There are several options for printing:

• Click "Print this page" on the left to print the whole section
• Download a handy PILL (Patient Information Leaflet) a two-page summary of the main questions and answers from here for flupentixol tablets for psychosis. This can then be printed.
• Download a handy PILL (Patient Information Leaflet) a two-page summary of the main questions and answers from here for flupentixol tablets for depression and anxiety. This can then be printed.
• Download a handy PILL (Patient Information Leaflet) a two-page summary of the main questions and answers from here for flupentixol decanoate (Depixol Depot injection) as an antipsychotic. This can then be printed.

There are many other Patient Information Leaflets (PILs) across the world for patients and carers. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets

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Flupentixol (flupenthixol) is licensed and officially approved to help treat the symptoms of:

• Depression, at low doses (e.g. up to 2 to 3 mg a day)

• Psychosis and schizophrenia, at higher doses, usually as a long-acting or depot injection (Depixol)

Flupentixol can also sometimes be used to help the symptoms of:

• Anxiety (GAD or Generalised Anxiety Disorder)

• Bipolar mania or hypomania

• PTSD (Post-Traumatic Stress Disorder)

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

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The usual dose of flupentixol tablets depends or what it is being taken for.

For psychosis, schizophrenia and mania in adults the usual dose is 3-9mg each day, up to a top dose of 18mg a day. In the elderly, the usual dose should start at 1-3mg a day.

For depression and anxiety, the usual dose is 0.5-1mg a day in the morning for a week, then increased to 2mg each morning if needed. The top dose for depression and anxiety is 3mg a day.

These doses should be halved in the elderly.

It is not recommended in children but this is only because it has not been studied rather than because of any concerns about safety.

^{Updated 10.11}

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This will rather depend on what you are taking it for. To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:

• Anxiety - main options, main medicines and handy chart
• Bipolar mania - main options, main medicines and handy chart
• Depression - main options, main medicines and handy chart
• PTSD - main options, main medicines and handy chart
• Psychosis - main options, main medicines and handy chart
• Schizophrenia - main options, main medicines and handy chart

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

^{Updated 10.11}

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This will rather depend on what you are taking it for. To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:

• Bipolar mood disorder - main options, main medicines and handy chart
• Psychosis - main options, main medicines and handy chart
• Schizophrenia - main options, main medicines and handy chart

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

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The brain has many naturally occurring chemical messengers (or "neurotransmitters"). Two of these are called serotonin (sometimes called 5-HT) and noradrenaline. Both are important in the areas of the brain that control mood and thinking. It is known that these chemical messengers are not as effective or active as normal in the brain when someone is depressed. Flupentixol may increase the amount of these chemical messengers released in the brain. This can help correct the lack of action of these messengers and help to improve mood. It also has a calming action.

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Take your flupentixol as directed on the medicine label. Try to take it at regular times each day. Taking it at mealtimes may make it easier to remember as there is no problem about taking flupentixol with or after food. If you are told to take it once a day this should be in the morning as it may make you more alert. If you have to take it more than once each day the last dose should be taken no later than about 4pm or teatime to make sure that you are not kept awake when you go to bed.

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Tablets:
The tablets should be swallowed with at least half a glass of water whilst you are sitting or standing. This is to make sure that they reach the stomach and do not stick in your throat.
Injections:
It is sometimes necessary or helpful for flupentixol to be given as a "depot" injection. This is usually only done when flupentixol is used for psychosis. A depot injection is a long-acting injection usually given into a buttock. The injection releases the medication over several weeks and so you will not have to remember to take tablets at regular times each day. Depot injections are otherwise no more or less effective than tablets or capsules. If you are in hospital it will be given to you by a nurse. Outside hospital it may be given to you by a Community Psychiatric Nurse, as a day patient or by your G.P. or community nurse. You may need to have this injection every few weeks for some time. To start with you will be given a test dose to make sure the drug suits you. Then, if there are no problems, 5 to 10 days later you will be given your first full dose injection which will then be repeated every one or two weeks. They are usually given into the buttock although some may be able to be given into the thigh.

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This will depend on what you are having it for. Click the links for the answer for each condition:

• Anxiety
• Bipolar mania or hypomania
• Depression
• Psychosis
• PTSD (Post-Traumatic Stress Disorder
• Schizophrenia

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This will depend on what you are taking flupentixol for. It may also depend on how unwell you have been or how severe the symptoms have been, as people respond differently. Click on the link below for the answer for that condition:

• Anxiety (GAD or Generalised Anxiety Disorder)
• Bipolar mania or hypomania
• Depression
• Psychosis
• Schizophrenia
• PTSD (Post-Traumatic Stress Disorder)

This should be discussed with your doctor as people respond differently. Some people may need to continue taking it for months or even years. Usually it is best to take them for at least 6 to 12months to make sure you are fully over your symptoms, or even longer if for schizophrenia.

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Flupentixol is not addictive as such but if you have taken it for a long time you may get some effects if you stop them suddenly. So-called "cholinergic rebound" can occur if stopped suddenly e.g. feeling sick, tiredness, sweating, anxiety and insomnia. It usually mild and only last a few days. Sometimes muscle stiffness and restlessness can occur. It is best to stop flupentixol slowly to let your brain get used to the change. The other main problem could be your symptoms coming back.

For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation. Flupentixol has none of these and so is not addictive. Any discontinuation effects are probably more of an "adjustment" reaction from sudden removal of a drug rather than "withdrawal".

Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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Start again as soon as you remember unless it is almost time for your next dose, then go on as before. Do not try to catch up by taking two or more doses at once as you may get more side-effects. You should tell your doctor about this next time you meet. Missing the occasional dose (e.g. once a week) is unlikely to be a big problem.

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices which can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, in a car etc.

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Although you will not suffer any withdrawal effects, it is unwise to stop taking flupentixol suddenly, even if you feel better. Flupentixol tablets must be taken every day for them to continue to work. If you do stop taking them before you are advised to do so by your doctor your symptoms could return.

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The table below will show you some of the main side effects you might get from flupentixol. If you are taking a low dose for anxiety or low mood, you will probably get very few of these, or they will be mild.

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

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Flupentixol may make you feel drowsy. You should not drive (see below) or operate machinery until you know how it affects you. You should be careful as it may affect your reaction times.

Flupentixol can also have an alerting effect in some people so it should not be taken later than 4pm each evening.

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In low doses it is not thought that flupentixol causes any changes in weight. If, however, you do start to put on weight tell your doctor next time you meet as he or she can arrange for you to see a dietician for advice.

Any weight gain can be part of the so-called ”metabolic syndrome”. You might want to read a bit more about this.

Click here for a few tips on how to help you feel less hungry and lose weight.

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Drugs can affect desire (libido), arousal (erection) and ability to have an orgasm (to come). Flupentixol is not thought to have a major affect any of these. If this does happen, you should discuss this with your doctor, as a change in dose or medicine may help minimise the problem. He or she might also do a blood test so see if your prolactin level is too high as high prolactin can have a negative effect on desire.

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You should have no problem with any foods or drinks, other than alcohol (see separate question).

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. epilepsy, asthma or a chest infection (as alcohol can make it harder to breathe)
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

You should be careful about drinking alcohol while taking flupentixol as it may make you feel sleepy. If this happens, you will need to take extra care if you need to drive or operate machinery. You must seek advice on this. 

It is not safe to drive after drinking alcohol, with or without flupentixol. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

^{Updated 11.11}

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You should have no problems if you take other medicines with flupentixol. It has no known drug interactions. It is a good idea to make sure your doctor knows about all the medicines you are taking. You should tell your doctor before starting or stopping this or any other drugs. There may be other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking. However, it seems that there are no extra problems if smoking with flupentixol or zuclopenthixol.

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, it seems that there are no extra problems if smoking cannabis with flupentixol or zuclopenthixol. But, it might make you feel a bit more drowsy and may have more dry mouth, blurred vision and finding it hard to pass water (wee). Also, don't forget that cannabis can make psychotic symptoms worse.

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, it seems that there are no extra problems with cocaine and flupentixol or zuclopenthixol. Flupentixol might in fact reduce the cravings for cocaine and reduce the effects of cocaine.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with flupentixol or zuclopenthixol and ecstasy, but again this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). It is known that flupentixol or zuclopenthixol can increase the effects of opiates (e.g. heroin, methadone, codeine). This can lead to more sedation and more chance of not being able to breathe properly. Deaths have been reported.

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You should have no problems with "The Pill" and flupentixol.

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking flupentixol, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain (the tuberoinfundibular system if you want to know). This area of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain. This is just what we want to help reduce some of the symptoms caused by too much dopamine e.g. psychosis, paranoia. However, if these medicines also block dopamine in the area of the brain that keeps prolactin under control, prolactin can get out of control and increase. Higher than usual levels of prolactin in the brain and blood will stop your periods (or at least make them irregular or unpredictable). Much higher levels can lead to your breasts leaking milk or lactating (the medical term is galactorrhoea). The name of the hormone (prolactin) might help you guess this anyway i.e. pro- (meaning for) -lactin (as in lactation).  High prolactin can make it more difficult to become pregnant, and over many years can have an effect on your sex-life, and maybe even your bones.

Flupentixol is one of those medicines that can increase prolactin. It can happen within a few weeks and can carry on for the whole time you are on flupentixol. So, if your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to see if your prolactin is high and to find if there are any other causes. This should be easy to work out if you had a prolactin test before you started on flupentixol. If it is caused by flupentixol then you should talk to your doctor about the options e.g. reduce the dose (which doesn't often help much), or switch medicines to one that has less effect on prolactin. Sometimes adding another medication can help if nothing else works.

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

Flupentixol is not classified, as it is not available in the USA. There is no evidence of a teratogenic effect, animal tests show a low risk of danger but some problems have been reported and so you should seek personal advice from your GP, who may then if necessary seek further specialist advice.

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.
• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.
• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter
• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit
• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half
• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was premature (early), or has kidney, liver, heart or brain problems.

We know that flupentixol and zuclopenthixol get into breast milk, but that the amount is only around 1-2% (well within the safe level). There are many reports of mums breast-feeding with no problems while taking flupentixol and zuclopenthixol. You should discuss this with your doctor, nurse or health visitor. They will be able to make regular checks on your baby to make sure there are no problems, especially during the first 4 weeks.

^{Updated 11.11}

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Flupentixol can affect your driving in two ways. Firstly, you may feel drowsy and/or suffer from blurred vision at first when taking this drug. Secondly, it can slow down your reactions or reflexes. This is especially true if you also have a dry mouth, blurred vision, constipation etc. (the so-called "anticholinergic side effects"). Until these wear off, or you know how flupentixol affects you, do not drive or operate machinery. You should be careful as they may affect your reaction times or reflexes even though you feel well.

If you are taking any medicines, the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

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You might sometimes need to have a blood test, to check on some possible side effects e.g. prolactin levels, blood sugar etc.

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