PubMed · 1978003
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G Wardell. 1990-11-03. Depot clopenthixol.. https://doi.org/10.1016/0140-6736(90)92605-h
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Zuclopenthixol serum concentrations were measured in 58 psychiatric patients referred for routine therapeutic drug monitoring (TDM). Patients were treated for prolonged time with zuclopenthixol decanoate in viscoleo in doses of 50-500 mg, administered intramuscularly at 14-day intervals. The serum concentration was determined at days 7 (C7) and 14 (C14) following injection. The mean ratio C7/C14 was 2.0 and was independent of the dosage given. In 14 patients, additional blood samples were drawn at day 3 (C3) following injection. The mean ratio C3/C14 of this group was 3.2. An almost log-linear decline of the serum concentration from day 3 to 14 appeared, which corresponds to an apparent half-life of zuclopenthixol in this dosage form of 7.4 days. The marked fluctuations of serum concentrations of zuclopenthixol from peak to trough levels in patients given fortnightly injections of the depot preparation indicate that shorter intervals between injections should be considered in many cases in order to diminish side effects.
The effect of therapeutic drug monitoring (TDM), including pharmacokinetic guidance, was examined in 994 psychiatric patients treated with perphenazine (Trilafon) or zuclopentixol (Cisordinol). Before monitoring of the serum level, half of the serum concentrations from patients given perphenazine tablets (466 patients) was below the therapeutic level, and about one third was above. For perphenazine depot (208 patients), almost no patients had a serum concentration below the therapeutic level whereas 40% had concentrations above. For zuclopentixol tablets (231 patienter) and zuclopentixol depot (163 patients), about 60% of the patients had concentrations above the therapeutic level. For all four groups, it was found that slightly more than half of the patients with serum concentrations outside the therapeutic level was reexamined. The dosage was changed in most of these patients (80-90%) in order to bring the concentration within the therapeutic level. Half of those in whom the dose was changed obtained concentrations within the therapeutic level. It is concluded that since the recommendations for changes of the dosage is followed to a wide extent, the therapeutic drug monitoring service does influence the treatment significantly.
The three-dimensional structures and molecular electrostatic potentials of the cis(Z) and trans(E)-isomers of flupenthixol and clopenthixol were examined by computer graphics and molecular mechanical and quantum mechanical calculations, and their internal molecular motions were studied by molecular dynamics simulations in vacuo and in aqueous solution. The simulations demonstrated that both the side chains and the tricyclic ring systems of clopenthixol and flupenthixol are highly flexible. The angle between the two phenyl ring planes varied between 105 and 171 degrees during the simulations in solution. The electrostatic potentials around the 2-substituent were significantly more negative in the trans(E)-isomers than in the cis(Z)-isomers. The stronger negative potentials may weaken electrostatic receptor interactions and, thereby, cause the trans(E)-isomers to be less active than cis(Z)-isomers. Differences both in three-dimensional structure and in electronic structure may cause the difference in pharmacological activity between cis(Z)- and trans(E)-thioxanthenes.