20:55:06
Hi Jas!
I sent you a babblemail :-)
Ed.
Posted by Tepiaca on May 23, 2005, at 22:11:46
In reply to Flupenthixol deconoate inject. questions - Ed UK, posted by jasmineneroli on May 22, 2005, at 20:55:06
5 or 6 years ago one stupid doctor decided to put me on Flupentixol tablets ( I was on Zyprexa ). He thougth this drug could really help me to control my fear. And because I had no idea of drugs in that time I started taking it. After 3 tablets I suffered the first and the worst akaticia in my life. Since that day, I have been reading about psychiatric medicines, because I dont want this to happen again on me. Sometimes doctor do not think twice before making a decision.Maybe you should look for another doctor opinion.
It seems nonsense to me to be on that drugs on these days, (although sometimes are more effective than the new ones), but I would not try it as a first option.Take care
Tep
Posted by jasmineneroli on May 24, 2005, at 18:56:11
In reply to Re: Flupenthixol deconoate inject. questions - Ed, posted by xbunny on May 23, 2005, at 7:33:07
Thank you for your reply. It was good to hear from someone who has experienced this drug.
My sister does feel it helps her, but she is still getting the occasional panic/fear rising when out by herself (on a bus, for instance). So I'm not sure how effective it really is, compared to other drugs.
I think you (& others) may be right, the reason for the depot site mode of treatment is possible non-compliance. However, her non-compliance is more in terms of not re-filling prescriptions, because she is afraid to go out. A visiting nurse comes every fortnight to administer the flupenthixol - I don't see why she couldn't just bring tablets!!
I was also wondering if it was a very cheap drug??She does suffer from insomnia at restlessness too, and when I spoke to her on the phone, she was "tripping over words" her speech was not as fluent as usual. So I do have concerns and will raise them with my parents.
Thanks so much for the link, btw.
Jas
Posted by jasmineneroli on May 24, 2005, at 19:00:25
In reply to Re: Flupenthixol deconoate inject. questions - Ed, posted by med_empowered on May 23, 2005, at 3:29:50
No problem not being Ed......I'm glad you're out there!
Thanks a lot for the info - it really confirms some of my concerns, and I'm going to urge my parents to get involved with her treaters ( a bit convaluted in the UK!).
Jas
Posted by jasmineneroli on May 24, 2005, at 19:08:36
In reply to Re: Flupenthixol deconoate inject. questions - Ed » med_empowered, posted by Larry Hoover on May 23, 2005, at 7:33:37
Thanks for the input, Lar.
As I've noted in a reply to another poster, I do think that her treaters are going the depot route because of potential non-compliance, however this would be more due to fear of going out (and thus not re-filling her prescriptions). A nurse comes to administer the drug, so I'm not sure why she couldn't bring tablet version. It's so hard not being there and asking the doctor myself.
She has been on both Prozac and Paxil in the past, and whilst I was there, was compliant in taking them. She seemed to be doing better on the Paxil to me, however I'm not "in the loop"!
I'm pretty concerned about the choice of drug, and everyone's feedback is solidifying that concern.
Time to get involved!
Thanks again,
Jas
Posted by jasmineneroli on May 24, 2005, at 19:12:13
In reply to Re: Flupenthixol deconoate inject. questions - Ed, posted by med_empowered on May 23, 2005, at 8:30:36
MedEmp:
You bring up a really good point! I bet though, that the Flupenth. is cheaper that Risperdal and Zyprexa, in the UK and that might be a reason for the choice too.
I've just thought too, she has a serious weight problem and I wonder if that would make Zyprexa contra-indicated, due to potential weight gain????
Regards,
Jas
Posted by jasmineneroli on May 24, 2005, at 19:12:57
In reply to Re: Flupenthixol deconoate inject. questions - Ed UK » jasmineneroli, posted by ed_uk on May 23, 2005, at 17:53:01
Thx Ed., I sent you one too :)
Jas
Posted by jasmineneroli on May 24, 2005, at 19:15:24
In reply to Re: Flupenthixol deconoate inject. questions - Ed UK » jasmineneroli, posted by Tepiaca on May 23, 2005, at 22:11:46
Thx Tep:
Yes, I think part of the reason for chosing this drug, was the fear control thing too......but I'm not sure it's helping all that much.
Your feedback has helped, I'm going to be in touch with my family in the UK.
Regards,
Jas
Posted by jasmineneroli on May 24, 2005, at 19:17:31
In reply to Re: Flupenthixol deconoate inject. questions - Ed UK » jasmineneroli, posted by Phillipa on May 22, 2005, at 21:44:40
> Is that the same as prolixin? Fondly, Phillipa
No, I don't think so. It's an ancient AP though, I'm pretty concerned about its use.
Regards,
Jas
Posted by ed_uk on May 25, 2005, at 8:02:59
In reply to Re: Flupenthixol deconoate inject. questions - Ed » xbunny, posted by jasmineneroli on May 24, 2005, at 18:56:11
>restlessness
Flupenthixol can cause restlesness.
Regards,
Ed.
This is the end of the thread.
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