From the Guidelines
Fluphenazine should be used with caution and as a second-line therapy due to its association with significant side effects, including extrapyramidal symptoms and tardive dyskinesia, as suggested by current research 1.
Overview of Fluphenazine
Fluphenazine is a typical antipsychotic medication primarily used to treat schizophrenia and other psychotic disorders. It functions by blocking dopamine D2 receptors in the brain, which helps in reducing positive symptoms of psychosis such as hallucinations and delusions. The medication is available in oral forms and as long-acting injectable formulations.
Dosage and Administration
The common dosing for oral fluphenazine ranges, but specific details can vary based on the patient's condition and response to the medication. For instance, the dosage can start at a certain level and be adjusted based on the patient's needs and tolerance. The long-acting injectable formulation, fluphenazine decanoate, is typically administered every 2-4 weeks for maintenance therapy, with the initial dose often in the range of 12.5-25 mg.
Side Effects and Monitoring
As a typical antipsychotic, fluphenazine carries a significant risk of extrapyramidal side effects, including:
- Akathisia
- Parkinsonism
- Dystonia
- Tardive dyskinesia These movement disorders necessitate careful monitoring, and in some cases, anticholinergic medications like benztropine may be prescribed to manage acute symptoms. Other potential side effects include sedation, orthostatic hypotension, anticholinergic effects, hyperprolactinemia, and QT prolongation. Regular monitoring of movement disorders, metabolic parameters, and cardiac function is crucial during treatment with fluphenazine, as indicated by guidelines for managing psychiatric conditions 1.
Considerations for Use
Given the potential for significant side effects, the use of fluphenazine should be carefully considered, especially in elderly patients, where the risk of irreversible tardive dyskinesia is higher 1. Atypical antipsychotic agents are generally preferred due to their diminished risk of developing extrapyramidal symptoms and tardive dyskinesia compared to typical antipsychotic agents like fluphenazine. However, in cases where atypical antipsychotics are not tolerated or effective, fluphenazine may be considered as a second-line therapy, with close monitoring for side effects.
From the FDA Drug Label
Fluphenazine hydrochloride is a trifluoromethyl phenothiazine derivative intended for the management of schizophrenia. Fluphenazine hydrochloride tablets are indicated in the management of manifestations of psychotic disorders.
Yes, Fluphenazine is a typical antipsychotic, as it is a phenothiazine derivative and is indicated for the management of schizophrenia and manifestations of psychotic disorders 2 2.
- Key points:
- Intended for the management of schizophrenia
- Indicated for the management of manifestations of psychotic disorders
- Phenothiazine derivative, which is a class of typical antipsychotics
From the Research
Overview of Fluphenazine
- Fluphenazine is a typical antipsychotic drug from the phenothiazine group of antipsychotics 3.
- It has been commonly used in the treatment of schizophrenia, but its use has declined with the advent of atypical antipsychotic medications 3.
Efficacy of Fluphenazine
- Studies have compared the efficacy of fluphenazine with atypical antipsychotics, such as amisulpride, risperidone, quetiapine, and olanzapine, and found no significant differences in terms of mental state and clinical response 3.
- Fluphenazine has also been compared with placebo, and results suggest that it is effective in reducing relapse rates, but with significant extrapyramidal adverse effects 4, 5.
- A study examining the dose-response relationship of fluphenazine found that higher doses were associated with greater clinical improvement, but also with more severe extrapyramidal symptoms 6.
Comparison with Low-Potency Antipsychotics
- Fluphenazine has been compared with low-potency antipsychotic drugs, and results suggest that there is no significant difference in terms of response to treatment and acceptability of treatment 7.
- However, fluphenazine was associated with a higher incidence of movement disorders, such as akathisia and dystonia, while low-potency antipsychotics produced more sedation 7.
Adverse Effects
- Fluphenazine is associated with significant extrapyramidal adverse effects, such as akathisia, dystonia, and rigidity 3, 4, 5, 7.
- It is also associated with other adverse effects, such as dizziness, drowsiness, dry mouth, nausea, and vomiting, although these may be less frequent than with low-potency antipsychotics 7.