Fluphenazine(floo fen’ a zeen)
Fluphenazine Decanoate
Injection: Modecate Concentrate (CAN)
Fluphenazine Hydrochloride
Oral tablets, concentrate, elixir, injection: Apo-Fluphenazine (CAN)
PREGNANCY CATEGORY C
Drug Classes
Antipsychotic
Dopaminergic blocker
Phenothiazine
Therapeutic Actions
Mechanism not fully understood: Antipsychotic drugs block postsynaptic dopamine receptors in the brain, depress the RAS, including the parts of the brain involved with wakefulness and emesis; anticholinergic, antihistaminic (H1), and alpha-adrenergic blocking activity also may contribute to some of its therapeutic (and adverse) actions.
Indications
Management of manifestations of psychotic disorders; the longer acting parenteral dosage forms, fluphenazine enanthate and fluphenazine decanoate, indicated for management of patients (chronic schizophrenics) who require prolonged parenteral therapy
Fluphenazine decanoate: Long-term or parenteral neuroleptic therapy
Unlabeled use: Post-herpetic neuralgia
Contraindications and Cautions
Contraindicated with hypersensitivity to fluphenazine, other phenothiazines, tartrazine, or aspirin; coma or severe CNS depression; bone marrow depression; blood dyscrasia; circulatory collapse; subcortical brain damage; Parkinson disease; liver damage; cerebral arteriosclerosis; coronary disease; severe hypotension or hypertension; pregnancy.
Use cautiously with respiratory disorders (“silent pneumonia”); glaucoma, prostatic hypertrophy (anticholinergic effects may exacerbate glaucoma and urinary retention); epilepsy or history of epilepsy (drug lowers seizure threshold); breast cancer (elevations in prolactin may stimulate a prolactin-dependent tumor); thyrotoxicosis; peptic ulcer, decreased renal function; myelography within previous 24 hr or myelography scheduled within 48 hr; exposure to heat or phosphorous insecticides; pregnancy; lactation; children younger than 12 yr, especially those with chickenpox, CNS infections (children are especially susceptible to dystonias that may confound the diagnosis of Reye syndrome).
Available Forms
Tablets—1, 2.5, 5, 10 mg; injection—25 mg/mL (decanoate); 2.5 mg/mL (hydrochloride); oral elixir—2.5 mg/5 mL; solution (concentrate)—5 mg/mL
Dosages
Full clinical effects may require 6 wk–6 mo of therapy. Patients who have never taken phenothiazines, poor-risk patients (those with disorders that predispose to undue reactions) should be treated initially with this shorter-acting dosage form and then switched to the longer-acting parenteral forms, fluphenazine enanthate, or decanoate.
The duration of action of the esterified forms of fluphenazine is markedly longer than those of fluphenazine hydrochloride; the duration of action of fluphenazine enanthate is estimated to be 1–3 wk; the duration of action of fluphenazine decanoate is estimated to be 4 wk. No precise formula is available for the conversion of fluphenazine hydrochloride dosage to fluphenazine decanoate dosage, but one study suggests that 20 mg of fluphenazine hydrochloride daily was equivalent to 25 mg decanoate every 3 wk.
Adults
fluphenazine hydrochloride
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