Skip to main content
Log in

A depot neuroleptic withdrawal study

Plasma concentration of fluphenazien and flupenthixol and relapse frequency

  • Original Investigations
  • Published:
Psychopharmacology Aims and scope Submit manuscript

Abstract

A double-blind withdrawal trial in 41 chronic schizophrenic outpatients was carried out during 6 months. Depot neuroleptics (fluphenazine decanoate or flupenthixol decanoate) were compared with placebo to evaluate clinical and neurological effects during continued therapy and during withdrawal. The drugs were significantly more effective than placebo in preventing relapse and rehospitalization. In the placebo group 62% relapsed compared to 27% in the drug group. There was a weak and nonsignificant tendency to a higher relapse frequency in the flupenthixol group compared to the fluphenazine group. After withdrawal for 6 months, plasma levels for fluphenazine were detectable. Plasma levels for flupenthixol were not detectable after 9 weeks of withdrawal. The differences in the plasma levels may possibly explain the difference in relapse rate between the two depot neuroleptics. Furthermore, it was found that the patients who relapsed during fluphenazine treatment had a significantly lower plasma level of the drug than patients who did not relapse during treatment. The results from this study provide some information on the therapeutic levels of fluphenazine and flupenthixol in schizophrenic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Agrup-Andersson L, Bengtsson LÅ, Erlandsson K, Gottfries CG, Witzell-Östlund G (1974) Flupenthixol decanoate: Controlled investigation concerning dosage. Acta Psychiatr Scand (Suppl) 255:7–14

    Google Scholar 

  • Andrews P, Hall JN, Snaith RP (1976) A controlled trial of phenothiazine withdrawal in chronic schizophrenic patients. Br J Psychiatry 128: 451–455

    Google Scholar 

  • Armitage P (1971) Statistical methods in medical research. Oxford University Press, London Edinburgh Melbourne

    Google Scholar 

  • Åsberg M, Montgomery SA, Schalling D, Sedvall G (1978) Comprehensive psychopathological rating scale. Acta Psychiatr Scand (Suppl) 271:1–81

    Google Scholar 

  • Ayd FJ (1975) The depot fluphenazine: A reappraisal after 10 years clinical experience. Am J Psychiatry 132:491–500

    Google Scholar 

  • Davis JM (1975) Overview: Maintenance therapy in psychiatry. I. Schizophrenia. Am J Psychiatry 132:1237–1245

    Google Scholar 

  • Gottfries CG (1971) Flupenthixol and trifluphenazine: A double-blind investigation in the treatment of schizophrenics. Br J Psychiatry 119:547–548

    Google Scholar 

  • Hansen LB, Larsen N-E, Gulmann N (1982) Dose-response-relationships of perphenazine in the treatment of acute psychoses (in press)

  • Hirsch SR, Gaind R, Rohde PD, Stevens, BC, Wing JK (1973) Outpatient maintenance of chronic schizophrenic patients with long-acting fluphenazine: Double-blind placebo trial. Br Med J 1:633–637

    Google Scholar 

  • Jørgensen A (1978) A sensitive and specific radioimmunoassay for cis(Z)-flupenthixol in human serum. Life Sci 23:1533–1542

    Google Scholar 

  • Kane JM, Rifkin A, Quitkin F, Navak D, Saraf K, Ramos-Lorenzi JR, Klein DF, Sachar EJ (1979) Low-dose fluphenazine decanoate in maintenance treatment of schizophrenia. Psychiatry Res 1:341–348

    Google Scholar 

  • Nasrallah HA, rivera-Calimlim L, Rogol AD, et al. (1978) Fluphenazine decanoate: Plasma concentrations and clinical response. Psychopharmacol Bull 14:46–47

    Google Scholar 

  • Prien RF, Cole JO, Belkin NF (1968) Relapse in chronic schizophrenics following abrupt withdrawal of tranquillizing medication. Br J Psychiatry 115:679–686

    Google Scholar 

  • Simpson GM, Pi EH (1980) Pharmacokinetics of antipsychotic agents. Abstracts of the 12th CINP Congress, Göteborg

  • Sjöqvist F (1981) General issues related to age and the pharmacology of psychoactive drugs. In: Raskin A, Robinson D, Levine J (eds) Age and the pharmacology of psychoactive drugs. Elsevier, New York, pp 195–204

    Google Scholar 

  • Smith RC, Crayton J, Dekirmenjian H, Klass D, Davis JM (1979) Blood levels of neuroleptic drugs in nonresponding chronic schizophrenic patients. Arch Gen Psychiatry 36:579–584

    Google Scholar 

  • Svendsen O, Aaes-Jørgensen T (1979) Studies on the fate of vegetable oil after intramuscular injection into experimental animals. Acta Pharmacol Toxicol (Copenh) 45:352–378

    Google Scholar 

  • Wiles DH, Franklin M (1978) Radioimmunoassay for fluphenazine in human plasma. Br J Clin Pharmacol 5:265–268

    Google Scholar 

  • Wistedt B, Wiles D, Kolakowska T (1981) Slow decline of plasma drug and prolactin levels after discontinuation of chronic treatment with depot neuroleptics. Lancet I:1163

    Google Scholar 

  • Wistedt B (1981) A depot neuroleptic withdrawal study. A controlled study of the clinical effects of the withdrawal of depot fluphenazine decanoate and depot flupenthixol decanoate in chronic schizophrenic patients. Acta Psychiatr Scand 64:65–84

    Google Scholar 

  • Woggon B (1979) Neuroleptika-Absetzversuche bei chronisch schizophrenen Patienten. I. Literaturzusammenfassung. Int Pharmacopsychiatry 14:34–56

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wistedt, B., Jørgensen, A. & Wiles, D. A depot neuroleptic withdrawal study. Psychopharmacology 78, 301–304 (1982). https://doi.org/10.1007/BF00433729

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00433729

Key words

Navigation