fluphenazine PROLIXIN

Class: First Generation Antipsychotic/​Phenothiazine
FDA Indications: Psychotic Disorders
Off-Label Use: Bipolar Disorder
Forms: 2.5, 5, 10mg tablet; 5mg/mL po soln; 2.5mg/mL injectable; LAI: 25mg/5ml
Dose Range: 0.5-40 mg/day
Starting: PO: 0.5-10 mg daily in divided doses (q6-8), can titrate up to 40 mg total daily dose
IM: Approximately equivalent to 33% to 50% of oral dose
LAI(decanoate): 6.25 to 25 mg Q2 weeks
Stopping: Taper 6-8 weeks, rapid d/c can lead to rebound psychosis

NAMI drug fact sheet

Contraindications: In patients with suspected or established subcortical brain damage, in patients receiving large doses of hypnotics, and in comatose or severely depressed states
Serious Side Effects: , , , Cardiac Arrhythmias, Neutropenia and/or Agranulocytosis (rare), Hyperprolactinemia
Side Effects: EPS, Neuroleptic-Induced Deficit Syndrome, akathisia, priapism, galactorrhea, amenorrhea, dizziness, sedation/somnolence, xerostomia, anticholinergic side effects, sexual dysfunction, weight gain, hypotension
1° MOA: Dopamine 2 (D2) receptor antagonism in mesolimbic area
Target: D1 (high), D2 (very high), 5HT2 (very high), α1 (high), H1 (high), M1 (low)
t½: 18 (14-24)° TMAX: 2-6°
Substrate of: 2D6; 1A2
Inhibits: 2D6, 1A2; Induces:
Active Metabolites:
  • - high potency typical antipsychotic
  • - fluphenazine enanthate was the first depot agent introduced in 1964
  • - long-acting decanoate has a Tmax of 24°
Special Populations

Category C—Third-trimester use can result in EPS or withdrawal symptoms in the newborn. Although one case report described multiple anomalies, most evidence suggests that phenothiazines are relatively low risk during pregnancy

No Human Data–Potential Toxicity

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.

2019 BEE℞S Recommendation: Avoid, except in schizophrenia or bipolar disorder. Increased risk of CVA and greater rate of cognitive decline and mortality in persons with dementia. Avoid antipsychotics for behavioral problems of dementia or delirium unless nonpharmacological options have failed or are not possible and the older adult is threatening substantial harm to self or others.

No dosage adjustment necessary.

No dosage adjustment necessary


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Last updated February 29 2024 20:54:18. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.