Home Drug Guide Fluphenazine Decanoate

Drug Guide

Generic Name

Fluphenazine Decanoate

Brand Names Prolixin Decanoate

Classification

Therapeutic: Antipsychotic (typical/neuroleptic)

Pharmacological: Phenothiazine

FDA Approved Indications

Schizophrenia
Long-term treatment of chronic psychoses

Mechanism of Action

Blocks dopamine D2 receptors in the central nervous system, reducing psychotic symptoms.

Dosage and Administration

Adult: Typically 25-50 mg IM every 2 weeks, adjusted based on response.

Pediatric: Not generally used in children.

Geriatric: Use with caution; start at lower doses due to increased sensitivity.

Renal Impairment: Adjust dosing based on clinical response.

Hepatic Impairment: Use cautiously; no specific adjustments well-documented.

Pharmacokinetics

Absorption: Slow IM absorption; provides sustained release.

Distribution: Widely distributed in body tissues, crosses blood-brain barrier.

Metabolism: Liver metabolism primarily via CYP2D6; some conjugation.

Excretion: Primarily in urine as metabolites.

Half Life: Approximately 6-7 days, allowing every 2-week dosing.

Contraindications

Coma or CNS depression from alcohol or CNS depressants.
Bone marrow suppression.

Precautions

History of neuroleptic malignant syndrome.
Seizure disorder.
Cautious use in Parkinson’s disease, cardiovascular disease, and in elderly patients with dementia-related psychosis.

Adverse Reactions - Common

Extrapyramidal symptoms (Frequent)
Dystonia (Common)
Akathisia (Common)
Sedation (Common)
Weight gain (Common)

Adverse Reactions - Serious

Neuroleptic malignant syndrome (Rare)
Tardive dyskinesia (Rare)
Blood dyscrasias (e.g., agranulocytosis) (Rare)
QT prolongation and arrhythmias (Rare)

Drug-Drug Interactions

CNS depressants
Other QT-prolonging drugs
Anticholinergics

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor mental status, extrapyramidal symptoms, vital signs, and cardiovascular status.

Diagnoses:

Risk for falls due to sedation or orthostatic hypotension.
Impaired physical mobility.
Risk for neuroleptic malignant syndrome.

Implementation: Administer deep IM injection; monitor for adverse reactions; educate patient about symptoms to report.

Evaluation: Assess for reduction in psychotic symptoms and monitor for adverse effects.

Patient/Family Teaching

Take medication exactly as prescribed.
Report symptoms of extrapyramidal side effects, tardive dyskinesia, or neuroleptic malignant syndrome.
Avoid alcohol and CNS depressants.
Be cautious with dehydration and heat exposure.

Special Considerations

Black Box Warnings:

Increased mortality in elderly patients with dementia-related psychosis.
Risks of neuroleptic malignant syndrome.

Genetic Factors: CYP2D6 polymorphisms may affect metabolism.

Lab Test Interference: May cause false positives in certain assays.

Overdose Management

Signs/Symptoms: Extrapyramidal symptoms, hypotension, sedation, respiratory depression, seizures.

Treatment: Supportive care, manage hypotension with IV fluids, benzodiazepines for agitation, and general measures for overdose.

Storage and Handling

Storage: Store at controlled room temperature, 20-25°C (68-77°F).

Stability: Stable under proper storage conditions for the duration specified in the manufacturer’s package insert.