Flupentixol
Flupentixol (INN), also known as flupenthixol (former BAN), marketed under brand names such as Depixol and Fluanxol is a typical antipsychotic drug of the thioxanthene class. In addition to single drug preparations, it is also available as flupentixol/melitracena combination product containing both melitracen (a tricyclic antidepressant) and flupentixol.
Flupentixol is  not approved for use in the US. It is, however, approved for use in the UK, Australia, Canada, Russian Federation, South Africa, New Zealand, Philippines and various other countries.

# Medical uses
Flupentixol's main use is as a long-acting injection given once in every two or three weeks to individuals with schizophrenia who have poor compliance with medication and suffer frequent relapses of illness, though it is also commonly given as a tablet. There however is little evidence to support its use for this indication.
Flupentixol is also used in low doses as an antidepressant.

# Adverse effects
Adverse effect incidence
- Extrapyramidal side effects such as: (which usually become apparent soon after therapy is begun or soon after an increase in dose is made)
- Dry mouth
- Constipation
- Hypersalivation  excessive salivation
- Blurred vision
- Diaphoresis  excessive sweating
- Nausea
- Dizziness
- Somnolence
- Restlessness
- Insomnia
- Overactivity
- Headache
- Nervousness
- Fatigue
- Myalgia
- Hyperprolactinaemia and its complications such as: (acutely)
- Dyspepsia  indigestion
- Abdominal pain
- Flatulence
- Nasal congestion
- Polyuria  passing more urine than usual.
- Fainting
- Palpitations
- Blood dyscrasias (abnormalities in the cell composition of blood), such as:
- Neuroleptic malignant syndrome  a potentially fatal condition that appear to result from central D2 receptor blockade. The symptoms include:
- Jaundice
- Abnormal liver function test results
- Tardive dyskinesia  an often incurable movement disorder that usually results from years of continuous treatment with antipsychotic drugs, especially typical antipsychotics like flupenthixol. It presents with repetitive, involuntary, purposeless and slow movements.
- Hypotension
- Confusional state
- Seizures
- Mania
- Hypomania
- Depression
- Hot flush
- Anergia
- Appetite changes
- Weight changes
- Hyperglycaemia  high blood glucose (sugar) levels
- Abnormal glucose tolerance
- Pruritus  itchiness
- Rash
- Dermatitis
- Photosensitivity  sensitivity to light
- Oculogyration
- Accommodation disorder
- Sleep disorder
- Impaired concentration
- Tachycardia
- QTc interval prolongation  an abnormality in the electrical activity of the heart that can lead to potentially fatal changes in heart rhythm
- Torsades de Pointes
- Miosis  constriction of the pupil of the eye.
- Paralytic ileus  paralysis of the bowel muscles leading to severe constipation, inability to pass wind, etc.
- Mydriasis
- Glaucoma

## Interactions
It should be not used concomitantly with medications known to prolong the QTc interval (e.g. 5-HT3 antagonists, tricyclic antidepressants, citalopram, etc.) as this may lead to an increased risk of QTc interval prolongation. Neither should it be given concurrently with lithium (medication) as it may increase the risk of lithium toxicity and neuroleptic malignant syndrome. It should not be given concurrently with other antipsychotics due to the potential for this to increase the risk of side effects, especially neurological side effects such as neuroleptic malignant syndrome. It should be avoided in patients on CNS depressants such as opioids, alcohol and barbiturates.

## Contraindications
It should not be given in the following disease states:
- Phaeochromocytoma
- Prolactin-dependent tumours such as pituitary prolactinomas and breast cancer.
- Long QT syndrome
- Coma
- Circulatory collapse
- Subcortical brain damage
- Blood dyscrasia
- Parkinson's disease
- Dementia with lewy bodies

# Pharmacology
Binding profile
Acronyms used:
HFC - Human frontal cortex receptor
MB - Mouse brain receptor
RC - Cloned rat receptor
Its antipsychotic effects are likely caused by D2 and/or 5-HT2A antagonism, whereas its antidepressant effects at lower doses may be mediated by preferential D2/D3 autoreceptor blockade, resulting in increased postsynaptic activation.

# Society and culture
The combination of flupenthixol and melitracen is banned by Indian regulatory body.