Transition from Olanzapine to Clopixol

[Chip (OP)]

🧠 Transitioning from Olanzapine to Clopixol (Zuclopenthixol)

🔍 Background
Olanzapine is a second-generation (atypical) antipsychotic used long-term for schizophrenia, bipolar disorder, and treatment-resistant depression.

Clopixol (Zuclopenthixol) is a first-generation (typical) antipsychotic, often used in aggressive, psychotic, or noncompliant patients (e.g., via depot injection).


📊 Comparison Table
Olanzapine
- Class: Atypical (2nd Gen)
- Receptors: D2, 5HT2A, 5HT2C, H1, M1, α-1
- Sedation: High (via H1 and M1)
- EPS risk: Low to Moderate
- Depot: ZypAdhera
- Mood effect: Good
- Weight Gain: High

Clopixol
- Class: Typical (1st Gen)
- Receptors: D2, α-1, mild anticholinergic
- Sedation: Moderate to High
- EPS risk: Moderate to High
- Depot: Clopixol Acuphase / Depot
- Mood effect: Weak
- Weight Gain: Lower than Olanzapine


⚠️ Considerations After 25 Years of Olanzapine
- Dopamine Supersensitivity: Clopixol may hit harder at D2 → ↑EPS risk.
- Withdrawal Risk: Sudden Olanzapine cessation may cause insomnia, agitation, nausea.
- Mood effects: Clopixol has less mood-stabilizing potential.


✅ Suitable Scenarios for Clopixol
- Treatment-resistant schizophrenia
- Agitation/aggression
- Noncompliance (Depot formulation)

❌ Poor Fit Scenarios
- Bipolar depression
- Existing EPS or tardive dyskinesia
- Emotional dullness or lack of motivation


🔄 Suggested Cross-Taper Strategy

Week 1–2
- Continue Olanzapine full dose
- Start Clopixol oral at 2 mg at night

Week 3–4
- Decrease Olanzapine by 2.5–5 mg
- Increase Clopixol to 5–10 mg in divided doses

Week 5–6
- Reduce Olanzapine further (taper to 2.5 mg or every second day)
- Clopixol may be maintained at 10–15 mg, or switch to Depot

Ongoing
- Monitor EPS symptoms
- Optional: Add Propranolol or Benzatropine if needed


💡 Alternatives (if Clopixol poorly tolerated)
- Aripiprazole
- Lurasidone or Cariprazine
- Modafinil or low-dose stimulants (under supervision)