Review of treating mania with zuclopenthixol: Looking for a therapeutic window

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Abstract
Bjørndal F. Review of treating mania with zuclopenthixol: Looking for a therapeutic window. In 1961 Ravn & Rud published the first paper about the good antimanic effect of clopenthixol. The change in preparation to zuclopenthixol in 1982 and new research in treating mania without side effects made zuclopenthixol known as an alternative to haloperidol. Eight major clinical studies with a total of 122 patients are referred, and they show that zuclopenthixol has a good antimanic effect in 80% of the patients. The daily dose has been reduced over the years with no change in efficacy, indicating that the rate of nonresponder of 20% is dose-independent. In the responders a daily dose of 30-50 mg zuclopenthixol has been sufficient, and doses over 50 mg gave pronounced sedation. After 2 weeks' treatment it is possible to reduce the daily dose to 20-15 mg and avoid side effects. After 5-6 weeks' treatment most patients could be discharged and finish zuclopenthixol treatment as outpatients. Serum concentrations of zuclopenthixol were measured in 30% of the patients and showed no single therapeutic window, but the minimum level was 5 ng/ml. In general, serum concentration measurement is not necessary in clinical practice when using zuclopenthixol.