Prolixin (Fluphenazine) - Clinical Uses
Prolixin (fluphenazine) is a first-generation, high-potency typical antipsychotic primarily used for treating schizophrenia and for controlling severe psychomotor agitation, delusions, hallucinations, and combativeness. 1, 2
Primary Indications
Schizophrenia Treatment
- Fluphenazine is FDA-approved for the treatment of schizophrenia, functioning as a CNS dopamine D2 receptor antagonist 1, 3
- It is classified as a high-potency first-generation antipsychotic, similar to haloperidol 1, 3
- The medication is effective for controlling problematic delusions, hallucinations, severe psychomotor agitation, and combativeness 1
Behavioral Control in Specific Populations
- In Alzheimer's disease patients, fluphenazine is used as a second-line therapy for controlling problematic behavioral symptoms when atypical antipsychotics cannot be tolerated or are ineffective 1
- It is reserved for severe behavioral disturbances including delusions, hallucinations, and combativeness 1
Important Clinical Considerations
Side Effect Profile
- As a high-potency agent, fluphenazine is less sedating but carries a significantly higher risk of extrapyramidal symptoms (EPS) compared to low-potency antipsychotics 1, 3
- The risk of irreversible tardive dyskinesia can develop in up to 50% of elderly patients after 2 years of continuous use 1
- Acute dystonic reactions are more common with high-potency agents like fluphenazine, particularly in young males 1
Position in Treatment Guidelines
- Current guidelines recommend fluphenazine as second-line therapy, to be avoided if possible due to significant side effects involving cholinergic, cardiovascular, and extrapyramidal systems 1
- It should only be used when atypical antipsychotics are ineffective or not tolerated 1
- In resource-limited settings where second-generation agents are unavailable, first-generation antipsychotics like fluphenazine should be used judiciously at very low doses 3
Monitoring Requirements
- Baseline assessment of abnormal movements should be recorded before initiating therapy 1
- Assessment for dyskinesias should occur at least every 3 to 6 months using standardized scales like the Abnormal Involuntary Movement Scale 1
- If extrapyramidal symptoms occur, decrease the dosage or switch to another agent; avoid routine use of anticholinergic agents like benztropine 1