Zuclopenthixol dihydrochloride, administered orally, is one of the older generation of drugs (though still available and used worldwide) for managing the signs and symptoms of schizophrenia. This review found no long term randomised studies and very few studies that reported clinically meaningful data. Two trials compared zuclopenthixol with placebo, neither of which reported global or mental state outcomes. People allocated zuclopenthixol did have increased risk of movement disorder adverse effects compared with people on placebo, although compared with similar older antipsychotics, zuclopenthixol fared better and the risk of being 'unchanged or worse' was decreased. None of the findings suggest any clear difference between zuclopenthixol and other typical antipsycotics across a wide range of adverse effects. When compared with the newer generation of drugs, those taking zuclopenthixol were associated with no greater risk of being unchanged or worse compared with those taking risperidone, although the study size of trials was small. People allocated zuclopenthixol however, were prescribed anti-movement disorder medication more frequently than those treated with risperidone and many people left these short studies early (45% zuclopenthixol vs 30% risperidone).
If conclusions can be drawn from this to suggest that oral zuclopenthixol may have some clinical advantage over other older drugs in terms of global state, at least in the short term, this is an important finding. Although there is no information on service, functional, behavioural outcomes and clinically significant outcomes such as relapse, we think it should remain a choice in the treatment of those for whom older generation drugs are indicated.