Dr Edith Sciberras,  Dr  Joseph Cassar & Dr Maria Bezzina Xuereb

As part of Liaison Psychiatry team at Mater Dei Hospital, in August 2019, we were called to review a 30 year old gentleman, who took an intentional overdose with suicidal intent of around 90 tablets of Flupentixol/melitracen (Deanxit). He had no other past medical history and was not on any treatment. Deanxit was initially prescribed by his family doctor in the context of anxiety and the patient only took it sporadically according to need. The overdose was carried out with leftover tablets from a prior prescription. He had not consulted his family doctor in the year after his first prescription or any psychiatrist about experiencing low mood and anxiety. He was admitted to the Coronary Care Unit at Mater Dei Hospital for cardiac monitoring due to high risk of arrhythmias. Upon psychiatric review, the patient was not easily aroused. Thereafter, he became confused and agitated, indicating delirium secondary to the Deanxit anti-cholinergic side effects. The patient was kept on a cardiac monitor and off psychotropic treatment for a few days before being transferred to the Psychiatric Unit. He was diagnosed with a moderate to severe depressive episode for which he was started on SSRIs.

Deanxit is made up of two components: flupentixol 0.5mg (antipsychotic) and melitracen 10mg (tricyclic antidepressant). Neurological side effects are mostly related to flupentixol. Very common flupentixol neurological side-effects (<1/10) include: somnolence, akathisia, hyperkinesia and hypokinesia. Common side-effects (<1/100 to <1/10) include tremor, dystonia, dizziness, headache and disturbance in attention. Uncommon (<1/1,000 to <1/100) to rare (<1/10,000 to <1/1,000) side-effects include tardive dyskinesia, dyskinesia, parkinsonism, speech disorder and convulsions. Very rare side-effects (<1/10,000) include neuroleptic malignant syndrome.1

However, in cases of over-dosage, anti-cholinergic symptoms related to melitracen dominate. These include mydriasis, tachycardia, urinary retention, mucosal dryness, intestinal hypomotility, irritability, agitation, hallucinations, convulsions, pyrexia, depressed level of consciousness, coma, respiratory depression, cardiac arrhythmias (ventricular arrhythmia, torsade de pointes, ventricular fibrillation), cardiac failure, hypotension, cardiogenic shock, metabolic acidosis and hypokalaemia. 2

Self-medication with Deanxit is commonly seen in our clinical experience, however this should be recognised and prohibited. There are various other safer medications available for most of the intended applications of this drug. In any case, when used, it should only be given for a short term under the supervision of a specialist doctor.

References

  1. Fluanxol Tablets – Summary of Product Characteristics [Internet]. Retrieved 16 September 2019. Available from: www.medicines.org.uk/emc/product/998/smpc
  2. Malta Medicines Authority. Summary of Product Characteristics of Deanxit [online]. Available at: http://www.medicinesauthority.gov.mt/medicine-details?id=85239 [Accessed 2 Oct 2019].