Pipotiazine palmitate, commonly known as Piportil Depot, is an antipsychotic medication, classified as a phenothiazine, that was primarily used to treat schizophrenia. It is now no longer available, due to lack of availability of a key ingredient of the medication.

Pipotiazine palmitate brand names

  • Piportil Depot

What is pipotiazine palmitate prescribed for?

Pipotiazine palmitate is a first-generation antipsychotic drug, in the class of phenothiazines, that was used to treat schizophrenia and other psychosis [1].

Due to a lack of availability of a component ingredient of the medication, production of pipotiazine palmitate was discontinued in 2015, causing physicians to have to change medications for those previously prescribed pipotiazine palmitate [2].

Pipotiazine palmitate was only available as a depot injection, to be administered once every four weeks, as the medication is slowly released into the body throughout this period of time. Depot injections are known as long-acting injectable medications (LAIs), of which there are several alternatives currently available for the treatment of schizophrenia [3].

How does pipotiazine palmitate work?

Pipotiazine palmitate works in the same way as other first-generation antipsychotic medications, by reducing the activity of the neurotransmitter, dopamine [4]. This then helps to alleviate the positive symptoms of psychosis, including hallucinations and delusions.

However, this mechanism of action is also the cause of several side effects impacting movement, which prompted the creation of second-generation antipsychotics, which impact both serotonin and dopamine and have significantly fewer effects on movement, although can cause other side effects [5].

How is pipotiazine palmitate usually taken?

Pipotiazine palmitate was administered only as a depot injection and was not available as an oral medication [2]. This would require a medical professional to administer the medication, either by visiting the home of the person requiring the medication, or in a hospital or clinic [4].

As with most LAIs, pipotiazine palmitate would initially be commenced at a low dose, to be gradually increased to find a therapeutic dose for the individual.

Initially, 25mg of pipotiazine palmitate would be administered, with careful monitoring of any physical or mental side effects and individual response to the medication. This dose would then be repeated around a week later, if the first dose was tolerated.

The following doses would be increased to a maintenance dose of 50-100mg, to be administered every 4 weeks. This maintenance dose could be increased to a maximum of 200mg if required [6].

Elderly people would be commenced on a lower dose of 5-10mg, which could be slowly increased, due to an increased risk of adverse effects [1].

Often, LAIs are prescribed to people who have a history of medication noncompliance, meaning that they forget or chose not to take their medication, thus causing a worsening in their condition. LAIs remove the need to remember to take daily medication, allow for monthly monitoring of medication tolerance and changes in symptoms, and can help to prevent hospitalization [4].

How long does pipotiazine palmitate stay in your system?

Following an injection of pipotiazine palmitate, improvements could be noticed within 3-4 days, although the medication would be effective for 4 weeks [7].

As pipotiazine palmitate lasts for 4 weeks, switching to a new medication would present with very little risk of withdrawal symptoms, allowing for a new medication to be introduced while the previous medication is still working [2].

Pipotiazine palmitate side effects

When starting a new medication, you may experience some common side effects. They should reduce within the first few weeks, but if they continue or become problematic, you may require a reduction in your dose or a change of medication, so it is important to contact your doctor.

Many antipsychotic medications cause similar side effects, and your doctor may prescribe a medication to help alleviate troubling side effects [5].

Common side effects of pipotiazine palmitate include:

  • Dry mouth
  • Blurry vision
  • Restlessness
  • Constipation
  • Shaking or tremors
  • Increase in appetite and weight
  • Drowsiness
  • Dizziness
  • Secretion of milk
  • Sexual dysfunction

Serious side effects of pipotiazine palmitate and other antipsychotic medications are less common but may still occur. Contact your doctor immediately if you experience any of the following:

  • Increase in body temperature
  • Muscle stiffness, pain, or weakness
  • Excessive tiredness
  • Irregular heartbeat
  • Problems with vision
  • Difficulty urinating
  • Fever
  • Unusual bleeding or bruising
  • Yellowing of the skin or eyes
  • Chest pain
  • Fainting
  • Seizure
  • Changes in mental state, including emerging or worsening depression, anxiety, mania, agitation, or aggression, or an increase in psychotic symptoms

Pipotiazine palmitate precautions

Pipotiazine palmitate is no longer available, but you may be prescribed alternative antipsychotic medications to treat your condition.

It is important that your doctor is aware of any past or present mental health conditions you have experienced, to enable safe monitoring of your condition while on antipsychotic medication, or to decide if it is safe for you.

Discuss with your doctor all your past and present physical health conditions, as they may impact your ability to take this medication safely.

Ensure you tell your doctor if you have experienced any issues with your heart, liver, kidney, blood, brain, thyroid, or prostate, seizures, Parkinson’s disease, glaucoma, or breathing difficulties, as it may not be safe for you to take this medication or other phenothiazines, or your doctor may wish to prescribe a lower dose and closely monitor your physical health during your treatment.

It has been found that older adults are at an increased risk of stroke when taking antipsychotic medications, so they should be used with caution and in lower doses within this age group [5].

Tell your doctor about all medications you are currently taking, or plan to take (including vitamins and dietary supplements), as they may cause adverse reactions.

Tell your doctor if you are pregnant or planning to become pregnant, as antipsychotic medications can cause harm to the fetus, so these medications should only be used during pregnancy if the benefit of the treatment outweighs the potential risk to the baby. Stopping medication may cause a serious worsening in mental health, so options should be carefully considered [5].

Pipotiazine palmitate interactions

Pipotiazine palmitate and other phenothiazine antipsychotics can interact with other medications, potentially causing a decrease in the effectiveness of your medication or an increase in side effects. This includes heart medications, pain killers, antivirals, diuretics, antihistamines, seizure medications, antidepressants, mood stabilizers, sedatives, tranquilizers, and sleeping pills [6]. In most cases, these can make the medication either more or less effective, which can be dangerous or cause poor symptom management.

It is advised to avoid or limit alcohol intake while on an antipsychotic medication, as alcohol can increase the drowsiness and sedative effects of the medication and can worsen symptoms [1].

Pipotiazine palmitate storage

Depot injections, such as pipotiazine palmitate, would be stored at a medical facility and would not be required to be kept at home [4].

What to do if you overdose on pipotiazine palmitate

If you think you have been given too much pipotiazine palmitate, contact a medical professional immediately, or in case of an emergency, call 911. Symptoms of a pipotiazine palmitate overdose include muscle pain and stiffness, tremors, drowsiness, low blood pressure, and irregular heartbeat.

FAQs about pipotiazine palmitate

Is pipotiazine palmitate still available?

Pipotiazine palmitate is no longer available, due to an ingredient of the injection solution no longer being available [2].

Resources:

  1. Davis, C. (2008). Pipotiazine. In S.J. Enna & D.B. Byland, xPharm: The Comprehensive Pharmacology Reference (pp. 1-5). Elsevier Inc. Retrieved from https://doi.org/10.1016/B978-008055232-3.62427-4
  2. Haddad, P., Taylor, M., Patel, M., & Taylor, D. (2015). Guidance on Switching Away from Piportil Depot (Pipotiazine Palmitate) Injection. British Journal of Psychiatry, 206(6), 521-521. Retrieved from https://doi.org/10.1192/bjp.206.6.521
  3. Mustafa F.A. (2017). Switching Away from Pipotiazine Palmitate: A Naturalistic Study. Therapeutic Advances in Psychopharmacology, 7(1), 25–28. Retrieved from https://doi.org/10.1177/2045125316672575
  4. Dinesh, M., David, A., & Quraishi, S.N. (2004). Depot Pipotiazine Palmitate and Undecylenate for Schizophrenia. The Cochrane Database of Systematic Reviews, 2004(4), CD001720. Retrieved from https://doi.org/10.1002/14651858.CD001720.pub2
  5. Chokhawala, K., & Stevens, L. (2022). Antipsychotic Medications. In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519503/
  6. Sanofi-aventis Canada Inc. (Revised 2011). Piportil L. Retrieved from https://pdf.hres.ca/dpd_pm/00014620.PDF
  7. Gallant, D.M., Mielke, D., Bishop, G., Oelsner, T., & Guerrero-Figueroa, R. (1975). Pipotiazine Palmitate: An Evaluation of a New Long Acting Intramuscular Antipsychotic Agent in Severely Ill Schizophrenic Patients. Diseases of the Nervous System, 36(4), 193–196. Retrieved from https://pubmed.ncbi.nlm.nih.gov/1090427/