zh health Department: Health REPUBLIC OF SOUTH AFRICA Private Bag X828, PRETORIA, 0001, Civitas Building, Pretoria Reference: EDP052017/01 NOTICE: RECOMMENDED THERAPEUTIC ALTERNATIVE FOR FLUPHENAZINE DECANOATE The Primary Health Care and Adult Hospital Level Standard Treatment Guidelines (STGs) and Essential Medicines List (EML) currently recommend long term depot therapy with an antipsychotic for schizophrenia in patients with adherence problems. Three depot antipsychotics are listed in the STGs and EML, flupenthixol decanoate, fluphenazine decanoate and zuclopenthixol decanoate. The fluphenazine decanoate product however has been discontinued. Although there are no exact equivalent doses, the following may be used to switch patients from fluphenazine decanoate to an alternative depot antipsychotic (for further information, see Guidelines for Antipsychotic Medication Switches, NHS Foundation Trust, and available from http://www. health gov.za/index. php/circulars): Fluphenazine decanoate 26mg = Flupenthixol decanoale 20mg OR Zuclopenthixol decanoate 200mg ‘Switching patients: On the date scheduled for the fluphenazine decanoate injection, replace with either flupenthixol decanoate, IM or zuclopenthixol decanoate, IM at the estimated equivalent dose (above). Continue with either monthly- or two-weekly injections as per the patient's previous schedule on fluphenazine decanoate. «Inform the patient of the switch and advise that any adverse effect should be reported as soon as possible. * Review monthly for adverse effects and early signs of relapse. Adjust the dose of the new depot injection accordingly. = Consult with a psychiatrist as appropriate Comments may be submitted via e-mail to: Dr R Lancaster Tel: 012 395 9756 E-mailRuth.Lancaster@health.gov.za | SAEDP@health.aov.za Kind regards HKhmorw bw MS K JAMALOODIEN DIRECTOR: AFFORDABLE MEDICINES DATE: 02\00 (7 NDOH Circular notice - Alternatives to fluphenazinedecanoate May 2017