GUIDELINES FOR THE USE OF
ZUCLOPENTHIXOL ACETATE "CLOPIXOL ACUPHASE" IM injection IN THE COMMUNITY

1.Zuclopenthixol acetate is a depot injection in thin vegetable oil. One IM injection 50-150mg has a fairly rapid and pronounced antipsychotic effect, which lasts for up to 3 days.

It is indicated for the treatment of acute psychoses including mania and exacerbation of chronic psychosis, but not for rapid tranquillisation.

Zuclopenthixol acetate produces a response within 2 hours of injection, tranquillisation and sedation reach a maximum between 8 - 12 hours and the antipsychotic effect peaks at about 36 hours.

2.In common with other antipsychotic agents it can produce drowsiness, sedation, dry mouth, nasal stuffiness and postural hypotension, particularly in the elderly. Other side effects to be borne in mind include tachycardia, blurring of vision, constipation and urinary hesitancy or retention. Acute dystonias (including oculogyric crisis), parkinsonian rigidity, tremor, akinesia and akathisia may occur in susceptible patients. Confusional states or epileptic fits can occur. In the elderly the maximum dose is 100mg and hypothermia has been reported rarely. The ability to drive a car or operate machinery may be affected and patients should be warned of this risk.

3.In the rare event of it being prescribed in the community, the following guidelines apply:

A.The Prescription

1.A senior psychiatrist (i.e. not SHO, Registrar or Junior Clinical Assistant) and the CPN should jointly assess the patient and prescribe the injection plus a supply of 10 procyclidine tablets for "as required" use.

2.The CPN/nurse should take the prescription to Springfield Hospital pharmacy to obtain the supply.

B.The Patient

Should:a.provide informed written consent

b.have previously received depot injections

c.have a Care Plan which states the use of Zuclopenthixol acetate and how the patient is to be followed up.

Should not:a.be left alone for the next 24 hours

b.be struggling or extremely disturbed

c.have a serious physical illness e.g. cardiovascular/stroke, epilepsy, diabetes, etc.

d.be known to have had NMS (Neuroleptic Malignant Syndrome).

If there is no carer, do not give Zuclopenthixol acetate.

C.Administration

1.The injection should preferably be given in the morning

2.TPR & BP (temperature, pulse, respiration and blood pressure) should be taken before and 30 mins after giving the injection. The baseline TPR & BP should be within normal limits.

3.The nurse giving the injection should stay with the patient for the first hour and call back 2 hours later when TPR & BP should be repeated.

4.The following morning (24 hours later) the patient should be seen again by the CPN/nurse and TPR & BP repeated.

5.Side effects should be documented on the form provided each time the CPN visits, i.e. at least 30 mins, 2 hours and 24 hours.

6.The patient should then be seen daily for up to 3 days.

7.Each visit should include a Mental State assessment.

D.The Carer

1.A responsible carer should stay with the patient over the next 24 hours. This should be documented in the patient’s notes.

2.The carer should be given the above supply of procyclidine tablets with clear written instructions about their use.

3.Precise written instructions should be provided to both patient and carer regarding side effects, sedation, etc.

4.The carer should be given the telephone number of the CPN/psychiatrist, also of their GP and the Springfield Duty Nurse in case of emergency.

The patient’s GP and the Springfield Duty Nurse should be informed that the patient has received the injection.

TPR, BP and any side effects to be documented at baseline and then at 30mins,

2 hours and 24 hours after injection.

Patient/Client Name: ..................................... Date: ....................................

Consultant Name: ......................................... CPN: ....................................