Fluphenazine
PROLIXIN
What it isHigh-potency first-generation antipsychotic; schizophrenia.
Why this oneIts depot is usually given more often than haloperidol decanoate, allowing quicker adjustment but requiring more injection visits.
What limits itHigh extrapyramidal and tardive dyskinesia risk. Little anticholinergic or metabolic burden by comparison.
FDA-approved for
- schizophrenia (~1959)
FDA label
Read the full label on DailyMed ↗
BOXED WARNING Increased mortality in elderly patients with dementia-related psychosis treated with antipsychotics; not approved for dementia-related psychosis.
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Psychotic disorders | Adult | 2.5-10 mg/day divided q6-8h | <20 mg/day | 40 mg/day |
| Psychotic disorders (maintenance) | Adult | 1-5 mg/day, often single daily dose | 1-5 mg/day | 40 mg/day |
| Psychotic disorders | Geriatric | 1-2.5 mg/day | per response | per response |
Renal Undefined
Hepatic Contraindicated with liver damage
Instructions
- Institute at low initial dose, increase as needed to clinical effect
- When controlled, reduce gradually to maintenance
- Oral dose is approximately 2-3x the parenteral dose
Contraindications
- Suspected or established subcortical brain damage
- Patients receiving large doses of hypnotics
- Comatose or severely depressed states
- Blood dyscrasia or liver damage
Cautions
- Tardive dyskinesia
- Neuroleptic malignant syndrome
- Extrapyramidal symptoms (pseudoparkinsonism, dystonia, akathisia)
- Hepatic damage/jaundice
- Blood dyscrasias (agranulocytosis, leukopenia)
- Hypotension
- Seizure threshold lowering
- Anticholinergic effects
Adverse reactions
- Extrapyramidal symptoms (pseudoparkinsonism, dystonia, dyskinesia, akathisia)
- Drowsiness
- Dry mouth
- Blurred vision
- Hypotension
Pregnancy Undefined
Lactation Undefined
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Cost, est. cash$20–$1,500/dose or month
Generic entry1987
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.
Mechanism of action: Fluphenazine ballicule
Open Fluphenazine in the interactive console ↗
Memory aids: mascots and interaction avatars
Spooky greyscale mascot → high-potency first generation antipsychotic (FGA)
Prolix (adjective) - speaking at great length, wordy, redundant
