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Apo-Fluphenazine (CA), Moditen (UK), PMS-Fluphenazine (CA)
Pharmacologic class: Phenothiazine, dopaminergic blocker
Therapeutic class: Anxiolytic, antipsychotic
Pregnancy risk category C
Unclear. May alter postsynaptic mesolimbic dopamine receptors in brain and reduce release of hypothalamic and hypophyseal hormones thought to depress reticular activating system, thereby preventing psychotic symptoms.
Depot injection: 25 mg/ml
Elixir: 2.5 mg/5 ml
Injection: 2.5 mg/ml
Oral concentrate: 5 mg/ml
Tablets: 1 mg, 2.5 mg, 5 mg, 10 mg
⊘Indications and dosages
➣ Psychotic disorders
Adults: 2.5 to 10 mg/day (hydrochloride) P.O. in divided doses q 6 to 8 hours or as a single dose at bedtime; typical daily dosage is 1 to 5 mg; give oral doses above 20 mg/day with caution. Or initially, 1.25 mg I.M., divided and given q 6 to 8 hours. Parenteral hydrochloride dosage is one-third to one-half of oral dosage. Or 12.5 to 25 mg I.M. or subcutaneously (decanoate); base subsequent dosage and dosing intervals of 1 to 4 weeks on patient response; don't exceed 100 mg.
• Elderly patients
• Hypersensitivity to drug, sulfites (with injectable form), or benzyl alcohol
• Angle-closure glaucoma
• Bone marrow depression
• Severe hepatic or cardiovascular disease
Use cautiously in:
• diabetes, respiratory disease, prostatic hypertrophy, CNS tumors
• elderly patients
• pregnant or breastfeeding patients (safety not established)
• children with acute illnesses, infections, gastroenteritis, or dehydration.
☞ Be aware that parenteral form is for I.M. and subcutaneous use only. Don't give I.V.
• Don't give parenteral form to comatose or severely depressed patient.
• Use gloves when handling. To prevent contact dermatitis, keep drug away from clothing and skin.
• Dilute concentrated oral forms in juice, milk, or semisolid food just before administering.
• Give long-acting, oil-based preparations with dry needle of at least 21G.
• Be aware that antacids and adsorbent antidiarrheals may decrease adsorption of fluphenazine. Give 1 hour before or 2 hours after fluphenazine.
CNS: drowsiness, sedation, extrapyramidal reactions, tardive dyskinesia, pseudoparkinsonism, neuroleptic malignant syndrome, seizures
CV: hypotension, tachycardia
EENT: blurred vision, dry eyes, lens opacities, nasal congestion
GI: constipation, dry mouth, anorexia, paralytic ileus
GU: urinary retention, menstrual irregularities, inhibited ejaculation, priapism, gynecomastia, lactation
Hematologic: eosinophilia, hemolytic anemia, aplastic anemia, agranulocytosis, leukopenia, thrombocytopenia
Hepatic: jaundice, hepatitis
Metabolic: galactorrhea, hyperthermia
Skin: photosensitivity, rash
Other: allergic reactions, pain at injection site, sterile abscess
Drug-drug.Activated charcoal, adsorbent antidiarrheals, antacids: decreased fluphenazine adsorption
Anticholinergics: decreased fluphenazine effects
Antidepressants, antihistamines, general anesthetics, MAO inhibitors, opioid analgesics, sedative-hypnotics: additive CNS depression
Antihistamines, disopyramide, quinidine, tricyclic antidepressants (TCAs): increased risk of anticholinergic effects
Antihypertensives: additive hypotension
Barbiturates: increased fluphenazine metabolism and decreased efficacy
Bromocriptine: decreased bromocriptine efficacy
Guanethidine: inhibition of antihypertensive effects
Lithium: disorientation, unconsciousness, extrapyramidal symptoms
Meperidine: excessive sedation and hypotension
Ofloxacin: increased QTc interval
Phenytoin: increased or decreased phenytoin blood level
Pimozide: increased risk of potentially serious cardiovascular reactions
Propranolol: increased blood levels of both drugs
TCAs: increased blood levels and effects of TCAs
Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin: increased levels
Granulocytes, hematocrit, hemoglobin, leukocytes, platelets: decreased values
Pregnancy tests: false-positive or false-negative result
Urine bilirubin: false-positive result
Drug-herbs.Angel's trumpet, jimsonweed, scopolia: increased anticholinergic effects
Chamomile, hops, kava, skullcap: increased CNS depression
St. John's wort: photosensitivity
Yohimbe: fluphenazine toxicity
Drug-behaviors.Alcohol use: increased CNS depression
Sun exposure: increased risk of photosensitivity
☞ Monitor patient for signs and symptoms of neuroleptic malignant syndrome (extrapyramidal symptoms, hyperthermia, autonomic symptoms).
☞ Stop giving drug and notify prescriber immediately if patient shows signs or symptoms of blood dyscrasias (fever, infection, sore throat, cellulitis, or weakness).
• Observe for tardive dyskinesia.
• Watch for bleeding tendency.
• Monitor CBC, bilirubin level, and liver function test results.
• Assess kidney function and ophthalmic test results in patients on long-term therapy.
☞ Tell patient not to stop taking drug suddenly, because serious adverse effects may occur.
• Advise patient to report urinary retention or constipation.
☞ Instruct patient to immediately report unusual bleeding or bruising.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, and vision.
• Tell patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.
• Inform patient that he'll undergo regular blood testing during therapy.
• Tell female patient to inform prescriber if she is pregnant or breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.