Cisordinol Depot: Uses, Dosage & Side Effects
Long-acting injectable antipsychotic for schizophrenia maintenance treatment
Quick Facts About Cisordinol Depot
Key Takeaways About Cisordinol Depot
- Long-acting depot injection: Cisordinol Depot is administered once every 2–4 weeks by deep intramuscular injection, providing sustained antipsychotic effect without the need for daily oral medication
- Maintenance treatment for schizophrenia: Primarily used for ongoing management of schizophrenia and other psychoses, particularly to reduce the risk of relapse in patients who have difficulty adhering to oral treatments
- Movement disorder risk: As a first-generation antipsychotic, Cisordinol Depot carries a significant risk of extrapyramidal symptoms (tremor, muscle spasms, restlessness) and tardive dyskinesia with long-term use
- Do not stop abruptly: Sudden discontinuation can cause withdrawal symptoms including nausea, insomnia, restlessness, and sweating — treatment should be gradually tapered under medical supervision
- Avoid alcohol: Cisordinol Depot enhances the sedating effects of alcohol, potentially causing excessive drowsiness, impaired coordination, and dangerous situations
What Is Cisordinol Depot and What Is It Used For?
Cisordinol Depot contains zuclopenthixol decanoate, a long-acting injectable antipsychotic (neuroleptic) medication. It is used for maintenance treatment of schizophrenia and other psychotic disorders, particularly when symptoms include hallucinations, delusions, thought disturbances, agitation, restlessness, hostility, and aggression.
Cisordinol Depot belongs to the thioxanthene class of first-generation (typical) antipsychotics. The active substance, zuclopenthixol, works primarily by blocking dopamine D1 and D2 receptors in the mesolimbic and mesocortical pathways of the brain. By reducing excessive dopaminergic activity, it helps control the positive symptoms of psychosis such as hallucinations (hearing or seeing things that are not there), delusions (fixed false beliefs), and disorganized thinking.
The “depot” formulation is designed for slow, sustained release of the active drug from the intramuscular injection site. Zuclopenthixol decanoate is dissolved in fractionated coconut oil (viscoleo) and, after injection into the gluteal muscle, the ester is slowly hydrolysed to release active zuclopenthixol over a period of 2–4 weeks. This depot mechanism ensures relatively constant plasma levels between injections, which is a significant advantage for patients who struggle with daily oral medication adherence.
Long-acting injectable (LAI) antipsychotics like Cisordinol Depot have been shown in clinical studies to reduce relapse rates compared with oral formulations, primarily because they eliminate the problem of missed doses. Schizophrenia is a chronic condition that typically requires lifelong treatment, and medication non-adherence is one of the most common reasons for relapse and rehospitalisation. The depot formulation addresses this challenge directly by providing guaranteed drug delivery at each clinic visit.
In addition to its dopamine-blocking activity, zuclopenthixol also has affinity for serotonin 5-HT2 receptors, alpha-1 adrenergic receptors, and histamine H1 receptors. The alpha-1 adrenergic blockade contributes to the sedative and blood-pressure-lowering effects, while H1 receptor antagonism accounts for some of the sedation and weight gain associated with the drug. The serotonin receptor blockade may provide some additional benefit in managing anxiety and agitation.
Cisordinol Depot is intended for maintenance treatment only — it is not suitable for acute management of psychotic episodes due to its slow onset of action. For acute situations, oral or short-acting injectable formulations of zuclopenthixol (such as Cisordinol Acutard) may be used instead. The depot formulation is typically initiated after the patient has been stabilised on an oral form of zuclopenthixol.
Clinical indications
The primary approved indications for Cisordinol Depot include:
- Schizophrenia — all subtypes, for maintenance treatment to prevent relapse
- Other chronic psychotic disorders — including schizoaffective disorder and persistent delusional disorders
- Psychoses with prominent agitation or aggression — where the calming properties of zuclopenthixol are particularly beneficial
The medication is especially suitable for patients who have demonstrated poor adherence to oral antipsychotics, who prefer the convenience of a fortnightly or monthly injection, or who have a history of relapse related to medication discontinuation. The decision to initiate depot treatment should be a shared decision between the patient and their treating psychiatrist, taking into account the patient’s preferences, clinical history, and treatment goals.
What Should You Know Before Taking Cisordinol Depot?
Cisordinol Depot must not be used if you are allergic to zuclopenthixol, have circulatory collapse, reduced consciousness, blood disorders (haematological dyscrasias), pheochromocytoma, or are in a comatose state. Several conditions require special caution and regular monitoring during treatment.
Before starting Cisordinol Depot, your doctor will carry out a thorough clinical assessment, including a review of your medical history, current medications, and any previous responses to antipsychotic therapy. Because the depot formulation remains in the body for several weeks after each injection, it is particularly important to identify any contraindications or risk factors before the first dose. If serious adverse effects develop, they may persist for a prolonged period after the injection.
Contraindications
Cisordinol Depot must not be given in the following situations:
- Hypersensitivity — allergy to zuclopenthixol or any of the excipients (including fractionated coconut oil)
- Circulatory collapse — severe disturbances in blood circulation
- Reduced consciousness — including states caused by intoxication with alcohol, sedatives, or opioid analgesics
- Coma — regardless of the underlying cause
- Haematological dyscrasias — certain blood disorders affecting blood cell production
- Pheochromocytoma — a rare tumour of the adrenal glands that causes excessive catecholamine release
These contraindications are absolute, meaning the drug must not be administered under any of these circumstances. The long-acting nature of the depot formulation makes adherence to contraindications especially critical, as the drug cannot be rapidly removed from the body once injected.
Warnings and Precautions
Speak to your doctor before receiving Cisordinol Depot if you have any of the following conditions or risk factors:
- Impaired liver function — zuclopenthixol is metabolised by the liver, and dose adjustments may be necessary. Additional blood tests may be required to monitor liver function during treatment
- History of seizures or epilepsy — antipsychotics can lower the seizure threshold
- Diabetes mellitus — antipsychotics can affect blood glucose levels, and diabetes medication may need to be adjusted
- Organic brain syndrome — brain damage caused by alcohol, solvent abuse, or other toxic substances
- Risk factors for stroke — including smoking, high blood pressure, and dementia
- History of low white blood cell count — antipsychotics can occasionally cause leucopenia or agranulocytosis
- Cardiovascular disease or QT prolongation — a history of cardiac conditions or a family history of QT interval prolongation on ECG warrants careful monitoring
- Use of other antipsychotic medications — concurrent use increases the risk of adverse effects
- History of venous thromboembolism — antipsychotic use has been associated with blood clot formation
- Cancer treatment — potential interactions with oncological therapies
- Advanced age — elderly patients are more susceptible to adverse effects and may require lower doses
- High fever with severe muscle stiffness, sweating, and reduced consciousness — these may be signs of neuroleptic malignant syndrome (NMS), a rare but potentially life-threatening condition that requires immediate medical intervention
- Unusual movements of the mouth and tongue — this may be an early sign of tardive dyskinesia, a potentially irreversible movement disorder
- Fever with severe sore throat and difficulty urinating — may indicate agranulocytosis, a dangerous drop in white blood cells that impairs the body’s ability to fight infections
- Swelling, pain, and redness in the legs — may indicate deep vein thrombosis, which can potentially travel to the lungs causing pulmonary embolism
Movement disorders
Extrapyramidal symptoms (EPS) are among the most significant adverse effects associated with first-generation antipsychotics like zuclopenthixol. These include tremor, muscle spasms (dystonia), restlessness (akathisia), and muscle rigidity. These symptoms are most likely to occur during the first days after treatment initiation or after dose increases. If you experience persistent involuntary movements, inform your doctor promptly, as the dose may need to be reduced or additional medication prescribed to manage these effects.
With long-term treatment, there is a risk of developing tardive dyskinesia — involuntary, repetitive movements particularly affecting the face, tongue, and jaw. This condition may be irreversible in some cases, which is why regular clinical assessments are essential throughout treatment. If early signs of tardive dyskinesia appear, your doctor may decide to discontinue or change the treatment.
Oral health
Dry mouth is a common side effect of Cisordinol Depot. During long-term treatment, persistent dry mouth can lead to dental caries and damage to the oral mucosa. Patients should maintain rigorous oral hygiene, brushing teeth thoroughly with fluoride toothpaste twice daily and attending regular dental check-ups.
Withdrawal symptoms
Abrupt discontinuation of zuclopenthixol can cause withdrawal symptoms including nausea, vomiting, loss of appetite, diarrhoea, rhinorrhoea (runny nose), sweating, muscle pain, paraesthesia (tingling sensations), insomnia, restlessness, anxiety, and agitation. Some patients may also experience dizziness, alternating sensations of warmth and cold, and tremor. These symptoms typically begin 1–4 days after stopping and subside within 7–14 days. Treatment should therefore be tapered gradually under medical supervision.
Pregnancy and Breastfeeding
Cisordinol Depot should only be used during pregnancy when absolutely necessary and when the potential benefit clearly justifies the risk to the unborn child. Women who are pregnant, planning to become pregnant, or suspect they may be pregnant should discuss the risks and benefits with their doctor before starting or continuing treatment.
Newborns exposed to antipsychotics during the third trimester (last three months of pregnancy) may experience withdrawal symptoms and extrapyramidal effects including tremor, muscle stiffness or weakness, drowsiness, agitation, breathing difficulties, and feeding problems. If your baby shows any of these symptoms after birth, seek medical attention promptly.
Breastfeeding: Small amounts of zuclopenthixol are excreted in breast milk. Women should consult their doctor about the risks and benefits of breastfeeding during treatment. In most cases, alternative feeding methods may be recommended.
Fertility: Animal studies have shown that zuclopenthixol may impair fertility. Patients concerned about fertility should discuss this with their healthcare provider before starting treatment.
Children and adolescents
Cisordinol Depot is not recommended for use in children and adolescents. There is insufficient data on the safety and efficacy of zuclopenthixol decanoate in this patient population.
Driving and operating machinery
Cisordinol Depot can cause drowsiness and dizziness, particularly at the start of treatment and after dose increases. Patients should not drive or operate machinery until they are sure that these effects have subsided. You are personally responsible for assessing whether you are fit to drive or perform work that requires alertness.
How Does Cisordinol Depot Interact with Other Drugs?
Cisordinol Depot interacts with several important medication classes. Certain combinations are contraindicated (quinidine, codeine, bromocriptine, cabergoline), while others require dose adjustment or enhanced monitoring. Always inform your doctor about all medications you are taking.
Drug interactions with Cisordinol Depot can occur through several mechanisms. Zuclopenthixol is metabolised in the liver by cytochrome P450 enzymes, primarily CYP2D6 and CYP3A4. Medications that inhibit or induce these enzymes can alter zuclopenthixol plasma levels. Additionally, pharmacodynamic interactions can occur when Cisordinol Depot is combined with other drugs that affect the central nervous system, cardiac conduction, or blood pressure regulation.
It is critically important to inform your doctor about all medications you are taking, including over-the-counter products and herbal supplements, before receiving Cisordinol Depot.
Major Interactions (Avoid Combination)
The following medications must not be taken concurrently with Cisordinol Depot due to the risk of serious adverse effects:
| Drug / Class | Risk | Recommendation |
|---|---|---|
| Quinidine | Both drugs affect cardiac rhythm; increased risk of QT prolongation and arrhythmias | Contraindicated — do not combine |
| Codeine | Zuclopenthixol may reduce the analgesic efficacy of codeine through CYP2D6 inhibition | Avoid combination — use alternative analgesics |
| Bromocriptine, Cabergoline | Dopamine agonists directly oppose the mechanism of action of zuclopenthixol; mutual reduction of efficacy | Contraindicated — do not combine |
Interactions Requiring Dose Adjustment or Monitoring
The following medications may require dose adjustments or increased monitoring when used together with Cisordinol Depot:
| Drug / Class | Effect | Action Required |
|---|---|---|
| Tricyclic antidepressants | Mutual inhibition of metabolism; increased plasma levels of both drugs | Monitor closely; dose reduction may be needed |
| Fluoxetine, Paroxetine, Venlafaxine | CYP2D6 inhibition by SSRIs/SNRIs increases zuclopenthixol levels | Monitor for increased side effects; consider dose reduction |
| Antihypertensives | Enhanced blood-pressure-lowering effect; risk of orthostatic hypotension | Monitor blood pressure; adjust antihypertensive dose as needed |
| Barbiturates and similar sedatives | Additive CNS depression; increased sedation and respiratory depression | Reduce doses of sedatives; monitor respiratory function |
| Levodopa and dopaminergic drugs | Reduced efficacy of levodopa due to dopamine receptor blockade | Avoid combination if possible; monitor Parkinson's symptoms |
| Diuretics (especially potassium-depleting) | Hypokalaemia increases risk of cardiac arrhythmias and QT prolongation | Monitor potassium levels and ECG regularly |
| Other QT-prolonging drugs (amiodarone, dofetilide, moxifloxacin, erythromycin, mefloquine, methadone, lithium, cisapride) | Additive QT prolongation; increased risk of torsades de pointes and fatal arrhythmias | Avoid combination where possible; if essential, intensive ECG monitoring required |
| Other antipsychotics | Additive dopamine blockade; increased risk of extrapyramidal symptoms and sedation | Avoid polypharmacy; use lowest effective doses if combination necessary |
Alcohol interaction
Cisordinol Depot enhances the sedating effects of alcohol, which can cause excessive drowsiness, impaired motor coordination, and reduced mental alertness. Patients should avoid consuming alcohol during treatment. This interaction is pharmacodynamic — both substances depress central nervous system function, and the combined effect can be significantly greater than either alone. This is particularly dangerous when driving, operating machinery, or in situations requiring quick reactions.
What Is the Correct Dosage of Cisordinol Depot?
Cisordinol Depot is administered by deep intramuscular injection into the gluteal muscle. The usual adult dose is 200–400 mg (1–2 ml) every 2–4 weeks. Your doctor will individualise the dose based on your clinical response.
Cisordinol Depot is exclusively administered by a healthcare professional — a doctor or nurse — via deep intramuscular injection into the gluteal (buttock) muscle. The medication is never self-administered. The depot formulation allows the drug to be released slowly from the injection site, maintaining relatively constant blood levels between injections. This pharmacokinetic profile provides stable symptom control and reduces the peaks and troughs associated with oral dosing.
After injection, peak plasma concentrations of zuclopenthixol are typically reached within 3–7 days, with an apparent elimination half-life of approximately 19 days for the depot formulation. This extended half-life supports the 2–4 week dosing interval.
Adults
Standard Adult Dosing
The usual dose is 200–400 mg (1–2 ml) administered by deep intramuscular injection into the gluteal muscle. The typical interval between injections is 2–4 weeks.
- If the dose exceeds 400 mg (2 ml), it should be divided across two separate injection sites
- When switching from oral Cisordinol tablets to the depot injection, continue tablets at a reduced dose for one week after the first injection
- Your doctor may adjust the dose or the interval between injections based on your individual response
| Patient Group | Dose Range | Interval | Notes |
|---|---|---|---|
| Adults | 200–400 mg (1–2 ml) | Every 2–4 weeks | Doses >400 mg split across two injection sites |
| Elderly (over 65) | Lower end of range | Every 2–4 weeks | Start low and titrate cautiously; increased sensitivity |
| Hepatic impairment | Reduced dose required | Individualised | Extra blood tests for liver function monitoring |
| Children | Not recommended | N/A | Insufficient safety and efficacy data |
Elderly Patients
Elderly patients (over 65 years) typically require doses at the lower end of the dosing range. Older adults are more susceptible to the adverse effects of antipsychotics, including orthostatic hypotension (dizziness upon standing), sedation, and extrapyramidal symptoms. The dose should be initiated at the lowest level and increased cautiously based on clinical response and tolerability.
It is particularly important to note that in elderly patients with dementia, the use of antipsychotics has been associated with a small increase in the risk of death compared with those not receiving such treatment. Cisordinol Depot is not specifically approved for the treatment of behavioural symptoms in dementia, and the risk-benefit ratio should be carefully evaluated in these patients.
Missed Dose
If you miss a scheduled injection, contact your doctor or clinic as soon as possible to arrange a new appointment. Do not double the dose to make up for a missed injection. Because the depot formulation provides sustained release over several weeks, a short delay in receiving the injection is unlikely to cause immediate deterioration, but prolonged gaps between injections increase the risk of psychotic relapse. Consistent, regular dosing is essential for maintaining effective symptom control.
Overdose
Cisordinol Depot is always administered by a healthcare professional, which makes accidental overdose unlikely. However, in the event of an overdose, symptoms may include:
- Drowsiness progressing to coma
- Abnormal involuntary movements and extrapyramidal symptoms
- Seizures
- Cardiovascular collapse (shock) and hypotension
- Hypo- or hyperthermia (abnormally low or high body temperature)
- Cardiac rhythm disturbances, including QT prolongation, irregular or slow heartbeat
Overdose requires immediate emergency medical treatment. There is no specific antidote for zuclopenthixol. Treatment is supportive and symptomatic, and may include cardiac monitoring, maintenance of airway and ventilation, and management of circulatory support. Due to the depot nature of the formulation, monitoring may need to continue for an extended period.
Duration of treatment
Schizophrenia is typically a chronic condition requiring long-term or lifelong treatment. It is important to continue taking the medication regularly, even during periods when you feel well, because the underlying condition persists and stopping treatment prematurely significantly increases the risk of symptom relapse. Your doctor will determine the appropriate duration of treatment based on your individual clinical situation.
What Are the Side Effects of Cisordinol Depot?
Like all medications, Cisordinol Depot can cause side effects, although not everyone experiences them. The most common include drowsiness, dry mouth, movement disorders (extrapyramidal symptoms), and restlessness. Most side effects are dose-dependent and often improve as treatment continues.
Side effects with Cisordinol Depot are most pronounced at the start of treatment and frequently diminish with continued therapy as the body adapts to the medication. The severity and incidence of side effects are generally dose-dependent — higher doses are more likely to produce adverse effects. Your doctor will aim to use the lowest effective dose to minimise the risk of side effects while maintaining adequate symptom control.
The following side effects have been reported with zuclopenthixol, categorised by their frequency of occurrence:
Very Common
Affects more than 1 in 10 patients
- Drowsiness (somnolence)
- Dry mouth
- Restlessness and inability to sit still (akathisia)
- Involuntary movements (hyperkinesia)
- Slow or reduced movements (hypokinesia)
- Movement disorders (extrapyramidal symptoms) — tremor, muscle spasms, rigid movements
Common
Affects 1 in 10 to 1 in 100 patients
- Rapid heartbeat (tachycardia), palpitations
- Tremor, muscle rigidity (dystonia, hypertonia)
- Dizziness, headache, tingling/numbness (paraesthesia)
- Impaired attention, memory problems, gait disturbances
- Blurred vision, difficulty focusing (accommodation disturbance)
- Vertigo (spinning sensation), nasal congestion, breathing difficulties
- Increased salivation, constipation, vomiting, indigestion, diarrhoea
- Urinary problems, urinary retention, excessive urination
- Increased sweating, itching, muscle pain
- Increased appetite, weight gain
- Fatigue, weakness, general malaise, pain
- Insomnia, depression, anxiety, nervousness, abnormal dreams
- Agitation, decreased libido
Uncommon
Affects 1 in 100 to 1 in 1,000 patients
- Overactive reflexes, involuntary movements (dyskinesia), fainting
- Lack of coordination (ataxia), speech difficulties, reduced muscle tone
- Seizures, migraine
- Parkinsonism — slow movements, shuffling gait, tremor at rest, mask-like facial expression
- Circling eye movements, dilated pupils
- Sensitivity to sound (hyperacusis), tinnitus (ringing in ears)
- Abdominal pain, nausea, flatulence
- Rash, photosensitivity, skin pigmentation changes, oily skin, eczema
- Muscle stiffness, inability to open mouth (trismus), twisted neck (torticollis)
- Decreased appetite, weight loss
- Low blood pressure, hot flushes
- Thirst, abnormally low body temperature, fever
- Redness or tenderness at injection site
- Abnormal liver function tests
- Sexual dysfunction — ejaculation failure, erectile dysfunction, difficulty achieving orgasm, vaginal dryness
- Apathy, nightmares, increased libido, confusion
Rare
Affects 1 in 1,000 to 1 in 10,000 patients
- Low platelet count (thrombocytopenia), low white blood cells (neutropenia, leucopenia)
- Elevated prolactin levels (hyperprolactinaemia)
- High blood sugar (hyperglycaemia), impaired glucose tolerance, elevated blood lipids
- Hypersensitivity reactions
- Breast enlargement in men (gynaecomastia), excessive milk production (galactorrhoea)
- Absent menstruation (amenorrhoea), persistent painful erection (priapism)
- Slow heart rate, ECG changes (QT prolongation)
- Irregular heart rhythms (ventricular arrhythmias, ventricular fibrillation, ventricular tachycardia) — rarely life-threatening
- Torsades de pointes (a specific type of dangerous heart rhythm)
Very Rare
Affects fewer than 1 in 10,000 patients
- Neuroleptic malignant syndrome (NMS) — high fever, severe muscle rigidity, altered consciousness, sweating, and rapid heartbeat. This is a medical emergency
- Jaundice — yellowing of the skin and eyes indicating liver damage
- Venous thromboembolism — blood clots in the legs (DVT) that can travel to the lungs causing pulmonary embolism with chest pain and breathing difficulties
- Anaphylactic reaction — severe allergic reaction with fever, rash, swelling, and sometimes low blood pressure
- Agranulocytosis — severely low white blood cell count, making infections potentially life-threatening
If you experience any side effects, including those not listed above, tell your doctor, pharmacist, or nurse. You can also report suspected side effects directly to your national medicines regulatory agency. By reporting side effects, you help provide more information about the safety of this medicine.
How Should You Store Cisordinol Depot?
Cisordinol Depot should be stored out of the sight and reach of children, in the original carton to protect from light. Do not use after the expiry date printed on the label.
Proper storage of Cisordinol Depot is essential to maintain the medication’s effectiveness and safety. As this medication is administered in healthcare settings, storage is typically managed by the clinic or pharmacy. However, the following storage guidelines apply:
- Keep out of the sight and reach of children at all times
- Store the ampoules in the outer carton to protect from light, as the solution is light-sensitive
- Do not use after the expiry date printed on the label — the expiry date refers to the last day of the stated month
- Do not dispose of medicines via household waste or wastewater — return unused or expired medication to your pharmacy for safe disposal to protect the environment
Cisordinol Depot 200 mg/ml solution for injection is supplied in colourless glass ampoules. The solution itself is a clear, yellowish liquid. If the solution appears cloudy, discoloured, or contains particles, it should not be used.
What Does Cisordinol Depot Contain?
Each millilitre of Cisordinol Depot contains 200 mg of zuclopenthixol (as the decanoate ester). The only other ingredient is fractionated coconut oil, which serves as the vehicle for the depot injection.
Active ingredient
The active substance is zuclopenthixol decanoate. Each 1 ml ampoule contains 200 mg of zuclopenthixol (equivalent to approximately 144 mg of zuclopenthixol base). Zuclopenthixol is a thioxanthene derivative with potent dopamine D2 receptor antagonist activity.
Other ingredients
The only excipient is fractionated coconut oil (also known as medium-chain triglycerides or viscoleo). This oil serves as the vehicle in which the zuclopenthixol decanoate ester is dissolved. After intramuscular injection, the oil depot slowly releases the active compound, enabling the long-acting pharmacokinetic profile.
Packaging
Cisordinol Depot 200 mg/ml is supplied as a solution for injection in colourless glass ampoules. The standard pack size is 10 ampoules of 1 ml each (containing 200 mg zuclopenthixol per ampoule) in cardboard cartons. The solution is a clear, yellowish liquid.
Manufacturer
Cisordinol Depot is manufactured by H. Lundbeck A/S, a Danish pharmaceutical company headquartered in Valby, Denmark, that specialises in treatments for brain diseases including psychiatric and neurological disorders.
Frequently Asked Questions About Cisordinol Depot
Cisordinol Depot (zuclopenthixol decanoate) is a long-acting injectable antipsychotic used for maintenance treatment of schizophrenia and other chronic psychotic disorders. It is given as a deep intramuscular injection every 2–4 weeks. The depot formulation is particularly suited for patients who have difficulty adhering to daily oral medication, as it provides sustained symptom control over extended periods. It is effective against positive psychotic symptoms including hallucinations, delusions, thought disturbances, agitation, hostility, and aggression.
Cisordinol Depot is typically administered once every 2 to 4 weeks. The exact interval is determined by your doctor based on your individual response to treatment. Most patients receive their injection every 2–3 weeks initially, with the interval potentially extended to 4 weeks once stable. The injection is given by a healthcare professional into the gluteal (buttock) muscle. Peak drug levels occur 3–7 days after injection, and the drug is slowly released over the following weeks.
The most common side effects of Cisordinol Depot include drowsiness, dry mouth, and movement disorders (extrapyramidal symptoms) such as tremor, muscle spasms, restlessness, and involuntary movements. Other frequently reported effects include increased heart rate, dizziness, weight gain, constipation, and insomnia. Most side effects are most pronounced at the beginning of treatment and often improve with continued use. Inform your doctor if any side effects become bothersome or persist.
No, you should avoid alcohol during treatment with Cisordinol Depot. The medication enhances the sedating effects of alcohol, which can lead to excessive drowsiness, impaired coordination, slowed reactions, and potentially dangerous situations. This is particularly important when driving, operating machinery, or in any situation that requires alertness. If you have questions about alcohol use during treatment, speak with your doctor.
Cisordinol tablets contain zuclopenthixol hydrochloride for daily oral use, while Cisordinol Depot contains zuclopenthixol decanoate for injection every 2–4 weeks. Both contain the same active drug (zuclopenthixol) but differ in their formulation and duration of action. The depot injection provides sustained release over weeks, eliminating the need for daily dosing and improving medication adherence. The depot form is typically used for maintenance treatment after the patient has been stabilised on oral zuclopenthixol. When switching from tablets to depot, oral treatment is continued at a reduced dose for one week after the first injection.
Cisordinol Depot should only be used during pregnancy when absolutely necessary and when the benefit clearly outweighs the risk. Newborns exposed to antipsychotics in the third trimester may experience withdrawal symptoms including tremors, muscle stiffness, drowsiness, agitation, and feeding difficulties. Women who are pregnant, planning a pregnancy, or breastfeeding should discuss treatment options carefully with their doctor. Small amounts of zuclopenthixol pass into breast milk, so breastfeeding during treatment is generally not recommended.
References
This article is based on the following peer-reviewed sources and international medical guidelines:
- European Medicines Agency (EMA). Zuclopenthixol – Summary of Product Characteristics (SmPC). Available at: www.ema.europa.eu
- World Health Organization (WHO). Model List of Essential Medicines, 23rd edition (2023). Geneva: WHO.
- British National Formulary (BNF). Zuclopenthixol decanoate. National Institute for Health and Care Excellence (NICE). Available at: bnf.nice.org.uk
- Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry, 14th edition (2021). Wiley-Blackwell.
- Leucht S, Cipriani A, Spineli L, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. The Lancet. 2013;382(9896):951–962. doi:10.1016/S0140-6736(13)60733-3
- National Institute for Health and Care Excellence (NICE). Psychosis and schizophrenia in adults: prevention and management. Clinical guideline CG178 (2014, updated 2024). Available at: www.nice.org.uk/guidance/cg178
- Kishimoto T, Hagi K, Nitta M, et al. Effectiveness of long-acting injectable vs oral antipsychotics in patients with schizophrenia: a meta-analysis of prospective and retrospective cohort studies. Schizophrenia Bulletin. 2018;44(3):603–619. doi:10.1093/schbul/sbx090
- British Association for Psychopharmacology (BAP). Evidence-based guidelines for the pharmacological treatment of schizophrenia (2020). Journal of Psychopharmacology. 2020;34(1):3–78.
- Correll CU, Citrome L, Haddad PM, et al. The use of long-acting injectable antipsychotics in schizophrenia: evaluating the evidence. Journal of Clinical Psychiatry. 2016;77(suppl 3):1–24.
- American Psychiatric Association. Practice Guideline for the Treatment of Patients with Schizophrenia, 3rd edition (2021). Washington, DC: APA.
Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, comprising licensed specialist physicians in psychiatry, clinical pharmacology, and neuroscience. Our team follows international evidence-based guidelines including those from WHO, EMA, NICE, BAP, and APA.
Medical Writing
iMedic Medical Editorial Team – specialists in psychiatry and psychopharmacology with extensive clinical and academic experience in the management of psychotic disorders.
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