Zuclopenthixol

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Mahesh Jayaram - One of the best experts on this subject based on the ideXlab platform.

  • The Cochrane Library - Zuclopenthixol versus placebo for schizophrenia
    Cochrane Database of Systematic Reviews, 2015
    Co-Authors: Michael Lacey, Mahesh Jayaram
    Abstract:

    Background Zuclopenthixol is an older antipsychotic that has three distinct formulations (Zuclopenthixol dihydrochloride, Zuclopenthixol acetate or Acuphase and Zuclopenthixol decanoate). Although it has been in common use for many years no previous systematic review of its efficacy compared to placebo in schizophrenia has been undertaken. Objectives To evaluate the effectiveness of all formulations of Zuclopenthixol when compared with a placebo in schizophrenia. Search methods On 6 November 2013 and 20 October 2015, we searched the Cochrane Schizophrenia Group Trials Register, which is based on regular searches of MEDLINE, EMBASE, CINAHL, BIOSIS, AMED, PubMed, PsycINFO, and registries of clinical trials. We also checked the references of all included studies and contacted authors of included studies for relevant studies and data. Selection criteria We included all randomised controlled trials comparing Zuclopenthixol of any form with placebo for treatment of schizophrenia or schizophrenia-like psychoses. Data collection and analysis We extracted and cross-checked data independently. We identified only a small number of studies so we cross checked all studies. We calculated fixed-effect relative risks (RR) and 95% confidence intervals (CI) for dichotomous data. We analysed by intention-to-treat. Where possible we converted continuous outcomes into dichotomous outcomes. When this was not possible we used mean differences (MD) for continuous variables. We assessed risk of bias for included studies and used GRADE (Grading of Recommendations Assessment, Development and Evaluation) to create a 'Summary of findings' table. Main results Only two studies, with a total of 65 participants, were eligible for inclusion in the review. Overall the quality of the two studies was low, with small study populations and significant sources of bias, so we were not able to use all the data in our comparisons. . The studies were old from 1968 and 1972, and would be unlikely to pass modern peer review standard. We were only able to find short-term data and only trials randomising Zuclopenthixol dihydrochloride. We also hoped to identify data for Zuclopenthixol acetate versus placebo and Zuclopenthixol decanoate versus placebo comparisons. We were unable to identify any studies that included data on these two fairly widely used drugs. For our primary outcome of interest, clinically significant improvement, we found one study that provided useable data. Global state measured by clinical global impression scale (CGI) improvement showed different ratings when assessed by a psychiatrist or a nurse.The psychiatrist scores failed to achieve statistical significance, however when assessed by nursing staff, the difference favouring Zuclopenthixol did reach statistical significance (1 RCT n = 29, RR 2.57 95% CI 1.06 to 6.20, very low quality data). There was also evidence of increased sedation with those treated with Zuclopenthixol when compared with placebo (1 RCT n = 29, RR 4.67 95% CI 1.23 to 17.68, very low quality data). 'Leaving the study early' data were equivocal. No useable data were available for outcomes such as relapse, mental state, death, quality of life, service use or economic costs. Authors' conclusions For people with schizophrenia this review shows that Zuclopenthixol dihydrochloride may help with the symptoms of schizophrenia. The review provides some trial evidence that, if taking Zuclopenthixol dihydrochloride, people may experience some adverse effects and sedation compared with placebo. However this evidence is of very low quality and with some significant sources of bias. There are no data for Zuclopenthixol decanoate or Zuclopenthixol acetate. For clinicians, the available trial data on the absolute effectiveness of Zuclopenthixol dihydrochloride do support its use but the limited nature of the data and significant sources of bias make conclusions hard to draw. Zuclopenthixol in all three forms is a commonly used antipsychotic and it is disappointing that there are so few data regarding its use.

  • Zuclopenthixol versus placebo for schizophrenia
    Cochrane Database of Systematic Reviews, 2015
    Co-Authors: Michael Lacey, Mahesh Jayaram
    Abstract:

    Background Zuclopenthixol is an older antipsychotic that has three distinct formulations (Zuclopenthixol dihydrochloride, Zuclopenthixol acetate or Acuphase and Zuclopenthixol decanoate). Although it has been in common use for many years no previous systematic review of its efficacy compared to placebo in schizophrenia has been undertaken. Objectives To evaluate the effectiveness of all formulations of Zuclopenthixol when compared with a placebo in schizophrenia. Search methods On 6 November 2013 and 20 October 2015, we searched the Cochrane Schizophrenia Group Trials Register, which is based on regular searches of MEDLINE, EMBASE, CINAHL, BIOSIS, AMED, PubMed, PsycINFO, and registries of clinical trials. We also checked the references of all included studies and contacted authors of included studies for relevant studies and data. Selection criteria We included all randomised controlled trials comparing Zuclopenthixol of any form with placebo for treatment of schizophrenia or schizophrenia-like psychoses. Data collection and analysis We extracted and cross-checked data independently. We identified only a small number of studies so we cross checked all studies. We calculated fixed-effect relative risks (RR) and 95% confidence intervals (CI) for dichotomous data. We analysed by intention-to-treat. Where possible we converted continuous outcomes into dichotomous outcomes. When this was not possible we used mean differences (MD) for continuous variables. We assessed risk of bias for included studies and used GRADE (Grading of Recommendations Assessment, Development and Evaluation) to create a 'Summary of findings' table. Main results Only two studies, with a total of 65 participants, were eligible for inclusion in the review. Overall the quality of the two studies was low, with small study populations and significant sources of bias, so we were not able to use all the data in our comparisons. . The studies were old from 1968 and 1972, and would be unlikely to pass modern peer review standard. We were only able to find short-term data and only trials randomising Zuclopenthixol dihydrochloride. We also hoped to identify data for Zuclopenthixol acetate versus placebo and Zuclopenthixol decanoate versus placebo comparisons. We were unable to identify any studies that included data on these two fairly widely used drugs. For our primary outcome of interest, clinically significant improvement, we found one study that provided useable data. Global state measured by clinical global impression scale (CGI) improvement showed different ratings when assessed by a psychiatrist or a nurse.The psychiatrist scores failed to achieve statistical significance, however when assessed by nursing staff, the difference favouring Zuclopenthixol did reach statistical significance (1 RCT n = 29, RR 2.57 95% CI 1.06 to 6.20, very low quality data). There was also evidence of increased sedation with those treated with Zuclopenthixol when compared with placebo (1 RCT n = 29, RR 4.67 95% CI 1.23 to 17.68, very low quality data). 'Leaving the study early' data were equivocal. No useable data were available for outcomes such as relapse, mental state, death, quality of life, service use or economic costs. Authors' conclusions For people with schizophrenia this review shows that Zuclopenthixol dihydrochloride may help with the symptoms of schizophrenia. The review provides some trial evidence that, if taking Zuclopenthixol dihydrochloride, people may experience some adverse effects and sedation compared with placebo. However this evidence is of very low quality and with some significant sources of bias. There are no data for Zuclopenthixol decanoate or Zuclopenthixol acetate. For clinicians, the available trial data on the absolute effectiveness of Zuclopenthixol dihydrochloride do support its use but the limited nature of the data and significant sources of bias make conclusions hard to draw. Zuclopenthixol in all three forms is a commonly used antipsychotic and it is disappointing that there are so few data regarding its use.

Gudrun Høiseth - One of the best experts on this subject based on the ideXlab platform.

  • Impact of CYP2D6 on serum concentrations of flupentixol, haloperidol, perphenazine and Zuclopenthixol.
    British Journal of Clinical Pharmacology, 2020
    Co-Authors: Ragnhild Birkeland Waade, Vigdis Solhaug, Gudrun Høiseth
    Abstract:

    AIMS To investigate the impact of cytochrome P450 2D6 (CYP2D6) on dose-adjusted serum concentrations of flupentixol, haloperidol, perphenazine and Zuclopenthixol in a therapeutic drug monitoring (TDM) cohort of psychiatric patients. We also especially studied the functional impact of CYP2D6*41 on dose-adjusted serum concentrations in the perphenazine-treated patients. METHODS Serum concentrations of flupentixol, haloperidol, perphenazine and Zuclopenthixol from CYP-genotyped patients were extracted retrospectively from a routine TDM database in the period March 2005 to May 2019. Samples were divided into three CYP2D6 phenotype subgroups according to genotype; normal metabolizers (NMs), intermediate metabolizers (IMs) and poor metabolizers (PMs). The effect of CYP2D6 phenotype on dose-adjusted serum concentrations of the four antipsychotics was evaluated by multivariable mixed model analyses. RESULTS Mean dose-adjusted serum concentrations of perphenazine (564 samples) were 3.9-fold and 1.6-fold higher in CYP2D6 PMs and IMs, respectively, compared with NMs (p

  • impact of cyp2d6 on serum concentrations of flupentixol haloperidol perphenazine and Zuclopenthixol
    British Journal of Clinical Pharmacology, 2020
    Co-Authors: Ragnhild Birkeland Waade, Vigdis Solhaug, Gudrun Høiseth
    Abstract:

    AIMS To investigate the impact of cytochrome P450 2D6 (CYP2D6) on dose-adjusted serum concentrations of flupentixol, haloperidol, perphenazine and Zuclopenthixol in a therapeutic drug monitoring (TDM) cohort of psychiatric patients. We also especially studied the functional impact of CYP2D6*41 on dose-adjusted serum concentrations in the perphenazine-treated patients. METHODS Serum concentrations of flupentixol, haloperidol, perphenazine and Zuclopenthixol from CYP-genotyped patients were extracted retrospectively from a routine TDM database in the period March 2005 to May 2019. Samples were divided into three CYP2D6 phenotype subgroups according to genotype; normal metabolizers (NMs), intermediate metabolizers (IMs) and poor metabolizers (PMs). The effect of CYP2D6 phenotype on dose-adjusted serum concentrations of the four antipsychotics was evaluated by multivariable mixed model analyses. RESULTS Mean dose-adjusted serum concentrations of perphenazine (564 samples) were 3.9-fold and 1.6-fold higher in CYP2D6 PMs and IMs, respectively, compared with NMs (p<0.001 and p<0.01). For Zuclopenthixol (658 samples), mean dose-adjusted serum concentrations were about 1.5-fold and 1.3-fold higher in CYP2D6 PMs and IMs, respectively, compared with NMs (p<0.01 and p<0.001). CYP2D6 was of minor or no importance to haloperidol (320 samples) and flupentixol (115 samples). In our data material, the genotype CYP2D6 *1/*41 appears to have a similar impact on dose-adjusted serum concentrations of perphenazine as *1/null (null = variant allele encoding no enzyme function). CONCLUSIONS This study shows that CYP2D6 is important for the metabolism of perphenazine and Zuclopenthixol, but not for haloperidol and flupentixol. The CYP2D6*41 allele appears to have a reduced function close to non-functional variant alleles.

  • Impact of age and CYP2D6 genotype on exposure of Zuclopenthixol in patients using long-acting injectable versus oral formulation—an observational study including 2044 patients
    European Journal of Clinical Pharmacology, 2020
    Co-Authors: Marit Tveito, Robert Løvsletten Smith, Espen Molden, Gudrun Høiseth
    Abstract:

    Purpose Zuclopenthixol is an antipsychotic available as oral and long-acting injectable (LAI) formulations. The aim of this study was to investigate the effect of age on Zuclopenthixol exposure during oral and LAI administrations without and with adjustment for CYP2D6 genotype. Methods Data on serum concentrations of Zuclopenthixol and CYP2D6 genotype (available for 28.2% of the population) from patients using oral or LAI Zuclopenthixol were included retrospectively from a therapeutic drug monitoring service during the period 2005–2019. As a measure of exposure, dose-adjusted serum concentration (C/D ratio) was used. Based on age, patients were grouped to older (≥ 65 years) or younger (18–64 years). Linear mixed model analyses without and with adjustment for CYP2D6 genotype were used. Results Serum concentrations of Zuclopenthixol from 1145 (14.1% older) and 899 patients (24.6% older) in the LAI and oral groups were included, respectively. Compared with younger patients, older patients had a higher C/D ratio of Zuclopenthixol for LAI (+ 25–33%, p < 0.001) and oral formulation (+ 25–29%, p ≤ 0.003) without and with adjustment for CYP2D6 genotype. The doses were lower in older versus younger patients (oral: − 30%; LAI: − 20%; p < 0.001). Compared with the younger LAI users without reduced CYP2D6 function, a higher C/D ratio was observed in the older LAI users with reduced CYP2D6 function (+ 104%, p < 0.001). Conclusion The present study showed that Zuclopenthixol exposure increases in older patients and that the older LAI users with reduced CYP2D6 function are exposed to high serum concentrations. Also, the present study showed that similar dose reductions are required for oral and LAI users.

Michael Lacey - One of the best experts on this subject based on the ideXlab platform.

  • The Cochrane Library - Zuclopenthixol versus placebo for schizophrenia
    Cochrane Database of Systematic Reviews, 2015
    Co-Authors: Michael Lacey, Mahesh Jayaram
    Abstract:

    Background Zuclopenthixol is an older antipsychotic that has three distinct formulations (Zuclopenthixol dihydrochloride, Zuclopenthixol acetate or Acuphase and Zuclopenthixol decanoate). Although it has been in common use for many years no previous systematic review of its efficacy compared to placebo in schizophrenia has been undertaken. Objectives To evaluate the effectiveness of all formulations of Zuclopenthixol when compared with a placebo in schizophrenia. Search methods On 6 November 2013 and 20 October 2015, we searched the Cochrane Schizophrenia Group Trials Register, which is based on regular searches of MEDLINE, EMBASE, CINAHL, BIOSIS, AMED, PubMed, PsycINFO, and registries of clinical trials. We also checked the references of all included studies and contacted authors of included studies for relevant studies and data. Selection criteria We included all randomised controlled trials comparing Zuclopenthixol of any form with placebo for treatment of schizophrenia or schizophrenia-like psychoses. Data collection and analysis We extracted and cross-checked data independently. We identified only a small number of studies so we cross checked all studies. We calculated fixed-effect relative risks (RR) and 95% confidence intervals (CI) for dichotomous data. We analysed by intention-to-treat. Where possible we converted continuous outcomes into dichotomous outcomes. When this was not possible we used mean differences (MD) for continuous variables. We assessed risk of bias for included studies and used GRADE (Grading of Recommendations Assessment, Development and Evaluation) to create a 'Summary of findings' table. Main results Only two studies, with a total of 65 participants, were eligible for inclusion in the review. Overall the quality of the two studies was low, with small study populations and significant sources of bias, so we were not able to use all the data in our comparisons. . The studies were old from 1968 and 1972, and would be unlikely to pass modern peer review standard. We were only able to find short-term data and only trials randomising Zuclopenthixol dihydrochloride. We also hoped to identify data for Zuclopenthixol acetate versus placebo and Zuclopenthixol decanoate versus placebo comparisons. We were unable to identify any studies that included data on these two fairly widely used drugs. For our primary outcome of interest, clinically significant improvement, we found one study that provided useable data. Global state measured by clinical global impression scale (CGI) improvement showed different ratings when assessed by a psychiatrist or a nurse.The psychiatrist scores failed to achieve statistical significance, however when assessed by nursing staff, the difference favouring Zuclopenthixol did reach statistical significance (1 RCT n = 29, RR 2.57 95% CI 1.06 to 6.20, very low quality data). There was also evidence of increased sedation with those treated with Zuclopenthixol when compared with placebo (1 RCT n = 29, RR 4.67 95% CI 1.23 to 17.68, very low quality data). 'Leaving the study early' data were equivocal. No useable data were available for outcomes such as relapse, mental state, death, quality of life, service use or economic costs. Authors' conclusions For people with schizophrenia this review shows that Zuclopenthixol dihydrochloride may help with the symptoms of schizophrenia. The review provides some trial evidence that, if taking Zuclopenthixol dihydrochloride, people may experience some adverse effects and sedation compared with placebo. However this evidence is of very low quality and with some significant sources of bias. There are no data for Zuclopenthixol decanoate or Zuclopenthixol acetate. For clinicians, the available trial data on the absolute effectiveness of Zuclopenthixol dihydrochloride do support its use but the limited nature of the data and significant sources of bias make conclusions hard to draw. Zuclopenthixol in all three forms is a commonly used antipsychotic and it is disappointing that there are so few data regarding its use.

  • Zuclopenthixol versus placebo for schizophrenia
    Cochrane Database of Systematic Reviews, 2015
    Co-Authors: Michael Lacey, Mahesh Jayaram
    Abstract:

    Background Zuclopenthixol is an older antipsychotic that has three distinct formulations (Zuclopenthixol dihydrochloride, Zuclopenthixol acetate or Acuphase and Zuclopenthixol decanoate). Although it has been in common use for many years no previous systematic review of its efficacy compared to placebo in schizophrenia has been undertaken. Objectives To evaluate the effectiveness of all formulations of Zuclopenthixol when compared with a placebo in schizophrenia. Search methods On 6 November 2013 and 20 October 2015, we searched the Cochrane Schizophrenia Group Trials Register, which is based on regular searches of MEDLINE, EMBASE, CINAHL, BIOSIS, AMED, PubMed, PsycINFO, and registries of clinical trials. We also checked the references of all included studies and contacted authors of included studies for relevant studies and data. Selection criteria We included all randomised controlled trials comparing Zuclopenthixol of any form with placebo for treatment of schizophrenia or schizophrenia-like psychoses. Data collection and analysis We extracted and cross-checked data independently. We identified only a small number of studies so we cross checked all studies. We calculated fixed-effect relative risks (RR) and 95% confidence intervals (CI) for dichotomous data. We analysed by intention-to-treat. Where possible we converted continuous outcomes into dichotomous outcomes. When this was not possible we used mean differences (MD) for continuous variables. We assessed risk of bias for included studies and used GRADE (Grading of Recommendations Assessment, Development and Evaluation) to create a 'Summary of findings' table. Main results Only two studies, with a total of 65 participants, were eligible for inclusion in the review. Overall the quality of the two studies was low, with small study populations and significant sources of bias, so we were not able to use all the data in our comparisons. . The studies were old from 1968 and 1972, and would be unlikely to pass modern peer review standard. We were only able to find short-term data and only trials randomising Zuclopenthixol dihydrochloride. We also hoped to identify data for Zuclopenthixol acetate versus placebo and Zuclopenthixol decanoate versus placebo comparisons. We were unable to identify any studies that included data on these two fairly widely used drugs. For our primary outcome of interest, clinically significant improvement, we found one study that provided useable data. Global state measured by clinical global impression scale (CGI) improvement showed different ratings when assessed by a psychiatrist or a nurse.The psychiatrist scores failed to achieve statistical significance, however when assessed by nursing staff, the difference favouring Zuclopenthixol did reach statistical significance (1 RCT n = 29, RR 2.57 95% CI 1.06 to 6.20, very low quality data). There was also evidence of increased sedation with those treated with Zuclopenthixol when compared with placebo (1 RCT n = 29, RR 4.67 95% CI 1.23 to 17.68, very low quality data). 'Leaving the study early' data were equivocal. No useable data were available for outcomes such as relapse, mental state, death, quality of life, service use or economic costs. Authors' conclusions For people with schizophrenia this review shows that Zuclopenthixol dihydrochloride may help with the symptoms of schizophrenia. The review provides some trial evidence that, if taking Zuclopenthixol dihydrochloride, people may experience some adverse effects and sedation compared with placebo. However this evidence is of very low quality and with some significant sources of bias. There are no data for Zuclopenthixol decanoate or Zuclopenthixol acetate. For clinicians, the available trial data on the absolute effectiveness of Zuclopenthixol dihydrochloride do support its use but the limited nature of the data and significant sources of bias make conclusions hard to draw. Zuclopenthixol in all three forms is a commonly used antipsychotic and it is disappointing that there are so few data regarding its use.

Ajit Kumar - One of the best experts on this subject based on the ideXlab platform.

  • Zuclopenthixol dihydrochloride for schizophrenia.
    Cochrane Database of Systematic Reviews, 2017
    Co-Authors: Edward J Bryan, Marie Ann Purcell, Ajit Kumar
    Abstract:

    Background Oral Zuclopenthixol dihydrochloride (Clopixol) is an anti-psychotic treatment for people with psychotic symptoms, especially those with schizophrenia. It is associated with neuroleptic malignant syndrome, a prolongation of the QTc interval, extra-pyramidal reactions, venous thromboembolism and may modify insulin and glucose responses. Objectives To determine the effects of Zuclopenthixol dihydrochloride for treatment of schizophrenia. Search methods We searched the Cochrane Schizophrenia Group's Trials Register (latest search 09 June 2015). There were no language, date, document type, or publication status limitations for inclusion of records in the register. Selection criteria All randomised controlled trials (RCTs) focusing on Zuclopenthixol dihydrochloride for schizophrenia. We included trials meeting our inclusion criteria and reporting useable data. Data collection and analysis We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a random-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. Main results We included 20 trials, randomising 1850 participants. Data were reported for 12 comparisons, predominantly for the short term (up to 12 weeks) and inpatient populations. Overall risk of bias for included studies was low to unclear. Data were unavailable for many of our pre-stated outcomes of interest. No data were available, across all comparisons, for death, duration of stay in hospital and general functioning. Zuclopenthixol dihydrochloride versus: 1. placebo Movement disorders (EPSEs) were similar between groups (1 RCT, n = 28, RR 6.07 95% CI 0.86 to 43.04 very low-quality evidence). There was no clear difference in numbers leaving the study early (2 RCTs, n = 100, RR 0.29, 95% CI 0.01 to 6.60, very low-quality evidence). 2. chlorpromazine No clear differences were found for the outcomes of global state (average CGI-SI endpoint score) (1 RCT, n = 60, MD 0.00, 95% CI -0.49 to 0.49) or movement disorders (EPSEs) (3 RCTs, n = 199, RR 0.94, 95% CI 0.61 to 1.45), both very low-quality evidence. More people left the study early for any reason from the Zuclopenthixol group (6 RCTs, n = 766, RR 0.54, 95% CI 0.36 to 0.81, low-quality evidence). 3. chlorprothixene There was no clear difference in numbers leaving the study early for any reason (1 RCT, n = 20, RR 1.00, 95% CI 0.34 to 2.93, very low-quality evidence). 4. clozapine No useable data were presented. 5. haloperidol No clear differences between treatment groups were found for the outcomes global state score (average CGI endpoint score) (1 RCT, n = 49, MD 0.13, 95% CI -0.30 to 0.55) or leaving the study early (2 RCTs, n = 141, RR 0.99, 95% CI 0.72 to 1.35), both very low-quality evidence. 6. perphenazine Those receiving Zuclopenthixol were more likely to require medication in the short term for EPSEs than perphenazine (1 RCT, n = 50, RR 1.90, 95% CI 1.12 to 3.22, very low-quality evidence). Similar numbers left the study early (2 RCTs, n = 104, RR 0.63, 95% CI 0.27 to 1.47, very low-quality evidence). 7. risperidone Those receiving Zuclopenthixol were more likely to require medications for EPSEs than risperidone (1 RCT, n = 98,RR 1.92, 95% CI 1.12 to 3.28, very low quality evidence). There was no clear difference in numbers leaving the study early ( 3 RCTs, n = 154, RR 1.30, 95% CI 0.84 to 2.02) or in mental state (average PANSS total endpoint score) (1 RCT, n = 25, MD -3.20, 95% CI -7.71 to 1.31), both very low-quality evidence). 8. sulpiride No clear differences were found for global state (average CGI endpoint score) ( 1 RCT, n = 61, RR 1.18, 95% CI 0.49 to 2.85, very low-quality evidence), requiring hypnotics/sedatives (1 RCT, n = 61, RR 0.60, 95% CI 0.27 to 1.32, very low-quality evidence) or leaving the study early (1 RCT, n = 61, RR 2.07 95% CI 0.97 to 4.40, very low-quality evidence). 9. thiothixene No clear differences were found for the outcomes of 'global state (average CGI endpoint score) (1 RCT, n = 20, RR 0.50, 95% CI 0.17 to 1.46) or leaving the study early (1 RCT, n = 20, RR 0.57, 95% CI 0.24 to 1.35), both very low-quality evidence). 10. trifluoperazine No useable data were presented. 11. Zuclopenthixol depot There was no clear difference in numbers leaving the study early (1 RCT, n = 46, RR 1.95, 95% CI 0.36 to 10.58, very low-quality evidence). 12. Zuclopenthixol dihydrochloride (cis z isomer) versus Zuclopenthixol (cis z/trans e isomer) There were no clear differences in reported side-effects ( 1 RCT, n = 57, RR 1.34, 95% CI 0.82 to 2.18, very low-quality evidence) and in numbers leaving the study early (4 RCTs, n = 140, RR 2.15, 95% CI 0.49 to 9.41, very low-quality evidence). Authors' conclusions Zuclopenthixol dihydrochloride appears to cause more EPSEs than clozapine, risperidone or perphenazine, but there was no difference in EPSEs when compared to placebo or chlorpromazine. Similar numbers required hypnotics/sedatives when Zuclopenthixol dihydrochloride was compared to sulpiride, and similar numbers of reported side-effects were found when its isomers were compared. The other comparisons did not report adverse-effect data. Reported data indicate Zuclopenthixol dihydrochloride demonstrates no difference in mental or global states compared to placebo, chlorpromazine, chlorprothixene, clozapine, haloperidol, perphenazine, sulpiride, thiothixene, trifluoperazine, depot and isomers. Zuclopenthixol dihydrochloride, when compared with risperidone, is favoured when assessed using the PANSS in the short term, but not in the medium term. The data extracted from the included studies are mostly equivocal, and very low to low quality, making it difficult to draw firm conclusions. Prescribing practice is unlikely to change based on this meta-analysis. Recommending any particular course of action about side-effect medication other than monitoring, using rating scales and clinical assessment, and prescriptions on a case-by-case basis, is also not possible. There is a need for further studies covering this topic with more antipsychotic comparisons for currently relevant outcomes.

  • Zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses.
    The Cochrane database of systematic reviews, 2012
    Co-Authors: Kaushadh Jayakody, Roger Carl Gibson, Ajit Kumar, Shalmini Gunadasa
    Abstract:

    Medication used for acute aggression in psychiatry must have rapid onset of effect, low frequency of administration and low levels of adverse effects. Zuclopenthixol acetate is said to have these properties. To estimate the clinical effects of Zuclopenthixol acetate for the management of acute aggression or violence thought to be due to serious mental illnesses, in comparison to other drugs used to treat similar conditions. We searched the Cochrane Schizophrenia's Group Trials Register (July 2011). We supplemented this by citation searching and personal contact with authors and relevant pharmaceutical companies. All randomised clinical trials involving people thought to have serious mental illnesses comparing Zuclopenthixol acetate with other drugs. Two review authors extracted and cross-checked data independently. We calculated fixed-effect relative risks (RR) and 95% confidence intervals (CI) for dichotomous data. We analysed by intention-to-treat. We used mean differences (MD) for continuous variables. We found no data for the primary outcome, tranquillisation. Compared with haloperidol, Zuclopenthixol acetate was no more sedating at two hours (n = 40, 1 RCT, RR 0.60, 95% CI 0.27 to 1.34). People given Zuclopenthixol acetate were not at reduced risk of being given supplementary antipsychotics (n = 134, 3 RCTs, RR 1.49, 95% CI 0.97 to 2.30) although additional use of benzodiazepines was less (n = 50, 1 RCT, RR 0.03, 95% CI 0.00 to 0.47). People given Zuclopenthixol acetate had fewer injections over seven days compared with those allocated to haloperidol IM (n = 70, 1 RCT, RR 0.39, 95% CI 0.18 to 0.84, NNT 4, CI 3 to 14). We found no data on more episodes of aggression or harm to self or others. One trial (n = 148) reported no significant difference in adverse effects for people receiving Zuclopenthixol acetate compared with those allocated haloperidol at one, three and six days (RR 0.74, 95% CI 0.43 to 1.27). Compared with haloperidol or clotiapine, people allocated Zuclopenthixol did not seem to be at more risk of a range of movement disorders (< 20%). Three studies found no difference in the proportion of people getting blurred vision/dry mouth (n = 192, 2 RCTs, RR at 24 hours 0.90, 95% CI 0.48 to 1.70). Similarly, dizziness was equally infrequent for those allocated Zuclopenthixol acetate compared with haloperidol (n = 192, 2 RCTs, RR at 24 hours 1.15, 95% CI 0.46 to 2.88). There was no difference between treatments for leaving the study before completion (n = 522, RR 0.85, 95% CI 0.31 to 2.31). One study reported no difference in adverse effects and outcome scores, when high dose (50-100 mg/injection) Zuclopenthixol acetate was compared with low dose (25-50 mg/injection) Zuclopenthixol acetate. Recommendations on the use of Zuclopenthixol acetate for the management of psychiatric emergencies in preference to 'standard' treatment have to be viewed with caution. Most of the small trials present important methodological flaws and findings are poorly reported. This review did not find any suggestion that Zuclopenthixol acetate is more or less effective in controlling aggressive acute psychosis, or in preventing adverse effects than intramuscular haloperidol, and neither seemed to have a rapid onset of action. Use of Zuclopenthixol acetate may result in less numerous coercive injections and low doses of the drug may be as effective as higher doses. Well-conducted pragmatic randomised controlled trials are needed.

  • The Cochrane Library - Zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Kaushadh Jayakody, Roger Carl Gibson, Ajit Kumar, Shalmini Gunadasa
    Abstract:

    Background Medication used for acute aggression in psychiatry must have rapid onset of effect, low frequency of administration and low levels of adverse effects. Zuclopenthixol acetate is said to have these properties.

  • Zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses
    Cochrane Database of Systematic Reviews, 2012
    Co-Authors: Kaushadh Jayakody, Roger Carl Gibson, Ajit Kumar, Shalmini Gunadasa
    Abstract:

    Background Medication used for acute aggression in psychiatry must have rapid onset of effect, low frequency of administration and low levels of adverse effects. Zuclopenthixol acetate is said to have these properties.

  • Zuclopenthixol dihydrochloride for schizophrenia
    Schizophrenia Bulletin, 2009
    Co-Authors: Ajit Kumar, Daniel Strech
    Abstract:

    We searched the Cochrane Schizophrenia Group’s register (December 2004). This register is compiled of methodical searches of BIOSIS, CINAHL, Dissertation abstracts, EMBASE, LILACS, MEDLINE, PSYNDEX, PsycINFO, RUSSMED, Sociofile, supplemented with hand searching of relevant journals and numerous conference proceedings. To identify further trials, we also contacted a pharmaceutical company and authors of relevant studies.

Gabriel Rubio - One of the best experts on this subject based on the ideXlab platform.

  • * * Mental Health Centre of Ciudad Lineal, Madrid
    2016
    Co-Authors: Gabriel Rubio, Francisco López-muñoz, Cecilio Alamo, I. Martinez, Ana Recio, Guillermo Ponce, Miguel Ángel Jiménez-arriero, Tomás Palomo, Psychiatry Service, De Octubre
    Abstract:

    Risperidone versus Zuclopenthixol in the treatment of schizophrenia with substance abuse comorbidity: a long-term randomized, controlled, crossover stud

  • Original Research Long-Acting Injectable Risperidone Compared With Zuclopenthixol in the Treatment of Schizophrenia With Substance Abuse Comorbidity
    2015
    Co-Authors: Gabriel Rubio, Francisco López-muñoz, I. Martinez, Guillermo Ponce, Miguel Ángel Jiménez-arriero, Cecilio Alamo
    Abstract:

    Objective: This study aimed to compare the efficacy of long-acting risperidone and Zuclopenthixol in subjects with schizophrenia and substance abuse. Method: A total of 115 subjects with schizophrenia and substance use disorders were enrolled for an open, randomized, controlled, 6-month follow-up study. Fifty-seven subjects were selected for treatment with long-acting injectable risperidone, while another 58 were treated with Zuclopenthixol-depot. Results: Long-acting risperidone patients presented fewer positive urine tests (8.67 compared with 10.36, P = 0.005), showed improved scores on the Positive and Negative Syndrome Scale, and showed better compliance with the Substance Abuse Management program. The use of long-acting risperidone and less severe dependence explained the outcome at the end of the follow-up. Conclusions: Long-acting injectable risperidone was more effective than Zuclopenthixol-depot in improving substance abuse and schizophrenia symptoms in subjects with dual diagnosis. (Can J Psychiatry 2006;51:531–539) Information on funding and support and author affiliations appears at the end of the article

  • Long-Acting Injectable Risperidone Compared with Zuclopenthixol in the Treatment of Schizophrenia with Substance Abuse Comorbidity
    The Canadian Journal of Psychiatry, 2006
    Co-Authors: Gabriel Rubio, Francisco López-muñoz, I. Martinez, Guillermo Ponce, Miguel Ángel Jiménez-arriero, Cecilio Alamo
    Abstract:

    Objective:This study aimed to compare the efficacy of long-acting risperidone and Zuclopenthixol in subjects with schizophrenia and substance abuse.Method:A total of 115 subjects with schizophrenia and substance use disorders were enrolled for an open, randomized, controlled, 6-month follow-up study. Fifty-seven subjects were selected for treatment with long-acting injectable risperidone, while another 58 were treated with Zuclopenthixol-depot.Results:Long-acting risperidone patients presented fewer positive urine tests (8.67 compared with 10.36, P = 0.005), showed improved scores on the Positive and Negative Syndrome Scale, and showed better compliance with the Substance Abuse Management program. The use of long-acting risperidone and less severe dependence explained the outcome at the end of the follow-up.Conclusions:Long-acting injectable risperidone was more effective than Zuclopenthixol-depot in improving substance abuse and schizophrenia symptoms in subjects with dual diagnosis.

  • Risperidone versus Zuclopenthixol in the treatment of schizophrenia with substance abuse comorbidity: a long-term randomized, controlled, crossover study
    The European Journal of Psychiatry, 2006
    Co-Authors: Gabriel Rubio, Francisco López-muñoz, Cecilio Alamo, I. Martinez, Ana Recio, Guillermo Ponce, Miguel Ángel Jiménez-arriero, Tomás Palomo
    Abstract:

    Background: Substance use disorders (SUDs) are present in more than 50% of subjects diagnosed with schizophrenia. However, there are no controlled studies assessing the efficacy of antipsychotic drugs in this subgroup of patients. The aim of the present work was to compare the efficacy of risperidone and Zuclopenthixol in a sample of schizophrenic subjects with dual diagnosis. Method: Thirty-three male were selected for treatment with risperidone, while another 33 were treated with Zuclopenthixol. Substances most commonly used were alcohol, cannabis (both 82%) and cocaine (32%). Patients were randomized and treated for the first six months with one antipsychotic and the second six months with the other antipsychotic. Psychopathological and clinical scales were used every two months. Participants received training on how to reduce their consumption of substances (Substance Abuse Management Module, SAMM). Results: During the first six months risperidone group patients presented fewer positive urine tests and showed better compliance with the SAMM programme. In the second period the patients treated with risperidone significantly improved their scores on the PANSS-negative subscale. Differences between the CGIs indicated that the subjects who moved from risperidone to Zuclopenthixol worsened, while those who moved from Zuclopenthixol to risperidone significantly improved. Conclusions: Risperidone was more effective than Zuclopenthixol in improving the symptoms of schizophrenia and substance use.

  • Priapism Associated with Zuclopenthixol
    Annals of Pharmacotherapy, 2002
    Co-Authors: Julio Salado, Antonio Blázquez, Raquel Díaz-simón, Francisco López-muñoz, Cecilio Alamo, Gabriel Rubio
    Abstract:

    OBJECTIVE:To present a single case of Zuclopenthixol-induced priapism and a literature review.CASE SUMMARY:We report the case of a 31-year-old patient hospitalized due to behavioral alterations and treated with oral Zuclopenthixol, an antipsychotic from the thioxanthene family, who developed an acute, painful erection.DISCUSSION:The occurrence of priapism in our patient was related to Zuclopenthixol. This adverse reaction is reported for the first time in a patient not concomitantly treated with other drugs associated with the appearance of priapism. The capacity of Zuclopenthixol to induce priapism is thought to be due to its antagonist activity on α-adrenergic receptors.CONCLUSIONS:Priapism is an uncommon but potentially serious adverse effect of Zuclopenthixol that practitioners, as with many other antipsychotics, should be aware of.