|Trade names||Prolixin, Modecate, Moditen others|
|by mouth, IM, depot injection (fluphenazine decanoate)|
|Defined daily dose||10 mg (by mouth)|
1 mg (injection)
|Bioavailability||2.7% (by mouth)|
|Elimination half-life||IM 15 hours (HCL), 7-10 days (decanoate)|
|Chemical and physical data|
|Molar mass||437.53 g·mol−1|
|3D model (JSmol)|
Fluphenazine, sold under the brand names Prolixin among others, is an antipsychotic medication. It is used in the treatment of chronic psychoses such as schizophrenia, and appears to be about equal in effectiveness to low-potency antipsychotics like chlorpromazine. It is given by mouth, injection into a muscle, or just under the skin. There is also a long acting injectable version that may last for up to four weeks. Fluphenazine decanoate, the depot injection form of fluphenazine, should not be used by people with severe depression.
Common side effects include movement problems, sleepiness, depression and increased weight. Serious side effects may include neuroleptic malignant syndrome, low white blood cell levels, and the potentially permanent movement disorder tardive dyskinesia. In older people with psychosis as a result of dementia it may increase the risk of dying. It may also increase prolactin levels which may result in milk production, enlarged breasts in males, impotence, and the absence of menstrual periods. It is unclear if it is safe for use in pregnancy. Fluphenazine is a typical antipsychotic of the phenothiazine class. Its mechanism of action is not entirely clear but believed to be related to its ability to block dopamine receptors. In up to 40% of those on long term phenothiazines, liver function tests become mildly abnormal.
Fluphenazine came into use in 1959. The injectable form is on the World Health Organization's List of Essential Medicines. It is available as a generic medication. In the United States the tablets costs between $0.22 and $0.42 per day for a typical dose. The wholesale cost in the developing world of the long acting form is between US$0.20 and US$6.20 per injection as of 2014. It was discontinued in Australia around mid 2017.
A 2018 Cochrane review found that fluphenazine's was an imperfect treatment for schizophrenia and other inexpensive medication less associated with side effects may be an equally effective choice.
The defined daily dose is 1 mg by injection and 10 mg by mouth. It may be started at doses of 2.5 to 10 mg by mouth divided into three or four times per day. After the person is doing better the dose may be decreased to 1 to 5 mg per day. A formulation that is injected into a muscle may be given at a dose of 12.5 to 25 mg every 4 to 6 weeks.
The British National Formulary recommends a gradual withdrawal when discontinuing antipsychotics to avoid acute withdrawal syndrome or rapid relapse. Symptoms of withdrawal commonly include nausea, vomiting, and loss of appetite. Other symptoms may include restlessness, increased sweating, and trouble sleeping. Less commonly there may be a felling of the world spinning, numbness, or muscle pains. Symptoms generally resolve after a short period of time.
There is tentative evidence that discontinuation of antipsychotics can result in psychosis. It may also result in reoccurrence of the condition that is being treated. Rarely tardive dyskinesia can occur when the medication is stopped.
Fluphenazine acts primarily by blocking post-synaptic D2 receptors in the basal ganglia, cortical and limbic system. It also blocks alpha-1 adrenergic receptors, muscarinic-1 receptors, and histamine-1 receptors.
|Medication||Brand name||Class||Vehicle||Dosage||Tmax||t1/2 single||t1/2 multiple||logPc||Ref|
|Aripiprazole lauroxil||Aristada||Atypical||Watera||441–1064 mg/4–8 weeks||24–35 days||?||54–57 days||7.9–10.0|
|Aripiprazole monohydrate||Abilify Maintena||Atypical||Watera||300–400 mg/4 weeks||7 days||?||30–47 days||4.9–5.2|
|Bromperidol decanoate||Impromen Decanoas||Typical||Sesame oil||40–300 mg/4 weeks||3–9 days||?||21–25 days||7.9|||
|Clopentixol decanoate||Sordinol Depot||Typical||Viscoleob||50–600 mg/1–4 weeks||4–7 days||?||19 days||9.0|||
|Flupentixol decanoate||Depixol||Typical||Viscoleob||10–200 mg/2–4 weeks||4–10 days||8 days||17 days||7.2–9.2|||
|Fluphenazine decanoate||Prolixin Decanoate||Typical||Sesame oil||12.5–100 mg/2–5 weeks||1–2 days||1–10 days||14–100 days||7.2–9.0|||
|Fluphenazine enanthate||Prolixin Enanthate||Typical||Sesame oil||12.5–100 mg/1–4 weeks||2–3 days||4 days||?||6.4–7.4|||
|Fluspirilene||Imap, Redeptin||Typical||Watera||2–12 mg/1 week||1–8 days||7 days||?||5.2–5.8|||
|Haloperidol decanoate||Haldol Decanoate||Typical||Sesame oil||20–400 mg/2–4 weeks||3–9 days||18–21 days||7.2–7.9|||
|Olanzapine pamoate||Zyprexa Relprevv||Atypical||Watera||150–405 mg/2–4 weeks||7 days||?||30 days||–|
|Paliperidone palmitate||Invega Sustenna||Atypical||Watera||39–819 mg/4–12 weeks||13–33 days||25–139 days||?||8.1–10.1|
|Perphenazine decanoate||Trilafon Dekanoat||Typical||Sesame oil||50–200 mg/2–4 weeks||?||?||27 days||8.9|
|Perphenazine enanthate||Trilafon Enanthate||Typical||Sesame oil||25–200 mg/2 weeks||2–3 days||?||4–7 days||6.4–7.2|||
|Pipotiazine palmitate||Piportil Longum||Typical||Viscoleob||25–400 mg/4 weeks||9–10 days||?||14–21 days||8.5–11.6|||
|Pipotiazine undecylenate||Piportil Medium||Typical||Sesame oil||100–200 mg/2 weeks||?||?||?||8.4|
|Risperidone||Risperdal Consta||Atypical||Microspheres||12.5–75 mg/2 weeks||21 days||?||3–6 days||–|
|Zuclopentixol acetate||Clopixol Acuphase||Typical||Viscoleob||50–200 mg/1–3 days||1–2 days||1–2 days||4.7–4.9|
|Zuclopentixol decanoate||Clopixol Depot||Typical||Viscoleob||50–800 mg/2–4 weeks||4–9 days||?||11–21 days||7.5–9.0|
|Note: All by intramuscular injection. Footnotes: a = Microcrystalline or nanocrystalline aqueous suspension. b = Low-viscosity vegetable oil (specifically fractionated coconut oil with medium-chain triglycerides). c = Predicted, from PubChem and DrugBank. Sources: Main: See template.|
Fluphenazine came into use in 1959.
The injectable form is on the World Health Organization's List of Essential Medicines. It is available as a generic medication. In the United States the tablets costs between 0.22 and 0.42 USD per day for a typical dose. The wholesale cost in the developing world of the long acting form is between 0.20 and 6.20 USD per injection as of 2014. It was discontinued in Australia around mid 2017.
In horses, it is sometimes given by injection as an anxiety-relieving medication, though there are many negative common side effects and it is forbidden by many equestrian competition organizations.
- ↑ 1.0 1.1 "WHOCC - ATC/DDD Index". www.whocc.no. Archived from the original on 22 January 2021. Retrieved 1 August 2021.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 "fluphenazine decanoate". The American Society of Health-System Pharmacists. Archived from the original on 8 December 2015. Retrieved 1 December 2015.
- ↑ "Product Information: Modecate (Fluphenazine Decanoate Oily Injection )" (PDF). TGA eBusiness Services. Bristol-Myers Squibb Australia Pty Ltd. 1 November 2012. Archived from the original on 2 August 2017. Retrieved 9 December 2013.
- ↑ Tardy M, Huhn M, Engel RR, Leucht S (August 2014). "Fluphenazine versus low-potency first-generation antipsychotic drugs for schizophrenia". The Cochrane Database of Systematic Reviews. 8 (8): CD009230. doi:10.1002/14651858.CD009230.pub2. PMID 25087165.
- ↑ "Modecate Injection 25mg/ml - Patient Information Leaflet (PIL) - (eMC)". www.medicines.org.uk. Archived from the original on 7 November 2017. Retrieved 6 November 2017.
- ↑ "Fluphenazine". livertox.nih.gov. Archived from the original on 17 February 2013. Retrieved 6 November 2017.
- ↑ 7.0 7.1 McPherson, Edwin M. (2007). Pharmaceutical Manufacturing Encyclopedia (3rd ed.). Burlington: Elsevier. p. 1680. ISBN 9780815518563. Archived from the original on 8 December 2015. Retrieved 2 December 2015.
- ↑ 8.0 8.1 World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
- ↑ 9.0 9.1 "Fluphenazine Decanoate". International Drug Price Indicator Guide. Archived from the original on 2 August 2017. Retrieved 2 December 2015.
- ↑ 10.0 10.1 Rossi S, ed. (July 2017). "Fluphenazine - Australian Medicines Handbook". Australian Medicines Handbook. Adelaide, Australia: Australian Medicines Handbook Pty Ltd. Archived from the original on 9 August 2017. Retrieved 8 August 2017.
- ↑ Matar, Hosam E.; Almerie, Muhammad Qutayba; Sampson, Stephanie J. (12 June 2018). "Fluphenazine (oral) versus placebo for schizophrenia". The Cochrane Database of Systematic Reviews. 6: CD006352. doi:10.1002/14651858.CD006352.pub3. ISSN 1469-493X. PMC 6513420. PMID 29893410.
- ↑ Joint Formulary Committee, BMJ, ed. (March 2009). "4.2.1". British National Formulary (57 ed.). United Kingdom: Royal Pharmaceutical Society of Great Britain. p. 192. ISBN 978-0-85369-845-6.
Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse.
- ↑ 13.0 13.1 13.2 13.3 13.4 Haddad, Peter; Haddad, Peter M.; Dursun, Serdar; Deakin, Bill (2004). Adverse Syndromes and Psychiatric Drugs: A Clinical Guide. OUP Oxford. pp. 207–216. ISBN 9780198527480. Archived from the original on 22 April 2021. Retrieved 14 July 2019.
- ↑ Moncrieff J (July 2006). "Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse". Acta Psychiatrica Scandinavica. 114 (1): 3–13. doi:10.1111/j.1600-0447.2006.00787.x. PMID 16774655.
- ↑ Sacchetti, Emilio; Vita, Antonio; Siracusano, Alberto; Fleischhacker, Wolfgang (2013). Adherence to Antipsychotics in Schizophrenia. Springer Science & Business Media. p. 85. ISBN 9788847026797. Archived from the original on 22 April 2021. Retrieved 14 July 2019.
- ↑ Siragusa S, Saadabadi A. "Fluphenazine". StatPearls. PMID 29083807. Archived from the original on 28 August 2021. Retrieved 18 April 2020.
- ↑ PubChem. "Fluphenazine". pubchem.ncbi.nlm.nih.gov. Archived from the original on 21 August 2019. Retrieved 30 September 2019.
- ↑ Parent M, Toussaint C, Gilson H (1983). "Long-term treatment of chronic psychotics with bromperidol decanoate: clinical and pharmacokinetic evaluation". Current Therapeutic Research. 34 (1): 1–6.
- ↑ 19.0 19.1 Jørgensen A, Overø KF (1980). "Clopenthixol and flupenthixol depot preparations in outpatient schizophrenics. III. Serum levels". Acta Psychiatrica Scandinavica. Supplementum. 279: 41–54. doi:10.1111/j.1600-0447.1980.tb07082.x. PMID 6931472.
- ↑ 20.0 20.1 Reynolds JE (1993). "Anxiolytic sedatives, hypnotics and neuroleptics.". Martindale: The Extra Pharmacopoeia (30th ed.). London: Pharmaceutical Press. pp. 364–623.
- ↑ Ereshefsky L, Saklad SR, Jann MW, Davis CM, Richards A, Seidel DR (May 1984). "Future of depot neuroleptic therapy: pharmacokinetic and pharmacodynamic approaches". The Journal of Clinical Psychiatry. 45 (5 Pt 2): 50–9. PMID 6143748.
- ↑ 22.0 22.1 Curry SH, Whelpton R, de Schepper PJ, Vranckx S, Schiff AA (April 1979). "Kinetics of fluphenazine after fluphenazine dihydrochloride, enanthate and decanoate administration to man". British Journal of Clinical Pharmacology. 7 (4): 325–31. doi:10.1111/j.1365-2125.1979.tb00941.x. PMC 1429660. PMID 444352.
- ↑ Young D, Ereshefsky L, Saklad SR, Jann MW, Garcia N (1984). Explaining the pharmacokinetics of fluphenazine through computer simulations. (Abstract.). 19th Annual Midyear Clinical Meeting of the American Society of Hospital Pharmacists. Dallas, Texas.
- ↑ Janssen PA, Niemegeers CJ, Schellekens KH, Lenaerts FM, Verbruggen FJ, van Nueten JM, et al. (November 1970). "The pharmacology of fluspirilene (R 6218), a potent, long-acting and injectable neuroleptic drug". Arzneimittel-Forschung. 20 (11): 1689–98. PMID 4992598.
- ↑ Beresford R, Ward A (January 1987). "Haloperidol decanoate. A preliminary review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in psychosis". Drugs. 33 (1): 31–49. doi:10.2165/00003495-198733010-00002. PMID 3545764.
- ↑ Reyntigens AJ, Heykants JJ, Woestenborghs RJ, Gelders YG, Aerts TJ (1982). "Pharmacokinetics of haloperidol decanoate. A 2-year follow-up". International Pharmacopsychiatry. 17 (4): 238–46. doi:10.1159/000468580. PMID 7185768.
- ↑ Larsson M, Axelsson R, Forsman A (1984). "On the pharmacokinetics of perphenazine: a clinical study of perphenazine enanthate and decanoate". Current Therapeutic Research. 36 (6): 1071–88.
- ↑ Loving NS (31 March 2012). "Effects of Behavior-Modifying Drug Investigated (AAEP 2011)". The Horse Media Group. Archived from the original on 6 January 2017. Retrieved 13 December 2016.
- Pages using duplicate arguments in template calls
- Use dmy dates from December 2019
- Articles with invalid date parameter in template
- Chemical articles without CAS registry number
- Articles without EBI source
- Chemical pages without ChemSpiderID
- Chemical pages without DrugBank identifier
- Articles without KEGG source
- Articles without UNII source
- Drugs missing an ATC code
- Drugboxes which contain changes to watched fields
- Dopamine antagonists
- Primary alcohols
- Sigma receptor ligands
- Trifluoromethyl compounds
- Typical antipsychotics
- World Health Organization essential medicines