Generic Name

Fluphenazine Hydrochloride

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Classification

FDA Approved Indications

• Schizophrenia
• Chronic psychosis

Mechanism of Action

Blocks dopamine D2 receptors in the brain, reducing psychotic symptoms.

Dosage and Administration

Adult: Initial: 2.5 mg to 10 mg daily in divided doses; maintenance doses vary.

Pediatric: Use is generally not recommended; consult specific guidelines.

Geriatric: Start at lower doses due to increased sensitivity; monitor closely.

Renal Impairment: Adjust dose based on clinical response and tolerability.

Hepatic Impairment: Use with caution; no specific adjustments established.

Pharmacokinetics

Absorption: Well-absorbed orally

Distribution: Widely distributed, crosses blood-brain barrier

Metabolism: Primarily hepatic, via CYP450 enzymes

Excretion: Metabolites excreted in urine and feces

Half Life: 15 to 30 hours

Contraindications

• Hypersensitivity to phenothiazines
• ComAion, severely depressed CNS

Precautions

• Use cautiously in Parkinson's disease, history of seizures, blood dyscrasias, cardiovascular disease, pregnancy, and lactation

Adverse Reactions - Common

• Extrapyramidal symptoms (dystonia, Parkinsonism, akathisia) (Common)
• Drowsiness, sedation (Common)
• Dry mouth, blurred vision, urinary retention (Common)

Adverse Reactions - Serious

• Neuroleptic malignant syndrome (fever, muscle rigidity, autonomic instability) (Rare)
• Tardive dyskinesia (Less common with long-term use)
• Cardiac arrhythmias (QT prolongation) (Rare)

Drug-Drug Interactions

• CNS depressants, anticholinergic agents, other QT-prolonging drugs, drugs affecting CYP450 enzymes

Drug-Food Interactions

• Alcohol, caffeine

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Do not operate machinery until oculogically assessed; avoid alcohol; report worsening symptoms or adverse reactions; adhere to follow-up appointments.

Special Considerations

Black Box Warnings:

• Increased mortality in elderly patients with dementia-related psychosis

Genetic Factors: CYP2D6 poor metabolizers may experience increased plasma levels

Lab Test Interference: May affect liver function tests

Overdose Management

Signs/Symptoms: Serious CNS depression, extrapyramidal symptoms, hypotension, coma

Treatment: Supportive care, gastric lavage, activated charcoal; manage dysrhythmias; administer IV fluids and medications as needed

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F) in a tightly closed container

Stability: Stable under recommended storage conditions for the shelf life specified