fluphenazine

First generation antipsychotics are less commonly prescribed after the advent of second generation antipsychotics, which are more effective in treating the negative symptoms of schizophrenia and have better safety profiles.

Fluphenazine reduces dopamine activity in the brain, reducing symptoms of schizophrenia such as hallucinations and delusions.

Fluphenazine is a phenothiazine-derived antipsychotic that inhibits dopamine D1 and D2 receptors, reducing dopamine activity. It also depresses hormone release from the hypothalamus and pituitary gland, causing side effects.

Fluphenazine is not effective for managing behavioral complications in patients with intellectual disabilities. It is used off-label for Tourette syndrome.

Warnings

• Do not use fluphenazine in patients with dementia-related psychosis as it increases the risk of death from cardiovascular conditions or infections.
• Do not use fluphenazine in patients with hypersensitivity to fluphenazine or other phenothiazine derivatives.
• Avoid fluphenazine use in patients with various conditions, such as subcortical brain damage, severe CNS depression or coma, severe hypotension, poorly controlled seizure disorder, blood disorders, liver damage, stenosing peptic ulcer disease, history of NMS, Parkinson’s disease, low calcium levels, liver or kidney function impairment, severe reaction to insulin or electroconvulsive therapy, history of seizures, asthma, respiratory tract infections, or cardiovascular disease.

Side Effects

Common side effects of fluphenazine include irregular heart rhythms, rapid heart rate, high or low blood pressure, swelling, cerebral edema, EEG pattern changes, headache, dizziness, drowsiness, overactive reflexes, lethargy, muscle spasm, tremor, seizure, decreased gag reflex, extrapyramidal symptoms, constipation, urinary retention, blurred vision, dry mouth, corneal changes, glaucoma, lens opacities, retinitis pigmentosa, rash, redness, hives, eczema, dermatitis, red scaly patches, itching, pigmentation, photosensitivity, leukopenia, agranulocytosis, eosinophilia, pancytopenia, low platelet count, and bruising.

Seek medical attention immediately if you experience serious side effects such as serious heart symptoms, severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, severe nervous system reaction, or serious eye symptoms.

Dosages

Tablet

Elixir

Oral concentrate

Injectable solution

• 2.5 mg/mL (fluphenazine hydrochloride)
• 25 mg/mL (fluphenazine decanoate)

Adult:

• Initial dose: 2.5-10 mg/day orally divided every 6-8 hours
• Maintenance: 1-5 mg orally/intramuscularly divided every 6-8 hours; not to exceed 40 mg/day
• Injection: 12.5-25 mg (25 mg/mL) every 2-4 weeks
• Conversion from hydrochloride salt to decanoate: 10 mg/day orally HCl salt = approximately 12.5 mg intramuscularly/subcutaneously every 3 weeks of decanoate salt

Use with caution in patients with renal or hepatic impairment.

Geriatric: 1-2.5 mg/day orally, dosage titrated according to response

Pediatric: Safety and efficacy not established

Overdose

• Fluphenazine overdose can cause symptoms such as dry mouth, reduced sweating, urinary retention, constipation, increased heart rate, dilated pupils, and blurred vision.
• Treatment is symptomatic and supportive care; there is no specific antidote for fluphenazine overdose.

Drug Interactions

Inform your doctor of all medications you are currently taking to avoid potential drug interactions. Do not start, stop, or change the dosage of any medication without your doctor’s recommendation.

Severe interactions include amisulpride, disopyramide, ibutilide, indapamide, metrizamide, pentamidine, pimozide, procainamide, quinidine, and sotalol. For a complete list of drug interactions, consult the RxList Drug Interaction Checker.

Pregnancy and Breastfeeding

• Fluphenazine use during pregnancy should be individualized and based on benefits and risks.
• Use of antipsychotics during the third trimester carries a risk of abnormal muscle movements and/or withdrawal symptoms in newborns.
• Avoid breastfeeding while using fluphenazine.

Take fluphenazine exactly as prescribed. Notify your physician if you develop movement disorders or flu-like symptoms. Exercise caution to avoid extreme temperatures. Fluphenazine may cause drowsiness and seizures, so avoid hazardous activities. Keep out of reach of children and seek medical help immediately in case of overdose.

Summary

Fluphenazine is a first-generation antipsychotic used for the management of psychotic disorders in patients with chronic schizophrenia. It is not approved for use in dementia-related psychosis. Common side effects include irregular heart rhythms, rapid heart rate, high or low blood pressure, swelling, cerebral edema, headache, dizziness, drowsiness, overactive reflexes, lethargy, and more. Consult your doctor if pregnant or breastfeeding.