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Phenothiazine

Fluphenazine 

Fluphenazine is an antipsychotic medication primarily used to treat schizophrenia, effectively managing symptoms such as hallucinations, delusions, and disorganized thoughts. As a phenothiazine derivative, it regulates dopamine levels in the brain to help stabilize mood and behavior. Available in various forms, including tablets, elixir, oral concentrate, and injectable solutions, Fluphenazine caters to different patient needs. Usually recommended for adults, this medication must be administered under close medical supervision due to risks of severe side effects like tardive dyskinesia and neuroleptic malignant syndrome. Patients must adhere to prescribed dosages and monitor for any adverse effects. Fluphenazine is not recommended for children under 12 or elderly patients with dementia-related psychosis. Regular consultations with healthcare professionals are essential for safe and effective treatment management.

Fluphenazine Overview

Fluphenazine is an antipsychotic medication primarily used to treat schizophrenia and other psychotic disorders. Containing the active ingredient fluphenazine, it is a phenothiazine derivative that works by modulating dopamine levels in the brain, which are often imbalanced in patients with schizophrenia. Fluphenazine helps alleviate symptoms such as hallucinations, delusions, and disorganized thinking. This medication is FDA-approved for treating schizophrenia, although it has other off-label uses, including for severe behavioral issues and other psychiatric conditions.

Fluphenazine is available in various forms and strengths to suit different treatment needs: tablets in 1mg, 2.5mg, 5mg, and 10mg; elixir at 2.5mg per 5mL; oral concentrate at 5mg/mL; and injectable solutions with Fluphenazine hydrochloride at 2.5mg/mL and Fluphenazine decanoate at 25mg/mL. Depending on the patient’s condition and doctor’s recommendation, it can be administered orally or injected into the body. This medication is commonly prescribed for adults and is not recommended for children under the age of 12 or elderly patients with dementia-related psychosis.

Common side effects of Fluphenazine include drowsiness, dizziness, dry mouth, and constipation. More severe effects can consist of tardive dyskinesia, neuroleptic malignant syndrome, and changes in blood cell counts. Due to its potential side effects, following the prescribed dosage and not missing any doses is crucial. If an overdose occurs, immediate medical attention is necessary. Fluphenazine should be stored at an average temperature, away from light and moisture, and kept out of reach of children. Patients should be cautioned about potential interactions with other medications and substances like alcohol. Regular monitoring by a healthcare expert is essential to manage side effects & adjust dosages as needed.

Uses of Fluphenazine 

  • Bipolar Disorder
  • Schizophrenia
  • Dementia

Fluphenazine Dosage

Fluphenazine comes in the following dosage forms and strengths:

Tablets:

  • 1 mg
  • 2.5 mg
  • 5 mg
  • 10 mg

Elixir:

  • 2.5 mg per 5 mL

Oral Concentrate:

  • 5 mg per mL

Injectable Solutions:

  • Fluphenazine Hydrochloride: 2.5 mg per mL
  • Fluphenazine Decanoate: 25 mg per mL

Recommended Fluphenazine Dosage for Different Patients

For Schizophrenia in Adults:

  • Oral Tablets:
    • Initial dose: 2.5 mg to 10 mg per day in divided doses.
    • Maintenance dose: Adjust based on response; typical maintenance doses range from 1 to 40 mg daily.
  • Injectable Solution (Fluphenazine Decanoate):
    • Initial dose: 12.5 mg to 25 mg administered intramuscularly every 2 to 3 weeks.
    • Maintenance dose: May be adjusted based on response; some patients may require up to 100 mg every 3 to 4 weeks.

For Acute Psychosis:

  • Oral Tablets:
    • 2.5 mg to 10 mg per day in divided doses, adjusted according to the severity of symptoms.
  • Injectable Solution:
    • Fluphenazine Hydrochloride: Initial doses of 2.5 mg to 10 mg intramuscularly may be repeated every 4 to 6 hours as needed.

Elderly Patients:

  • Lower initial doses are recommended due to an increased sensitivity to side effects. Start at the lower end of the dose strength range and adjust cautiously.

Children:

  • Fluphenazine is not commonly recommended for use in children under 12 years old. If necessary, dose strength must be carefully calculated based on the child’s weight and clinical condition.

[Note: Dosage advice may vary among individuals. It’s important to discuss these recommendations with your doctor, who will customize them to suit your situation.]

How to Take Fluphenazine?

  • Take Fluphenazine precisely as prescribed by your doctor. Do not change or stop taking the dose without consulting your doctor first.
  • You can take Fluphenazine on a full or empty stomach, but eating food when you take it might lessen any stomach upset.
  • Consume the tablets or liquid in their entirety. Avoid crushing, chewing, or splitting the tablets unless directed otherwise.
  • Use a medication reminder or pillbox to help you remember to take Fluphenazine at the same time each day.
  • Do not drink alcohol while taking fluphenazine, as it can increase the risk of side effects.
  • Because Fluphenazine can cause dizziness or drowsiness, do not drive or operate any machinery until you know how it affects you.
  • Stay hydrated and increase fiber intake to prevent constipation, a common side effect.
  • Regular blood tests and monitoring should be performed as your doctor recommends while taking fluphenazine.
  • Notify your doctor if you experience or notice any severe or persistent side effects of this medication.

[Note: Your doctor will decide the proper amount for you as per your condition, following guidelines and studies on the drug. They’ll adjust it accordingly over time.]

How Does Fluphenazine Work?

Fluphenazine is an antipsychotic medication that functions by obstructing the action of dopamine, a neurotransmitter in the brain. By reducing dopamine activity, it helps alleviate symptoms of psychosis, such as hallucinations, delusions & disorganized thinking. It also exhibits anticholinergic and sedative effects, which can help manage agitation and anxiety associated with psychiatric disorders.

Fluphenazine Side Effects

Common side effects of this medication include:

  • Nausea
  • Dizziness
  • Sweating
  • Dry mouth
  • Lethargy
  • Constipation
  • Headache
  • Loss of appetite
  • Blurred vision
  • Drowsiness

Serious side of this medication include: 

  • Uncontrolled facial muscle movements include chewing, lip smacking, frowning, tongue, blinking, and eye movement.
  • Extreme drowsiness or feeling like you might faint.
  • Unusual dreams, restlessness, or feelings of excitement.
  • Blurred or tunnel vision, eye pain, or seeing halos around lights.
  • Pain or difficulty when urinating.
  • Severe constipation, abdominal pain, or bloating.
  • Jaundice is indicated by yellowing of the skin or eyes.
  • Experiencing a seizure.
  • Low white blood cell counts can cause fever, chills, mouth or skin sores, a sore throat, cough, trouble breathing, and lightheadedness.

[Note: This list may not encompass all potential side effects. Always seek medical advice from your medical expert regarding side effects.]

Fluphenazine Warnings

  • Increased Mortality in Elderly with Dementia-Related Psychosis: Individuals over 65 with dementia may experience psychosis symptoms such as hallucinations and delusions, known as dementia-related psychosis. Fluphenazine should not be used to treat this condition as it may increase the risk of death. Inform your healthcare provider if you or your loved one has dementia before starting fluphenazine.
  • Movement Control Difficulties: Fluphenazine, an antipsychotic medication, can cause tardive dyskinesia (TD), characterized by uncontrollable facial movements like blinking or tongue protrusion. TD is more common in older people, particularly women, but can occur in anyone. If these symptoms develop, notify your healthcare provider immediately. TD may subside with reduced dosage or discontinuation of fluphenazine.
  • Neuroleptic Malignant Syndrome: Fluphenazine can trigger neuroleptic malignant syndrome (NMS), a rare but life-threatening condition. Symptoms include high fever, rapid heartbeat, muscle stiffness, and confusion. Reach out for immediate medical attention if these symptoms appear. Your healthcare expert will likely switch you to a safer alternative.
  • Low White Blood Cell Counts: Fluphenazine may decrease white blood cell counts, compromising your ability to fight infections. If you experience frequent infections or fever, contact your healthcare provider, as this might necessitate stopping the medication.
  • Increased Prolactin Levels: Fluphenazine can elevate prolactin levels, leading to potential issues like nipple discharge, enlarged breasts, sexual dysfunction, menstrual irregularities, and weakened bones. Routine blood tests may be needed to monitor your prolactin levels.
  • Risks During Pregnancy: Administer Fluphenazine to pregnant women solely if the prospective advantages outweigh the potential risks to the unborn child. Babies exposed to Fluphenazine in the third trimester may face withdrawal symptoms and side effects after birth. Inform your healthcare pro if you are pregnant or planning to conceive while on fluphenazine.

Fluphenazine Precautions

  • Allergies: Notify your physician or pharmacist if you are allergic to Fluphenazine or phenothiazines like chlorpromazine or perphenazine. This product may also contain inactive ingredients that can cause allergic reactions.
  • Medical History: Share your medical history in detail, especially:
    • Brain-related issues: damage, CNS depression, cerebrovascular insufficiency, tumors, encephalitis, encephalopathy.
    • Blood disorders: leukopenia, thrombocytopenia, agranulocytosis.
    • Liver and kidney issues.
    • Breast cancer.
    • Eye disorders, including glaucoma.
    • Heart issues, especially extreme blood pressure conditions or mitral valve insufficiency.
    • Pheochromocytoma.
    • Seizure history.
    • Exposure to phosphorus insecticides.
    • Chronic respiratory problems, such as asthma or emphysema.
    • Low blood calcium levels.
    • Enlarged prostate, drug or alcohol dependency, Reye’s syndrome, dehydration.
  • Pre-Surgical Disclosure: Before undergoing surgery or diagnostic tests, inform your healthcare expert or dentist about all medications you use, including prescriptions, over-the-counter drugs, and herbal products.
  • Impairment Risks: Fluphenazine may cause dizziness, drowsiness, or blurred vision. Avoid driving, using machinery, or doing anything requiring alertness or clear vision until you can confidently undertake such activities.
  • Substance Interactions: Alcohol and marijuana (cannabis) can exacerbate dizziness or drowsiness. Avoid alcoholic beverages and discuss your cannabis use with your doctor.
  • Sun Sensitivity: The medication may increase sun sensitivity. Limit sun exposure, avoid tanning booths & sunlamps, and use sunscreen and protective clothing outdoors.
  • Heat Sensitivity: Fluphenazine may reduce sweating, increasing the risk of heat stroke. Avoid activities that may cause overheating, drink plenty of fluids, and stay cool during hot weather.
  • Cold Exposure: Avoid exposure to very cold temperatures, which can severely lower body temperature.

Fluphenazine Contraindications 

  • Do not use it if you are allergic to Fluphenazine or other phenothiazines, such as chlorpromazine, perphenazine, prochlorperazine, promethazine, thioridazine, or trifluoperazine.
  • Avoid it if you have liver disease, brain damage, severe depression, or blood cell disorders (low platelets, red or white cell counts).
  • Do not use following heavy alcohol consumption or sedative medications.

Fluphenazine Missed Dose

If you miss a dose of fluphenazine, take it as soon as you remember. However, if it’s almost time for your next scheduled dose of Fluphenazine, skip the missed dose and continue with your regular dosing schedule. Do not attempt to double the dose to make up for a missed one. Missing doses can increase the risk of relapse or withdrawal symptoms.

[Consult your doctor or pharmacist immediately if you’ve missed a medication dose and are uncertain when to take the next one.]

Fluphenazine Overdose 

If you suspect a Fluphenazine overdose, seek immediate medical attention. Symptoms may include severe dizziness, extreme drowsiness, agitation, confusion, or unusual muscle movements. Overdosing on Fluphenazine can be life-threatening due to its potent effects on the brain & nervous system. Prompt treatment is crucial to manage symptoms & prevent serious complications.

[If you’ve ingested more than the prescribed dosage, reach out for immediate medical attention or contact the Poison Help line at 1-800-222-1222.]

Fluphenazine Storage

  • Fluphenazine should be stored at room temperature, typically between 15°C and 30°C.
  • Fluphenazine should be stored in a light-resistant container or packaging to prevent light exposure, as light can degrade the medication.
  • Fluphenazine should be kept in a dry place and protected from moisture, as excessive moisture can also cause degradation.
  • When not in use, keep the medication container or bottle tightly sealed to avoid contamination and exposure to air and moisture.
  • Like all medications, Fluphenazine must be stored securely, out of the reach and sight of children and pets.
  • Bathrooms are not ideal storage locations due to the potential for excessive moisture and temperature fluctuations.
  • Specific formulations or brand-specific products may necessitate additional or slightly differing storage requirements, so adhering to the medication’s instructions is crucial.
  • Fluphenazine, like all medications, should be discarded after its expiration date, as its potency and effectiveness may have decreased.

[Consult your healthcare provider regarding proper disposal of unused medication and any storage-related queries you may have.]

Fluphenazine Interactions

  • Antihypertensive medications: Fluphenazine can enhance the effects of antihypertensive drugs, potentially causing excessive lowering of blood pressure.
  • Anticholinergic drugs: Fluphenazine may increase the anticholinergic effects (e.g., dry mouth, constipation, blurred vision) of other drugs with anticholinergic properties like certain antidepressants, antihistamines, and other medications for Parkinson’s disease.
  • Lithium: Concurrent use of Fluphenazine and lithium may increase the risk of extrapyramidal symptoms (e.g., tremors, muscle stiffness) and neurotoxicity.
  • Centrally-acting drugs: Fluphenazine may enhance the sedative effects of centrally-acting other medicines, such as anxiolytics, sedatives, hypnotics, and some pain medications.
  • Antiepileptic drugs: Fluphenazine may lower the seizure threshold, and its concurrent use with antiepileptic medications may require dosage adjustments.
  • Levodopa: Fluphenazine may counteract the therapeutic benefits of levodopa, a medication employed in the treatment of Parkinson’s disease.
  • Alcohol: Concomitant use of Fluphenazine and alcohol can increase the sedative effects and impair cognitive and motor function.
  • Drugs that prolong the QT interval: Fluphenazine may increase the risk of potentially life-threatening arrhythmias when used with other medicines that prolong the QT interval, such as certain antiarrhythmics, antidepressants, and antibiotics.

[Note: This list may not be exhaustive, and other medications could interact with Fluphenazine. It’s important to inform your doctor about all prescription, over-the-counter medicines and herbal products you are currently taking.]

Fluphenazine Alternatives

  • Haldol (haloperidol)
  • Thorazine (chlorpromazine)
  • Trilafon (perphenazine)
  • Stelazine (trifluoperazine)

[Note: Consult your healthcare provider before considering any alternative medications. Your healthcare expert will prescribe the most suitable treatment for you, as using these alternatives without professional guidance may lead to serious side effects.] 

Frequently Asked Questions

How is Fluphenazine decanoate administered?

Fluphenazine decanoate is administered intramuscularly or subcutaneously, typically by a healthcare expert in a clinical setting. As a long-acting form of fluphenazine, it usually requires an injection every 4 to 6 weeks or as prescribed by your healthcare provider. If you have any questions or concerns about your treatment, it is important to consult with your medical professional.

Can Fluphenazine lead to weight gain?

Weight gain is a potential side effect of Fluphenazine, although it is less common compared to some other antipsychotics. Following a balanced diet and engaging in routine exercise is important to minimize the risk of weight gain. If you are concerned about significant weight gain, discuss with your healthcare expert the possibility of adjusting or changing your medication.

What are the common side effects of fluphenazine?

Fluphenazine may cause several side effects, including drowsiness, headaches, dry mouth, constipation, and tremors. If you encounter these or other issues after starting fluphenazine, inform your healthcare provider. They may suggest medications or lifestyle adjustments to manage the side effects. For instance, chewing sugar-free gum can alleviate dry mouth by stimulating saliva production. If you experience tremors, your provider may adjust your Fluphenazine dosage or prescribe benztropine to relieve symptoms. It’s essential to consult with your provider for any concerns about specific side effects.

Is Fluphenazine safe to use during pregnancy?

The safety of Fluphenazine during pregnancy remains unclear due to limited data. Some reports suggest potential birth defects, while other studies indicate no harm. Generally, infants born to mothers who used antipsychotic drugs in the third trimester may be at risk for movement disorders or withdrawal symptoms such as tremors, sleepiness, or agitation. If you are pregnant, it is crucial to weigh the risks and benefits of taking Fluphenazine with your healthcare provider.

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