Download 27 October 2014 Dear Colleagues Discontinuation of Piportil

Head of Medicines Management
Trust Head Office
99 Waverley Rd
St Albans, Herts AL3 5TL
Telephone: 01727 804357
Email: Janet [email protected]
27 October 2014
Dear Colleagues
Discontinuation of Piportil (pipotiazine palmitate) Depot Injection
You may have received a letter (attached) from Sanofi-Aventis Ltd about the
global withdrawal of Piportil depot injection in March 2015. This is due to a
global shortage of the active pharmaceutical ingredient pipotiazine palmitate.
Unfortunately there is no generic or other branded product of pipotiazine
palmitate depot injection available in UK. All patients currently receiving
pipotiazine palmitate depot injection will therefore need to be reviewed and
switched to an alternative treatment before March 2015. No new patients
should be initiated on pipotiazine palmitate.
The choice of alternative will be a clinical decision by the prescriber in
conjunction with the patient.
Please consider the following steps if switching to another conventional /
typical antipsychotic depot injection.
• Full drug history
This can assist decision making for the alternative antipsychotic depot
injection.
• Dose interval and patient compliance
The pharmacokinetics of the preparation influences its dose interval. BNF1
states (according to response):
Pipotiazine palmitate and haloperidol decanoate are 4 weekly
Flupentixol decanoate varies from 2 – 4 weekly, but can be weekly
Fluphenazine decanoate varies from 14 – 35 days
Zuclopenthixol decanoate varies from 1 – 4 weekly
Patient compliance may need to be considered.
• Test dose
A test dose consisting of a small dose of the active drug in a small volume
of oil, tests the patient’s sensitivity to the drug, the base oil and EPSEs. It
is usually tested at least 5 – 7days prior to the first dose of the
antipsychotic depot injection, please refer the BNF1 for more details.
Please note the oil base in pipotiazine is palmitate whereas those in other
suggested alternative preparations is decanoate. Test doses should be
given in depot clinics where adrenaline is available in the event of an
anaphylactic reaction occurring.
• Equivalent doses of depot antipsychotics (Adapted from BNF1)
These equivalences are intended only as an approximate guide; individual
dosage instructions should also be checked; patients should be carefully
monitored after any change in medication
Antipsychotic drug
Flupentixol decanoate
Fluphenazine decanoate
Haloperidol (as decanoate)
Pipotiazine palmitate
Zuclopenthixol decanoate
Dose (mg)
Interval
40
25
100
50
200
2 weeks
2 weeks
4 weeks
4 weeks
2 weeks
Important
These equivalences must not be extrapolated beyond the maximum dose
for the drug
• Choice of conventional / typical antipsychotics depot (Adapted from
BNF1)
There is no clear-cut division in the use of the conventional antipsychotics,
but zuclopenthixol may be suitable for the treatment of agitated or
aggressive patients whereas flupentixol can cause over-excitement in
such patients. Zuclopenthixol decanoate may be more effective in
preventing relapses than other conventional antipsychotic depot
preparations. The incidence of extrapyramidal reactions is similar for the
conventional antipsychotics.
• How to switch2
The general consensus for switching antipsychotic depot injections is to
initiate the new / switched depot on the day that the previous depot
injection is due. This allows for a smooth switch over and helps minimise
the risk of overlapping the two drugs involved. However, please note the
test dose will need to be administered at least 5 -7 days prior to the
initiation, please refer to the BNF1.
• Monitor mental state and side effects closely during and after
switching
It is important to monitor the patient closely for any signs of relapse or
potential drug related side-effects during and after the switching period, so
that the dose and dosage interval of the switched antipsychotic depot
injection can be reviewed according to response.
Reference:
1. British National Formulary (BNF) 68th Edition (Section 4.2.2)
2. Psychotropic Drug Directory 2014 – Stephen Bazire (Section 2.2)
Please do not hesitate to call one of the Medicines Management Team if you have
any questions.
Yours sincerely
Janet
Janet Howell
Head of Medicines Management