Please check your internet connection and try again.
# Flupentixol and Melitracen
## Overview
Fixed-dose combination containing flupentixol (a thioxanthene antipsychotic) and melitracen (a tricyclic antidepressant). Used primarily for psychosomatic disorders with anxiety and depression.
## Primary Indications
- Psychosomatic disorders with anxiety-depressive components
- Anxiety with depressive symptoms (where combined therapy is indicated)
- Not first-line for major depressive disorder or psychosis alone
## Adult Dosing
- **Initial:** 1 tablet (flupentixol 0.5 mg / melitracen 10 mg) twice daily
- **Maintenance:** 1 tablet in the morning and at noon (avoid evening due to stimulation)
- **Maximum:** 2 tablets twice daily (flupentixol 1 mg / melitracen 20 mg per dose) in severe cases
- Duration should be limited (typically 2–4 weeks); long-term use not well-studied
## Pediatric Dosing
- **Not established** for children and adolescents under 18 years
- Safety and efficacy data insufficient; avoid in pediatric populations
## Dose Adjustments
- **Hepatic impairment:** Use with caution; no specific guidelines; consider avoiding in severe impairment
- **Renal impairment:** Caution in severe impairment (limited data)
- **Elderly:** Lower starting dose (e.g., 1 tablet daily); titrate slowly due to increased sensitivity
## Contraindications
- Hypersensitivity to any component
- CNS depression (e.g., alcohol, barbiturate intoxication)
- Blood dyscrasias, pheochromocytoma
- Recent myocardial infarction, severe cardiac conduction disorders
- Concurrent MAOI use (allow 14-day washout)
- Narrow-angle glaucoma, severe prostatic hypertrophy
## Adverse Effects
- **Common:** Drowsiness, dizziness, dry mouth, blurred vision, constipation, weight gain
- **Anticholinergic:** Urinary retention, tachycardia, confusion (especially in elderly)
- **Extrapyramidal symptoms (EPS):** Akathisia, dystonia, parkinsonism (from flupentixol component)
- **Serious:** QTc prolongation, neuroleptic malignant syndrome (rare), tardive dyskinesia (with long-term use), cardiac arrhythmias (melitracen-related)
## Key Drug Interactions
- **MAOIs:** Risk of hypertensive crisis; avoid concurrent use
- **SSRIs/SNRIs:** Increased risk of serotonin syndrome (especially with flupentixol)
- **CNS depressants** (alcohol, benzodiazepines): Additive sedation
- **QTc-prolonging drugs:** Increased arrhythmia risk (e.g., antiarrhythmics, certain antipsychotics)
- **Anticholinergics:** Additive anticholinergic effects
## Monitoring
- Baseline and periodic ECG (QTc interval), especially in elderly or with cardiac risk factors
- Blood pressure, heart rate
- Liver function tests periodically
- Extrapyramidal symptoms and tardive dyskinesia screening (at least every 3–6 months)
- Blood glucose and lipid profile with extended use
## Clinical Pearls
- Avoid evening dosing due to stimulant-like effects from melitracen
- Risk of EPS is dose-dependent; use lowest effective dose for shortest duration
- Withdraw gradually to avoid discontinuation symptoms
- Combination product is not interchangeable with individual components
- In many regions, this combination is considered a "rational" fixed-dose option, but evidence quality is limited
---
**Disclaimer:** This information is for educational purposes only. Always verify current prescribing information from the manufacturer's package insert and local clinical guidelines. Dosing may vary by country and protocol.
