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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.