fluphenazine (Permitil, Prolixin)

Fluphenazine is an oral antipsychotic medication used for the management of schizophrenia. Fluphenazine is one of the older, first-generation piperazine phenothiazine antipsychotic medications. Examples of other phenothiazines include:

• prochlorperazine (Compazine, Compro, Procomp),
• chlorpromazine (Promapar, Thorazine),
• perphenazine, trifluoperazine (Stelazine), and
• thioridazine (Mellaril).

Although the exact mechanism of phenothiazine antipsychotics is unknown, scientists believe that they may work by blocking the action of dopamine in the brain. Dopamine is a neurotransmitter (chemical) that nerves use to communicate with one another. Phenothiazine antipsychotics are used when patients do not respond to other antipsychotics.

The FDA approved fluphenazine in September 1959.

What brand names are available for fluphenazine?

Permitil, Prolixin

Is fluphenazine available as a generic drug?

Yes

Do I need a prescription for fluphenazine?

Yes

Fluphenazine causes extrapyramidal side effects such as:

• Abnormal muscle contractions
• Difficulty breathing and swallowing
• Neck spasms

Other side effects include:

• Low blood pressure
• Constipation
• Dry mouth
• Blurred vision
• Seizures
• Dizziness
• Drowsiness

Tardive dyskinesia (movement abnormalities of the face, arms, and legs) can result from fluphenazine treatment.

Neuroleptic malignant syndrome (NMS) which includes symptoms such as fever, muscle rigidity, altered mental status, irregular blood pressure, and irregular heart rate and rhythm can occur. These side effects can be severe so patients must seek medical help.

Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death, and fluphenazine should not be used for treating patients with dementia related psychosis.

The recommended starting dose of fluphenazine is 2.5 to 10 mg per day orally in divided doses, every 6 to 8 hours. Doses may be increased as needed and as tolerated to a maximum of 40 mg per day. Once symptoms are controlled, maintenance oral doses of 1 to 5 mg per day are recommended. Dose adjustment is based on individual response and side effects of the medication.

Combining fluphenazine with medications such as procainamide (Pronestyl), sotalol (Betapace), amiodarone (Cordarone), and dofetilide (Tikosyn) that affect heart rate and rhythm can cause abnormal heart beats.

Antidepressants such as fluoxetine (Prozac), sertraline (Zoloft), amitriptyline (Elavil), and nortriptyline (Pamelor) can cause an abnormal heart rate and rhythm; ombining them with fluphenazine increases the risk of abnormal heart beats.

Fluphenazine should not be combined with other antipsychotics such as aripiprazole (Abilify) and risperidone (Risperdal) because such combinations can cause abnormal muscle contractions, difficulty breathing and swallowing, and neck spasms. Patients should seek medical help when experiencing such effects.

Fluphenazine may increase lithium (Lithobid, Eskolith) levels in the body. Patients may experience increased side effects of lithium such as increased thirst, decreased heart rate, weakness, blurred vision, decreased concentration, and ringing in the ears.

Fluphenazine should be used with caution with medications that depress the central nervous system and cause sedation or drowsiness. Examples include alprazolam (Xanax), clonazepam (Klonopin), zolpidem (Ambien), codeine, morphine, and alcohol. Such combinations can cause excessive sedation, drowsiness, weakness, confusion, speech impairment, and in severe cases coma or death.

Safe and effective use of fluphenazine is not established in pregnant females; however, it should be avoided to prevent harm to the unborn.

Fluphenazine enters breast milk; therefore, it should be avoided in females who are nursing.

What preparations of fluphenazine are available?

Oral elixir: 2.5 mg/5 ml. Oral solution: 5 mg/ml. Tablets: 1, 2.5, 5, and 10 mg.

How should I keep fluphenazine stored?

Fluphenazine tablets, oral elixir, and oral solution should be stored between 20 C and 25 C (68 F and 77 F).