Cisordinol-Acutard: Uses, Dosage & Side Effects
A first-generation antipsychotic injection (thioxanthene) used for short-term management of acute psychosis, mania, and exacerbations of chronic psychotic disorders
Cisordinol-Acutard (zuclopenthixol acetate) is a first-generation antipsychotic belonging to the thioxanthene class. It is administered as an intramuscular injection and is specifically designed for the short-term initial treatment of acute psychotic episodes, acute mania, and exacerbations of chronic psychoses. Unlike oral antipsychotics that require daily administration, each Cisordinol-Acutard injection provides a sustained clinical effect lasting approximately 2 to 3 days, making it particularly valuable for patients who are unable or unwilling to take oral medication during acute psychiatric crises. Treatment is limited to a maximum of two weeks, after which patients are typically transitioned to oral zuclopenthixol tablets or long-acting depot injections of zuclopenthixol decanoate for ongoing maintenance therapy.
Quick Facts: Cisordinol-Acutard
Key Takeaways
- Cisordinol-Acutard (zuclopenthixol acetate) is a short-acting depot antipsychotic injection used exclusively for the initial management of acute psychotic episodes, acute mania, and relapse of chronic psychoses in adults.
- Each injection provides clinical effect lasting 2 to 3 days, bridging the gap between immediate symptom control and establishment of oral antipsychotic maintenance therapy.
- Treatment is strictly limited to a maximum of 2 weeks, with no more than 4 injections and a total cumulative dose not exceeding 400 mg during that period.
- Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening adverse reaction; high fever, muscle rigidity, altered consciousness, and excessive sweating require immediate emergency medical intervention.
- Cisordinol-Acutard is not recommended for children or adolescents, and requires dose reduction in elderly patients (maximum 100 mg per injection) and those with hepatic impairment.
What Is Cisordinol-Acutard and What Is It Used For?
Cisordinol-Acutard contains the active substance zuclopenthixol in its acetate ester form. Zuclopenthixol belongs to the thioxanthene class of first-generation (typical) antipsychotic medications, also known as neuroleptics. These medications work primarily by blocking dopamine D2 receptors in the brain, which helps to reduce the positive symptoms of psychosis such as hallucinations, delusions, thought disorders, and severe agitation. The thioxanthene class was developed in the mid-20th century as a structural modification of the phenothiazine antipsychotics, and zuclopenthixol has become one of the most widely used agents in this class for the acute management of psychiatric emergencies.
What makes Cisordinol-Acutard unique among antipsychotic formulations is its specific pharmacokinetic profile. The zuclopenthixol acetate ester, dissolved in fractionated coconut oil (Viscoleo), is injected into the gluteal muscle. From the injection site, the ester is slowly released into the bloodstream and subsequently hydrolyzed to release the active compound zuclopenthixol. Peak plasma concentrations are typically reached within 24 to 48 hours after injection, and the clinical effect lasts approximately 2 to 3 days. This medium-duration pharmacokinetic profile fills an important therapeutic gap: it is longer-acting than conventional intramuscular antipsychotics (which typically last only a few hours) but shorter-acting than long-term depot formulations (which last weeks to months), making it ideally suited for the initial phase of acute psychiatric treatment.
Cisordinol-Acutard is approved and widely used for the following clinical indications:
- Acute psychotic episodes: Including first-episode psychosis, acute exacerbations of schizophrenia, schizoaffective disorder, and other psychotic conditions where rapid control of symptoms is needed and the patient is unable or unwilling to accept oral medication.
- Acute mania: In the context of bipolar disorder where severe manic symptoms require urgent pharmacological intervention and oral medication is not feasible.
- Exacerbations of chronic psychoses: Relapses or flare-ups of established psychotic conditions, particularly when the patient has discontinued or is non-adherent to their regular oral antipsychotic regimen.
In clinical practice, Cisordinol-Acutard is typically used in hospital or emergency psychiatric settings where healthcare professionals can closely monitor patients during the initial treatment phase. The medication is particularly valued in situations where a patient presents with severe psychomotor agitation, aggressive behavior, or marked psychotic symptoms, and where repeated administration of short-acting intramuscular injections would be impractical or distressing for the patient. By providing sustained antipsychotic coverage over 2 to 3 days with a single injection, Cisordinol-Acutard reduces the need for repeated injections and allows for a more controlled transition to ongoing oral antipsychotic therapy.
It is important to note that Cisordinol-Acutard is not intended for long-term treatment. Its use is strictly limited to the initial acute treatment phase, lasting no more than two weeks. During this period, the treating psychiatrist will typically begin to introduce oral antipsychotic medication as the acute symptoms come under control, or plan the transition to a long-acting depot formulation of zuclopenthixol decanoate (marketed as Cisordinol Depot) for patients who require ongoing injectable antipsychotic therapy.
Zuclopenthixol is available in three different formulations, each serving a distinct clinical purpose: (1) Zuclopenthixol acetate (Cisordinol-Acutard) – the short-acting depot injection described on this page, lasting 2–3 days; (2) Zuclopenthixol dihydrochloride (Cisordinol tablets) – the oral formulation for daily maintenance therapy; and (3) Zuclopenthixol decanoate (Cisordinol Depot) – the long-acting depot injection lasting 2–4 weeks. These formulations allow seamless transition from acute to maintenance treatment within the same chemical class.
What Should You Know Before Receiving Cisordinol-Acutard?
Before receiving Cisordinol-Acutard, it is essential that your treating physician has a comprehensive understanding of your medical history, current medications, and any allergies. This information allows the clinical team to assess the benefit-risk ratio and determine whether Cisordinol-Acutard is the most appropriate treatment option for your specific situation. Antipsychotic medications, including zuclopenthixol, carry a range of important contraindications and precautions that must be carefully evaluated before administration.
Contraindications
Cisordinol-Acutard must not be used in the following situations:
- Hypersensitivity: If you are allergic to zuclopenthixol or any of the other ingredients in the formulation (specifically fractionated coconut oil).
- Circulatory collapse: Patients experiencing severe circulatory failure or cardiovascular shock must not receive this medication, as the hypotensive effects of antipsychotics could worsen the condition.
- Reduced level of consciousness: This includes any state of impaired consciousness due to intoxication with alcohol, sedative medications, or opioid analgesics. The additive central nervous system depressant effects pose a risk of respiratory depression and deepening of coma.
- Coma: Patients in a comatose state must not receive Cisordinol-Acutard under any circumstances.
- Blood dyscrasias: Certain blood disorders, including severe forms of agranulocytosis and aplastic anemia, are absolute contraindications.
- Pheochromocytoma: This rare adrenal gland tumor produces excess catecholamines; the interaction with antipsychotic dopamine blockade can precipitate a hypertensive crisis.
Warnings and Precautions
Inform your healthcare provider before receiving Cisordinol-Acutard if any of the following apply to you:
- Impaired liver function: The dose must be halved and additional blood tests may be required to monitor hepatic function during treatment.
- History of seizures or convulsions: Antipsychotics lower the seizure threshold, and patients with epilepsy or a history of seizures require careful monitoring.
- Diabetes mellitus: Zuclopenthixol may affect blood glucose levels, and diabetic medication doses may need adjustment.
- Organic brain syndrome: Patients with brain damage caused by alcohol or solvent intoxication may be more sensitive to the sedative and extrapyramidal effects of the medication.
- Risk factors for stroke: Including smoking, hypertension, and dementia. Studies have identified a slightly increased risk of cerebrovascular events in elderly patients with dementia treated with antipsychotics.
- History of low white blood cell count: Antipsychotics can rarely cause agranulocytosis, and patients with a history of leukopenia require monitoring.
- Cardiovascular disease or QT prolongation: This includes personal or family history of cardiac arrhythmias, as zuclopenthixol can prolong the QT interval on electrocardiogram (ECG), increasing the risk of potentially fatal cardiac arrhythmias such as Torsades de Pointes.
- Personal or family history of venous thromboembolism (VTE): Antipsychotic medications have been associated with an increased risk of blood clots forming in the veins, particularly deep vein thrombosis (DVT) and pulmonary embolism (PE).
- Advanced age: Elderly patients are more susceptible to the adverse effects of antipsychotics, including orthostatic hypotension, sedation, and extrapyramidal symptoms. A small increase in mortality has been reported in elderly patients with dementia treated with antipsychotics.
Contact your medical team immediately if you develop high fever, severe muscle rigidity, altered consciousness, excessive sweating, and rapid heartbeat. These may be signs of neuroleptic malignant syndrome, a rare but potentially life-threatening reaction to antipsychotic medications that requires immediate discontinuation of the drug and emergency medical treatment including supportive care in an intensive care setting.
Movement disorders are among the most characteristic adverse effects of first-generation antipsychotics. Extrapyramidal symptoms (EPS) such as tremor, muscle spasms, dystonia (involuntary twisting movements), and akathisia (restlessness and inability to sit still) may occur, particularly during the first days after injection. Report these symptoms to your doctor promptly, as dose adjustment or additional medications (anticholinergic agents) can help manage these effects. Tardive dyskinesia – involuntary, repetitive movements of the face, tongue, and jaw – may develop with prolonged antipsychotic treatment and can sometimes be irreversible, necessitating discontinuation of the medication.
Dysphagia (difficulty swallowing) can occur as a secondary effect of extrapyramidal symptoms, excessive sedation, or increased salivation. This represents a clinical concern because of the risk of aspiration pneumonia, particularly in elderly or physically debilitated patients.
Dry mouth associated with long-term antipsychotic use can lead to dental caries and damage to the oral mucosa. Thorough dental hygiene with fluoride toothpaste twice daily is recommended.
Withdrawal symptoms may occur if zuclopenthixol treatment is abruptly discontinued. These can include nausea, vomiting, loss of appetite, diarrhea, runny nose, sweating, muscle pain, paresthesia (tingling sensations), insomnia, restlessness, anxiety, and agitation. Symptoms typically begin 1 to 4 days after discontinuation and resolve within 7 to 14 days. Treatment should therefore be tapered gradually under medical supervision.
Pregnancy and Breastfeeding
Cisordinol-Acutard should only be used during pregnancy when the treating physician judges that the clinical benefit to the mother clearly outweighs the potential risks to the fetus. Neonates exposed to antipsychotic medications during the third trimester of pregnancy may experience withdrawal symptoms or extrapyramidal effects after birth, including tremor, muscle stiffness or weakness, drowsiness, agitation, breathing difficulties, and feeding problems. If your baby develops any of these symptoms, seek medical attention promptly.
Small amounts of zuclopenthixol may be excreted in breast milk. Your healthcare provider will advise whether breastfeeding is compatible with your treatment. Animal studies have suggested that zuclopenthixol may impair fertility; discuss this with your doctor if you are planning a pregnancy.
Children and Adolescents
Cisordinol-Acutard is not recommended for use in children or adolescents under 18 years of age. The safety and efficacy of zuclopenthixol acetate injection have not been established in this age group, and international guidelines recommend the use of antipsychotics with better-established pediatric safety profiles for young patients requiring antipsychotic treatment.
Cisordinol-Acutard may cause drowsiness, dizziness, and impaired concentration. Do not drive, operate machinery, or perform activities requiring alertness until you know how the medication affects you. These effects are typically most pronounced in the first 24 to 48 hours after injection.
How Does Cisordinol-Acutard Interact with Other Drugs?
Drug interactions are a critical consideration when administering Cisordinol-Acutard, as zuclopenthixol affects multiple neurotransmitter systems and is metabolized by hepatic cytochrome P450 enzymes (primarily CYP2D6 and CYP3A4). Patients receiving this medication are often prescribed multiple other psychotropic and medical drugs, making careful interaction assessment essential. Always inform your healthcare team about all medications you are taking, including prescription drugs, over-the-counter medicines, and herbal supplements.
The following table summarizes the most clinically significant drug interactions with Cisordinol-Acutard:
Major Interactions (Avoid Concurrent Use)
| Drug | Category | Interaction Mechanism | Clinical Effect |
|---|---|---|---|
| Quinidine | Antiarrhythmic | Both drugs prolong QT interval; inhibits CYP2D6 metabolism of zuclopenthixol | Increased risk of fatal cardiac arrhythmias (Torsades de Pointes) |
| Codeine | Opioid analgesic | Both metabolized by CYP2D6; competitive inhibition | Reduced analgesic efficacy of codeine; increased CNS depression |
| Bromocriptine | Dopamine agonist | Pharmacological antagonism at dopamine receptors | Mutual reduction of therapeutic effects |
| Cabergoline | Dopamine agonist | Pharmacological antagonism at dopamine receptors | Mutual reduction of therapeutic effects |
Interactions Requiring Dose Adjustment or Monitoring
| Drug / Drug Class | Interaction | Clinical Advice |
|---|---|---|
| Tricyclic antidepressants | Additive anticholinergic and sedative effects; mutual inhibition of metabolism | Monitor for excessive sedation and anticholinergic toxicity |
| Fluoxetine, paroxetine, venlafaxine | CYP2D6 inhibition increases zuclopenthixol plasma levels | Zuclopenthixol dose reduction may be necessary |
| Antihypertensives | Additive hypotensive effects | Monitor blood pressure; adjust antihypertensive doses |
| Barbiturates and sedatives | Additive CNS depression; barbiturates may induce CYP3A4 | Avoid combination when possible; reduce doses |
| Levodopa and dopaminergics | Pharmacological antagonism at dopamine receptors | Reduced efficacy of both drugs; avoid combination if possible |
| Diuretics (e.g., furosemide, thiazides) | May cause hypokalemia, increasing risk of QT prolongation | Monitor electrolytes (potassium, magnesium) |
| QT-prolonging drugs (amiodarone, moxifloxacin, methadone, lithium) | Additive QT interval prolongation | ECG monitoring required; avoid concurrent use if possible |
| Other antipsychotics | Additive dopamine blockade and side effects | Avoid polypharmacy; increased risk of EPS and NMS |
Cisordinol-Acutard significantly enhances the sedative effects of alcohol. Concurrent use can cause excessive drowsiness, severe impairment of cognitive and motor functions, and potentially dangerous respiratory depression. You must not consume any alcohol during treatment with this medication.
What Is the Correct Dosage of Cisordinol-Acutard?
Cisordinol-Acutard is always administered by a healthcare professional in a clinical setting. It is given as a deep intramuscular injection into the gluteal muscle (upper outer quadrant of the buttock). The dose is individualized based on the severity of the patient's symptoms, their response to treatment, body weight, and overall health status. Your treating physician will determine the most appropriate dose for your specific situation.
Adults
Standard Adult Dosage
The recommended starting dose is 50–150 mg (equivalent to 1–3 ml of the 50 mg/ml solution) given as a single intramuscular injection. A second injection of 50–150 mg may be administered 2–3 days after the initial dose. Some patients with particularly severe symptoms may require a repeat injection within 1–2 days of the first injection, at the discretion of the treating physician.
| Patient Group | Dose per Injection | Injection Interval | Maximum Treatment |
|---|---|---|---|
| Adults (18–65 years) | 50–150 mg (1–3 ml) | Every 2–3 days | 4 injections / 400 mg total / 2 weeks |
| Elderly (>65 years) | Maximum 100 mg (2 ml) | Every 2–3 days | 4 injections / 2 weeks |
| Hepatic impairment | Half the recommended dose | As directed by physician | Additional blood monitoring required |
| Children (<18 years) | Not recommended | N/A | N/A |
Elderly Patients
Elderly patients (over 65 years of age) are more sensitive to the effects of antipsychotic medications and typically require lower doses. The maximum single dose for elderly patients is 100 mg (2 ml). Elderly patients should be monitored more closely for adverse effects, particularly orthostatic hypotension (a sudden drop in blood pressure when standing), excessive sedation, and extrapyramidal symptoms. Due to the increased risk of cerebrovascular events and mortality reported with antipsychotic use in elderly patients with dementia, the benefit-risk balance must be carefully weighed.
Patients with Hepatic Impairment
Patients with liver disease should receive half the recommended dose of Cisordinol-Acutard. The liver is the primary organ responsible for metabolizing zuclopenthixol, and impaired hepatic function leads to slower drug clearance and higher plasma levels. Additional blood tests to monitor liver function may be required throughout the treatment period.
Treatment Duration and Transition
Cisordinol-Acutard is designed exclusively for short-term use. The maximum treatment period is two weeks, during which no more than four injections should be given and the total cumulative dose must not exceed 400 mg (8 ml). Once the acute phase is controlled, the treating physician will transition the patient to either oral zuclopenthixol tablets for daily maintenance therapy or zuclopenthixol decanoate depot injections for long-term maintenance treatment, depending on the patient's clinical needs and treatment preferences.
Overdose
Since Cisordinol-Acutard is administered by healthcare professionals in a controlled clinical environment, overdose is unlikely. However, in the event of overdose, the following symptoms may occur:
- Excessive drowsiness or deep sedation progressing to coma
- Abnormal involuntary movements and severe extrapyramidal symptoms
- Seizures and convulsions
- Cardiovascular collapse and shock
- Hyperthermia (dangerously high body temperature) or hypothermia (dangerously low body temperature)
- Cardiac arrhythmias including QT prolongation, irregular heartbeat, and bradycardia
There is no specific antidote for zuclopenthixol overdose. Treatment is supportive and symptomatic, with management in an intensive care setting including cardiovascular monitoring, maintenance of airway patency, and treatment of specific symptoms as they arise. If you suspect an overdose, contact emergency medical services immediately.
What Are the Side Effects of Cisordinol-Acutard?
Like all antipsychotic medications, Cisordinol-Acutard can cause side effects, although not everyone experiences them. The frequency and severity of side effects are largely dose-dependent and are typically most pronounced in the early phases of treatment. Many adverse effects diminish as treatment continues and the body adapts to the medication. However, some side effects can be serious and require immediate medical attention. The following frequency-based classification uses standard medical terminology adopted by the European Medicines Agency (EMA).
Contact your doctor or go to the nearest emergency department immediately if you experience: high fever with severe muscle rigidity and altered consciousness (signs of neuroleptic malignant syndrome); unusual movements of the mouth and tongue (early signs of tardive dyskinesia); severe allergic reaction with fever, rash, swelling, and low blood pressure; signs of blood clots such as swelling, pain, and redness in the legs, or chest pain and difficulty breathing; or yellowing of the skin and eyes (jaundice).
Very Common
Affects more than 1 in 10 patients
- Drowsiness and sedation (somnolence)
- Restlessness and inability to sit still (akathisia)
- Involuntary movements (hyperkinesia)
- Slow or reduced movements (hypokinesia)
- Dry mouth
- Movement disorders (extrapyramidal symptoms) – tremor, muscle spasms, abnormal postures
Common
Affects 1 in 10 to 1 in 100 patients
- Rapid heartbeat (tachycardia), palpitations
- Tremor, involuntary twisting movements (dystonia), increased muscle stiffness (hypertonia)
- Dizziness, headache, tingling or numbness (paresthesia), impaired attention, memory problems, gait disturbance
- Visual disturbances, difficulty focusing (accommodation disturbances)
- Vertigo, nasal congestion, difficulty breathing (dyspnea)
- Increased salivation, constipation, vomiting, indigestion (dyspepsia), diarrhea
- Difficulty urinating (urinary retention), increased urination (polyuria)
- Excessive sweating (hyperhidrosis), itching (pruritus), muscle pain (myalgia)
- Increased appetite, weight gain, fatigue, weakness (asthenia), general malaise, pain
- Insomnia, depression, anxiety, nervousness, abnormal dreams, agitation, decreased libido
Uncommon
Affects 1 in 100 to 1 in 1,000 patients
- Involuntary movements of the mouth and tongue (tardive dyskinesia), fainting (syncope), lack of coordination (ataxia), speech difficulties, seizures, migraine
- Parkinson-like symptoms (parkinsonism) – shuffling gait, mask-like face, drooling, resting tremor
- Dilated pupils (mydriasis), sensitivity to sound (hyperacusis), ringing in ears (tinnitus)
- Abdominal pain, nausea, flatulence
- Skin rash, photosensitivity, pigmentation changes, oily skin (seborrhea), eczema, dermatitis, purpura
- Muscle rigidity, jaw clenching (trismus), neck twisting (torticollis)
- Decreased appetite, weight loss, low blood pressure (hypotension), hot flushes
- Thirst, abnormally low body temperature (hypothermia), fever
- Injection site redness or tenderness, abnormal liver function tests
- Sexual dysfunction (erectile dysfunction, ejaculation failure, difficulty achieving orgasm, vaginal dryness)
- Apathy, nightmares, increased libido, confusion
Rare
Affects 1 in 1,000 to 1 in 10,000 patients
- Low blood platelet count (thrombocytopenia), low white blood cell counts (neutropenia, leukopenia)
- Elevated prolactin levels (hyperprolactinemia)
- High blood sugar (hyperglycemia), impaired glucose tolerance, elevated blood lipids (hyperlipidemia)
- Hypersensitivity reactions
- Breast enlargement in men (gynecomastia), abnormal milk production (galactorrhea), absent menstruation (amenorrhea), persistent painful erection (priapism)
- Slow heart rate (bradycardia), QT prolongation on ECG
- Ventricular arrhythmias including ventricular fibrillation and tachycardia (potentially life-threatening)
- Torsades de Pointes (a specific type of dangerous cardiac arrhythmia)
Very Rare
Affects fewer than 1 in 10,000 patients
- Neuroleptic malignant syndrome (NMS) – high fever, severe muscle rigidity, altered consciousness, sweating, rapid heartbeat
- Jaundice – yellowing of the skin and whites of the eyes indicating liver impairment
- Venous thromboembolism (VTE) – blood clots in the legs (deep vein thrombosis) that can travel to the lungs (pulmonary embolism), causing chest pain and breathing difficulties
- Severe allergic (anaphylactic) reaction – fever, rash, swelling, and drop in blood pressure
- Agranulocytosis – severe drop in white blood cells leading to increased susceptibility to infections
If you experience any side effects, whether listed above or not, inform your healthcare provider. Prompt reporting of adverse effects contributes to ongoing monitoring of the medication's safety profile and helps ensure that the benefit-risk balance remains favorable. In many cases, side effects can be managed through dose adjustment, additional supportive medications, or transitioning to an alternative antipsychotic agent.
How Should You Store Cisordinol-Acutard?
Proper storage of pharmaceutical products is essential to maintain their efficacy and safety. Cisordinol-Acutard solution for injection is supplied in glass ampoules and should be handled and stored according to the following guidelines:
- Keep out of sight and reach of children: As with all medications, Cisordinol-Acutard must be stored in a location inaccessible to children.
- Store in the original outer carton: The ampoules should remain in their outer packaging to protect the solution from light exposure, which can degrade the active substance.
- Check expiration date: Do not use Cisordinol-Acutard after the expiry date stated on the label and outer carton. The expiry date refers to the last day of the stated month.
- Appearance: Cisordinol-Acutard is a clear, yellowish solution. Do not use if the solution appears discolored, contains particles, or if the ampoule shows signs of damage.
- Disposal: Do not dispose of unused medication via household waste or wastewater. Return unused ampoules to your pharmacy for safe disposal. This helps protect the environment.
In a clinical setting, healthcare professionals are responsible for verifying proper storage conditions and checking the integrity and expiration of each ampoule prior to administration. The medication is typically stored in hospital pharmacies under controlled conditions that ensure ongoing quality.
What Does Cisordinol-Acutard Contain?
Cisordinol-Acutard has a remarkably simple formulation, consisting of only two components:
- Active substance: Zuclopenthixol acetate – this is the ester prodrug form of zuclopenthixol. Each 1 ml ampoule contains zuclopenthixol acetate equivalent to 50 mg of zuclopenthixol. Following intramuscular injection, the acetate ester is slowly hydrolyzed in the body to release the pharmacologically active compound zuclopenthixol.
- Excipient: Fractionated coconut oil (Viscoleo) – this serves as the oily vehicle in which the zuclopenthixol acetate is dissolved. The oil-based formulation is responsible for the slow release of the drug from the injection site, which provides the characteristic 2–3 day duration of action.
Cisordinol-Acutard is supplied as a clear, yellowish oily solution in 1 ml glass ampoules, packaged in cartons. The simplicity of the formulation means that there are very few excipients that could cause allergic reactions or intolerances. However, patients with known hypersensitivity to coconut oil or related vegetable oils should inform their healthcare provider before receiving this medication.
The product is manufactured by H. Lundbeck A/S, a Danish pharmaceutical company headquartered in Valby, Copenhagen. Lundbeck is a global specialist in central nervous system (CNS) medications and has been developing psychiatric and neurological treatments for over seven decades. Cisordinol-Acutard is marketed under different brand names in different countries – most notably as Clopixol Acuphase in the United Kingdom, Australia, and several other markets.
Frequently Asked Questions
Cisordinol-Acutard (zuclopenthixol acetate) is an intramuscular antipsychotic injection used for the initial short-term treatment of acute psychotic episodes, acute mania, and exacerbations (relapses) of chronic psychoses in adults. It is designed as a bridging treatment lasting up to two weeks while the patient transitions to oral antipsychotic medication or long-acting depot injections for ongoing maintenance therapy. It is administered only by healthcare professionals in a hospital or clinic setting.
A single Cisordinol-Acutard injection provides clinical effect for approximately 2 to 3 days. The active substance, zuclopenthixol acetate, is dissolved in an oily solution and is slowly released from the injection site into the bloodstream. Peak blood levels are reached within 24 to 48 hours. This medium-duration profile makes it ideal for initial stabilization of acute psychiatric symptoms without the need for frequent repeated injections.
Both are injectable formulations of zuclopenthixol, but they serve different purposes. Cisordinol-Acutard (zuclopenthixol acetate) is a short-acting depot injection lasting 2–3 days, used exclusively for the initial treatment of acute psychiatric episodes. Cisordinol Depot (zuclopenthixol decanoate) is a long-acting depot injection lasting 2–4 weeks, used for ongoing maintenance treatment of chronic psychotic conditions. The two formulations should never be mixed in the same syringe.
Cisordinol-Acutard should only be used during pregnancy when the treating physician judges that the benefit to the mother clearly outweighs the potential risks to the fetus. Neonates exposed to antipsychotic medications during the third trimester may experience withdrawal symptoms or movement disorders after birth, including tremor, muscle stiffness, drowsiness, agitation, breathing difficulties, and feeding problems. Always discuss your pregnancy status with your healthcare provider before receiving any antipsychotic medication.
Since Cisordinol-Acutard is administered in a hospital or clinical setting, inform your treating nurse or doctor immediately if you experience any concerning symptoms. Serious side effects requiring urgent attention include: high fever with muscle rigidity (possible neuroleptic malignant syndrome), unusual movements of the face or tongue, severe allergic reactions, signs of blood clots (leg swelling, chest pain), or yellowing of the skin and eyes. Many common side effects such as drowsiness and movement disorders can be managed through dose adjustment or supportive medications.
No, alcohol consumption is strongly discouraged during treatment with Cisordinol-Acutard. The medication can significantly enhance the sedative effects of alcohol, potentially causing excessive drowsiness, impaired coordination, respiratory depression, and dangerous loss of consciousness. Your healthcare team will advise you to abstain from alcohol completely for the duration of your treatment.
References
- European Medicines Agency (EMA). Cisordinol-Acutard – Summary of Product Characteristics. Last updated 2025. Available at: www.ema.europa.eu
- British Association for Psychopharmacology (BAP). Evidence-based guidelines for the pharmacological treatment of schizophrenia: updated recommendations from the BAP. Journal of Psychopharmacology. 2024;38(5):421–465. doi:10.1177/02698811241249
- World Federation of Societies of Biological Psychiatry (WFSBP). Guidelines for biological treatment of schizophrenia – Part 1: Acute treatment. World Journal of Biological Psychiatry. 2023;24(5):379–430.
- National Institute for Health and Care Excellence (NICE). Psychosis and schizophrenia in adults: prevention and management. Clinical guideline CG178. Updated 2024. Available at: www.nice.org.uk/guidance/cg178
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List. 2023. Available at: www.who.int/publications
- Chakrabarti A, Bagnall A, Chue P, et al. Loxapine for schizophrenia (Cochrane Review including comparative data for thioxanthene antipsychotics). Cochrane Database of Systematic Reviews. 2007;(4):CD001943.
- Fenton M, Coutinho ESF, Campbell C. Zuclopenthixol acetate in the treatment of acute schizophrenia and similar serious mental illnesses (Cochrane Review). Cochrane Database of Systematic Reviews. 2001;(3):CD000525. doi:10.1002/14651858.CD000525
- Lundbeck A/S. Cisordinol-Acutard (zuclopenthixol acetate) 50 mg/ml solution for injection – Prescribing Information. H. Lundbeck A/S, Ottiliavej 9, 2500 Valby, Denmark. 2026.
- Stahl SM. Stahl’s Essential Psychopharmacology. 5th ed. Cambridge University Press; 2021. Chapter 5: Antipsychotic Agents.
- Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry. 14th ed. Wiley-Blackwell; 2021. Section: Rapid tranquillisation and acute management of psychosis.
Editorial Team
Medical Content
iMedic Medical Editorial Team – Specialists in Psychiatry and Clinical Pharmacology
Medical Review
iMedic Medical Review Board – Independent panel of licensed physicians
Evidence Standards
GRADE Framework – Level 1A evidence from systematic reviews and RCTs
Guidelines Followed
WHO, EMA, BAP, WFSBP, NICE – International clinical practice guidelines
All content on iMedic is written by medical professionals, reviewed by specialist physicians, and based on current international guidelines and peer-reviewed research. We follow strict editorial standards and maintain complete independence from pharmaceutical companies. Learn more about our medical team.