Fluphenazine

Fluphenazine is a high-potency phenothiazine antipsychotic with a piperazine side chain that produces strong dopamine D2 receptor blockade in mesolimbic and mesocortical pathways. Its high D2 affinity relative to autonomic receptor blockade means less sedation and hypotension but more extrapyramidal side effects compared to low-potency phenothiazines like chlorpromazine. Available as long-acting decanoate and enanthate depot injections, it provides sustained antipsychotic coverage for 2-4 weeks per injection, improving adherence in chronic schizophrenia.

Adult

Test dose 12.5 mg, administered into the gluteal muscle, then 12.5 –100 mg after 4–7 days, then 12.5–100 mg every 14–35 days, adjusted according to response (Deep intramuscular injection).

Pediatric

Not specified

Renal adjustment

Manufacturer advises caution. Avoid in renal failure. Start with small doses in severe renal impairment because of increased cerebral sensitivity.

Hepatic adjustment

Manufacturer advises caution; avoid in hepatic failure.

Geriatric

Test dose 6.25 mg, administered into the gluteal muscle, then 12.5 –100 mg after 4–7 days, then 12.5–100 mg every 14–35 days, adjusted according to response (Deep intramuscular injection).

• Children
• CNS depression
• Comatose states
• Marked cerebral atherosclerosis
• Phaeochromocytoma
• Use in elderly dementia patients (increased mortality risk)