Zuclopenthixol, melperone and haloperidol/levomepromazine in the elderly. Meta-analysis of two double-blind trials at 15 nursing homes in Norway

Abstract

A meta-analysis was carried out of the data from two double-blind, multi-centre studies with identical methodology which compared the effectiveness of treatment of elderly patients with zuclopenthixol and with other antipsychotic drugs. In one study, patients were treated for 4 weeks with either zuclopenthixol or melperone; in the other, with either zuclopenthixol or a combination of haloperidol and levomepromazine. The meta-analysis evaluated the results of 96 patients, 49 in the zuclopenthixol group and 47 in the comparison group. Doses, which were adjusted to individual patient's needs, were low as shown by the percentages of defined daily doses for each of the study drugs. The results indicated that all three treatment alternatives were effective in the treatment of elderly patients with symptoms of agitation and hostility/aggressiveness. There was a trend, however, for zuclopenthixol to have a more rapid onset of effect. Zuclopenthixol also has the advantage for both patients and nursing staff that dosage is once daily. Only few and mild side-effects were reported with the three drug regimens.

The Potential Role of Zuclopenthixol Acetate in the Management of Refractory Hyperactive Delirium at the End of Life

“…5e7 A meta-analysis was performed on data from two double-blind, multicenter studies comparing the effectiveness of oral zuclopenthixol with oral haloperidol or oral levomepromazine for aggression and agitated behavior in institutionalized older adults with dementia. 8 The result indicated that all three drugs were effective in controlling symptoms of agitation and aggressiveness; however, zuclopenthixol had a more rapid onset and required once daily administration. 8 In one clinical review, zuclopenthixol acetate was recommended for the treatment of mental health emergencies that are resistant to high and repeated doses of benzodiazepine and haloperidol in hospital.…”

“…8 The result indicated that all three drugs were effective in controlling symptoms of agitation and aggressiveness; however, zuclopenthixol had a more rapid onset and required once daily administration. 8 In one clinical review, zuclopenthixol acetate was recommended for the treatment of mental health emergencies that are resistant to high and repeated doses of benzodiazepine and haloperidol in hospital. 9 A recently updated Cochrane Review of zuclopenthixol acetate for acute schizophrenia and similar serious mental illnesses was reported, based on seven controlled clinical studies involving 522 patients.…”

Rationale Therapie von Aggressivität und psychomotorischen Erregungszuständen mit Zuclopenthixol

“…So ist in der psychiatrischen Akutsituationf ür die Wahl eines Antipsychotikums eine rasch einsetzende,a bera nhaltendeb eruhigendeW irkung, gepaart mitg uter antipsychotischer Wirksamkeit entscheidend.E rregungsdämpfendeu nd anti-aggressive Eigenschaften sind charakteristischfür das klinische Wirkprofil von Zuclopenthixol. Seine Wirksamkeiti mp sychiatrischen Notfall (23,33)sowie beimanischen Episoden (1) ist belegt,ebensobei agitierten gerontopsychiatrischen Patienten (30,31)und beiexpansivem aggressivem Verhalten von Menschenmit Intelligenzminderung (IM) (18,19,29).…”