Once Weekly Pimozide versus Fluphenazine Decanoate as Maintenance Therapy in Chronic Schizophrenia

Abstract

In a double blind trial, 28 male chronic schizophrenic in-patients received either pimozide, given once weekly, or fluphenazine decanoate, given mostly once fortnightly. There was no difference in relapse rates over nine months. However, three-quarters of the patients on pimozide who completed the trial developed at least mild tardive dyskinesia. All patients on pimozide lost weight, the average loss being 5.4 kg (12 lbs). Plasma pimozide levels suggested satisfactory drug compliance. Plasma prolactin levels confirmed that in the pimozide group there was fluctuating dopamine receptor antagonism, while in the fluphenazine group average plasma prolactin levels throughout most of the interval between injections were at the upper limit of normal.

Comparison of treatment discontinuation and hospitalization among nonadherent patients initiating depot or oral typical antipsychotic medications

“…Randomized-controlled trials (RCTs) have shown few therapeutic differences between conventional antipsychotics in oral and long-acting injectable formulations (Levine et al, 1980;McCreadie et al, 1982). A systematic review of RCTs found that depot typical antipsychotics conferred a benefit over oral antipsychotics in terms of an overall improvement, but there were no differences in relapse rates, study discontinuation or adverse effects (Adams et al, 2001).…”

A review on schizophrenia and relapse—a quest for user‐friendly psychopharmacotherapy

“…The question in particular then is how better to deliver antipsychotics at the lowest possible, whereby dose and interval are relevant. Further novel strategies may be considered and should be learnt from the past such as innovative once weekly pimozide administration (McCreadie et al, 1982). With the fact in mind that poor adherence to (or withdrawal from) antipsychotic medications, for which adverse effects may be a cause, is an established risk factor for relapse, further investigations are certainly indicated to explore more user friendly manner of pharmacotherapy for clients with schizophrenia.…”

“…Extended but regular dosing strategies or drug holidays have been studied in the past (e.g. 4 day per week or weekly administration of pimozide (McCreadie et al ., ; McCreadie et al ., )), and more work on dosing interval is necessary especially from the viewpoint of long‐term relapse prevention.…”

Meet the relatives: a reintroduction to the clinical pharmacology of ‘typical’ antipsychotics (Part 2)

“…Given on 4 days a week, McCreadie et al (1980) found that it was as effective in maintenance as depot fluphenazine. In an intriguing study, it was then given once weekly to a group of in-patients using the same comparator (McCreadie 1982). On the basis of prior treatment regimes, doses ranged from 10 to 60 mg pimozide once weekly.…”