Fluphenazine is an antipsychotic drug indicated for people diagnosed with schizophrenia , other psychotic disorders, bipolar disorder, etc. What it does is block the D2 receptors of dopamine.

Its particularity is that in addition to being administered orally (in tablet or pill format) it is also marketed in liquid or injectable form. That is why it is also indicated for patients who find it difficult to follow an oral treatment.

Fluphenazine: general characteristics

Fluphenazine is an antipsychotic drug that blocks dopamine receptors , lowering the concentration of dopamine in the brain.

It is indicated for the treatment of schizophrenia and paranoid psychoses, specifically as maintenance treatment in chronic patients who have difficulty following oral therapy (pills). Its action is prolonged.

Mechanism of action

The mechanism of action of fluphenazine is not completely known, although it is known that is related to the blockade of the dopaminergic D2 receptors of the limbic system and the basal ganglia. This lowers the concentration of dopamine in the brain (as is generally the case with antipsychotics); this effect improves psychotic symptoms as dopamine is known to be found in excessively high concentrations in schizophrenia (and other psychotic disorders).

On the other hand, there is a relationship between the antipsychotic potency of the drug and the frequency of extrapyramidal effects (side effects involving movement disorders) with the occupation of D2 dopamine receptors.

Indications and contraindications

Fluphenazine is indicated to treat schizophrenia and other types of psychotic disorders. It acts on delusional symptoms, hallucinations, hostility, disorganized behavior, etc. It is also indicated for bipolar disorder.

The main contraindications of fluphenazine are having a hypersensitivity to it, having a cortical encephalic lesion, a liver lesion, having Parkinson’s disease, having prostatic hypertrophy, taking drugs that depress the CNS (Central Nervous System) and being a child under 3 years old, among others.

In relation to pregnancy and lactation, fluphenazine should only be taken (in pregnancy) if its indication is clear , and if the benefits of taking it outweigh the potential risks. Regarding breastfeeding, its use is not recommended, as it is not known whether the drug is excreted into breast milk or not.

Trade name

Fluphenazine is generally sold under the name “Prolixin” ; it comes in tablets or pills. There are five milligrams (5 mg) and 10 milligrams (10 mg). It is also available in other forms such as syrup (0.5 mg) and solution for injection (25 mg/ml) [the latter with the trade name “Fluphenazine decanoate”].

Other trade names I could carry are: Modecate, Motival and Prolixin Depot.

Side effects

The most common adverse effects of fluphenazine are nightmares, insomnia, weakness or tiredness, stomach discomfort, anxiety or nervousness, dry mouth , alterations of appetite or weight and skin more sensitive to the sun than usual.

Other adverse reactions that may occur are: nausea, loss of appetite, salivation, sweating, dry mouth, headache, constipation, photosensitivity, dystonia, dyskinesia, akathisia, hyperreflexia, tardive dyskinesia, drowsiness, lethargy and pseudoparkinsonism (motor impairment similar to Parkinson’s but qualitatively different, due to diffuse cortical alteration).

How do you use it?

Fluphenazine has several routes of administration; can be found in tablet (lozenge) or liquid (elixir and concentrate) format . This is why we have seen how it is especially indicated for patients who find it difficult to follow oral treatment (with pills). Specifically, fluphenazine in liquid form comes with a specially marked dropper to measure the doses.

It is usually taken 2 to 3 times a day (as an oral tablet); it can be taken with or without food. Normally the maximum dose is 20 mg per day in therapeutic treatment . In more severe patients, however, a dose of up to 40 mg/day is recommended. However, the doctor may gradually reduce the dose over the course of treatment if no serious symptoms or adverse drug reactions occur.

On the other hand, and as with all drugs, a specialist should be consulted to resolve any doubts regarding its use, dosage and contraindications.

Dose, frequency and duration

As we can see, these treatment parameters will depend on the patient’s pathology, age, state of health, etc. However, in general the recommended dose in most cases (with its due nuances) is 0.5 ml per injection, in patients using fluphenazine for the first time (it will be administered in the buttocks by deep injection); and 0.25 ml daily for 3 weeks in patients over 60.

Use of antipsychotics

Antipsychotics such as fluphenazine (as well as other types of psychopharmaceuticals), do not actually “cure” the condition for which they are administered . Rather, they relieve the symptoms it produces, improving the patient’s quality of life.

Ideally, they should be prescribed as a complement to another type of therapy , this time psychological. On the other hand, the involvement of the patient’s relatives is also essential for their evolution, especially in disorders such as schizophrenia, where all areas of the patient’s life are usually severely affected.

Other information: relationship with suicide

A study by De Alarcón and Carney (1969) showed a relationship between fluphenazine and suicide; they found that 16 patients diagnosed with schizophrenia and treated with fluphenazine (specifically, fluphenazine enanthate), had subsequently developed depression; in addition, 5 of them committed suicide.

The study authors attributed the facts to a possible depressive effect of fluphenazine.

Bibliographic references:

  • Agra, S. (1990). Long-acting neuroleptics and suicide risk. R.A.E.N., 10(33): 181-190.
  • De Alarcón, R. and Carney, M. (1969). Severe depressive mood changes following slow release intramuscular fluphenazine injection. Srit. Med. J.,; 3: 564-567.
  • Stahl, S.M. (2002). Essential Psychopharmacology. Neuroscientific bases and clinical applications. Barcelona: Ariel.
  • Vademecum. (2015). Fluphenazine.