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fluphenazine decanoate
generic
Black Box Warnings .
Dementia-Related Psychosis
not approved for dementia-related psychosis; incr. mortality risk in elderly patients on antipsychotic tx for dementia-related psychosis; most deaths due to cardiovascular or infectious events
Adult Dosing .
Dosage forms: INJ: 25 mg per mL
psychosis
- [12.5-100 mg IM q3-6wk]
- Start: 1.25x PO qd dose or 12.5-25 mg IM q3-6wk; incr. 12.5-25 mg q3-6wk; Max: 100 mg/dose; Info: lower doses and slower titration in elderly, debilitated; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: contraindicated
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to phenothiazines
- comatose patients
- subcortical brain damage
- CNS depression, severe
- respiratory depression, severe
- bone marrow depression, severe
- blood dyscrasia
- hepatotoxicity
- avoid: sun exposure
- avoid: UV light exposure, artificial
- caution: hypersensitivity to tartrazine (tab form)
- caution: pheochromocytoma
- caution: seizure disorder
- caution: cardiovascular disease
- caution: hypotension, severe
- caution: Parkinson disease
- caution: myasthenia gravis
- caution: pulmonary disease
- caution: GI disease, obstructive
- caution: surgery
- caution: environmental temperature, high
- caution: organophosphate poisoning
- caution: elderly patients
- caution: psychosis, dementia-associated
- caution: leukopenia history, drug-induced
- caution: neutropenia history, drug-induced
- caution: leukopenia
- caution: neutropenia
- caution: smoking habit change
Drug Interactions .
Overview
fluphenazine
phenothiazine
- CYP1A2 substrate
- CYP2D6 substrate
- anticholinergic effects
- CNS depression
- decreases central histamine effects
- dopamine antagonist
- extrapyramidal effects
- hyperprolactinemic effects
- hypotensive effects
- lowers seizure threshold
- myelosuppressive effects
- photosensitivity
- urine pH sensitive
Contraindicated
- potassium chloride
- potassium citrate
Avoid/Use Alternative
- aclidinium inhaled
- aldesleukin
- amifampridine
- aminolevulinic acid topical
- amphetamine
- apomorphine
- benzphetamine
- benztropine
- bromocriptine
- butalbital
- cabergoline
- chloramphenicol
- cladribine oral
- clonidine
- clozapine
- codeine
- deferiprone
- doxylamine
- eluxadoline
- epinephrine
- ethanol (alcoholic beverage)
- ethanol injection
- fexinidazole
- fluphenazine
- ganciclovir
- glucagon
- glycopyrrolate inhaled
- glycopyrronium topical
- haloperidol
- hydrocodone
- ipratropium inhaled
- isocarboxazid
- kava
- kratom
- lofexidine
- meperidine
- metaxalone
- methamphetamine
- metoclopramide
- midazolam
- olanzapine
- oxybate
- phenelzine
- pitolisant
- porfimer
- pramlintide
- primaquine
- promethazine
- radium Ra 223 dichloride
- rasagiline
- revefenacin inhaled
- rivastigmine
- ropeginterferon alfa-2b
- safinamide
- scopolamine
- selegiline
- selegiline transdermal
- sofpironium topical
- thalidomide
- tiotropium inhaled
- tradipitant
- tranylcypromine
- tretinoin topical
- trimethobenzamide
- triptorelin
- umeclidinium inhaled
- valganciclovir
- zuranolone
Monitor/Modify Tx
- 5-HTP
- abemaciclib
- acalabrutinib
- acebutolol
- ado-trastuzumab emtansine
- afamitresgene autoleucel
- albendazole
- alemtuzumab
- alfentanil
- alfuzosin
- aliskiren
- allopurinol
- almotriptan
- alprazolam
- alprostadil intracavernous
- amantadine
- amifostine
- amiloride
- amitriptyline
- amlodipine
- amoxapine
- anti-thymocyte globulin
- apraclonidine ophthalmic
- aprocitentan
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- arsenic trioxide
- articaine
- asciminib
- asenapine
- atenolol
- atidarsagene autotemcel
- auranofin
- avanafil
- axicabtagene ciloleucel
- azacitidine
- azathioprine
- azilsartan medoxomil
- baclofen
- baclofen intrathecal
- balsalazide
- baricitinib
- belantamab mafodotin
- belinostat
- benazepril
- bendamustine
- benznidazole
- berberine
- betaxolol
- betaxolol ophthalmic
- bethanechol
- betibeglogene autotemcel
- bevacizumab
- bexagliflozin
- bexarotene
- bisoprolol
- blinatumomab
- bortezomib
- bosutinib
- brentuximab vedotin
- brexpiprazole
- brexucabtagene autoleucel
- brimonidine ophthalmic
- brimonidine topical
- brivaracetam
- brompheniramine
- bumetanide
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- bupropion
- buspirone
- busulfan
- butorphanol
- cabazitaxel
- canagliflozin
- candesartan cilexetil
- cannabidiol
- cannabis
- capecitabine
- captopril
- carbamazepine
- carbinoxamine
- carboplatin
- carfilzomib
- cariprazine
- carisoprodol
- carmustine
- carteolol ophthalmic
- carvedilol
- cenobamate
- cetirizine
- chamomile, German
- chlophedianol
- chlorambucil
- chlorcyclizine
- chlordiazepoxide
- chloroprocaine
- chlorothiazide
- chlorpheniramine
- chlorpromazine
- chlorthalidone
- chlorzoxazone
- cidofovir
- cilostazol
- ciltacabtagene autoleucel
- cisplatin
- citalopram
- cladribine injection
- clemastine
- clevidipine
- clobazam
- clofarabine
- clomipramine
- clonazepam
- clorazepate
- coenzyme Q-10
- colchicine
- copanlisib
- copper histidinate
- crizotinib
- cyclobenzaprine
- cyclophosphamide
- cyproheptadine
- cytarabine
- dacarbazine
- dactinomycin
- dantrolene
- dapagliflozin
- dapsone
- daratumumab
- daridorexant
- darifenacin
- dasatinib
- daunorubicin
- decitabine
- deferasirox
- denileukin diftitox
- desflurane
- desipramine
- desvenlafaxine
- deuruxolitinib
- deutetrabenazine
- dexbrompheniramine
- dexchlorpheniramine
- dexmedetomidine
- dexmedetomidine injection
- dexrazoxane
- diazepam
- dichlorphenamide
- difelikefalin
- difenoxin
- dihydrocodeine
- diltiazem
- dimenhydrinate
- dinutuximab
- diphenhydramine
- diphenoxylate
- dipyridamole
- docetaxel
- domperidone
- dostarlimab
- doxazosin
- doxepin
- doxepin topical
- doxorubicin
- dronabinol
- droperidol
- duloxetine
- duvelisib
- efavirenz
- eflornithine
- eletriptan
- elinzanetant
- elivaldogene autotemcel
- elranatamab
- empagliflozin
- enalapril
- enalaprilat
- enfortumab vedotin
- entacapone
- entrectinib
- epcoritamab
- epirubicin
- eplerenone
- epoprostenol
- eribulin
- ertugliflozin
- escitalopram
- esketamine
- eslicarbazepine acetate
- esmolol
- estazolam
- eszopiclone
- ethacrynic acid
- ethanol (in some formulations)
- ethosuximide
- etomidate
- etoposide
- etripamil nasal
- etuvetidigene autotemcel
- everolimus
- exagamglogene autotemcel
- fam-trastuzumab deruxtecan
- fedratinib
- felbamate
- felodipine
- fenfluramine
- fenoldopam
- fentanyl
- ferumoxytol
- fesoterodine
- flaxseed
- flibanserin
- floxuridine
- flucytosine
- fludarabine
- fluorouracil
- fluoxetine
- flurazepam
- fluvoxamine
- foscarnet
- fosfomycin injection
- fosinopril
- foslevodopa
- fosphenytoin
- fostamatinib
- frovatriptan
- furosemide
- gabapentin
- gabapentin enacarbil
- ganaxolone
- garlic
- gemcitabine
- gemtuzumab ozogamicin
- gilteritinib
- givinostat
- glasdegib
- glofitamab
- glycopyrrolate
- guanfacine
- hydralazine
- hydrochlorothiazide
- hydromorphone
- hydroxychloroquine
- hydroxyurea
- hydroxyzine
- hyoscyamine
- ibritumomab tiuxetan
- ibrutinib
- idarubicin
- idecabtagene vicleucel
- idelalisib
- ifosfamide
- iloperidone
- iloprost
- imatinib
- imetelstat
- imipramine
- indapamide
- inotuzumab ozogamicin
- interferon beta 1a
- interferon beta 1b
- interferon gamma 1b
- iohexol
- iopamidol
- irbesartan
- irinotecan
- iron sucrose
- isatuximab
- isoflurane
- isosorbide dinitrate
- isosorbide mononitrate
- isradipine
- ivosidenib
- ixabepilone
- ketamine
- labetalol
- lacosamide
- lamotrigine
- landiolol
- leflunomide
- lemborexant
- lenalidomide
- levetiracetam
- levobunolol ophthalmic
- levocetirizine
- levodopa
- levomilnacipran
- levorphanol
- lidocaine
- lifileucel
- linezolid
- linvoseltamab
- lisinopril
- lisocabtagene maraleucel
- lithium
- lomustine
- lonafarnib
- loncastuximab tesirine
- lorazepam
- losartan
- lovotibeglogene autotemcel
- loxapine
- lubiprostone
- lumateperone
- lurasidone
- lurbinectedin
- lutetium Lu 177 dotatate
- lutetium Lu 177 vipivotide tetraxetan
- lymphocyte immune globulin, anti-thymocyte globulin
- magnesium sulfate
- maraviroc
- meclizine
- melatonin
- melphalan
- mepivacaine
- meprobamate
- mercaptopurine
- mesalamine
- mesalamine rectal
- methadone
- methocarbamol
- methohexital
- methotrexate
- methsuximide
- methyldopa
- methylene blue injection
- metolazone
- metoprolol
- metyrapone
- metyrosine
- midostaurin
- milnacipran
- milrinone
- milsaperidone
- minoxidil
- mirtazapine
- mitomycin
- mitotane
- mitoxantrone
- moexipril
- mogamulizumab
- molindone
- momelotinib
- morphine
- mosunetuzumab
- mycophenolate mofetil
- mycophenolic acid
- nadolol
- nalbuphine
- naltrexone
- naratriptan
- nattokinase
- naxitamab
- nebivolol
- nefazodone
- nelarabine
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- niraparib
- nisoldipine
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- nortriptyline
- obecabtagene autoleucel
- obinutuzumab
- ofatumumab
- olaparib
- oliceridine
- olmesartan medoxomil
- olsalazine
- opicapone
- opium
- orphenadrine
- oxaliplatin
- oxazepam
- oxcarbazepine
- oxybutynin
- oxycodone
- oxymorphone
- paclitaxel
- pacritinib
- palbociclib
- paliperidone
- palopegteriparatide
- paroxetine
- passion flower
- peginterferon alfa 2a
- peginterferon beta 1a
- pemetrexed
- penicillamine
- pentamidine
- pentazocine
- pentobarbital
- pentostatin
- perampanel
- perindopril
- perphenazine
- pheniramine
- phenobarbital
- phenoxybenzamine
- phentolamine
- phenytoin
- pimozide
- pindolol
- pirtobrutinib
- polatuzumab vedotin
- pomalidomide
- ponatinib
- pralatrexate
- pramipexole
- prazosin
- pregabalin
- primidone
- procarbazine
- prochlorperazine
- proguanil
- propafenone
- propofol
- propranolol
- protriptyline
- pyrilamine
- pyrimethamine
- quazepam
- quetiapine
- quinapril
- quizartinib
- ramelteon
- ramipril
- relacorilant
- remifentanil
- remimazolam
- repotrectinib
- ribavirin
- ribociclib
- rifabutin
- riociguat
- risperidone
- rituximab
- rizatriptan
- romidepsin
- ropinirole
- ropivacaine
- rotigotine transdermal
- rucaparib
- rufinamide
- ruxolitinib
- ruxolitinib topical
- sacituzumab govitecan
- sacubitril
- sarilumab
- satralizumab
- selinexor
- sertraline
- sevoflurane
- sildenafil
- silodosin
- sirolimus
- sirolimus albumin-bound
- sodium ferric gluconate complex
- solifenacin
- sotagliflozin
- sotalol
- sparsentan
- spironolactone
- stiripentol
- streptozocin
- succimer
- sufentanil
- sulfasalazine
- sumatriptan
- suvorexant
- tadalafil
- tafasitamab
- tagraxofusp
- talazoparib
- talquetamab
- tamsulosin
- tapentadol
- tarlatamab
- tasimelteon
- taurine
- tazemetostat
- teclistamab
- telmisartan
- temazepam
- temozolomide
- temsirolimus
- teplizumab
- terazosin
- teriflunomide
- tetrabenazine
- thioguanine
- thioridazine
- thiotepa
- thiothixene
- tiagabine
- timolol
- timolol ophthalmic
- tisagenlecleucel
- tizanidine
- tocilizumab
- tofacitinib
- tolcapone
- tolterodine
- topiramate
- topotecan
- torsemide
- trabectedin
- tramadol
- trandolapril
- trastuzumab
- trazodone
- treosulfan
- treprostinil
- triamterene
- triazolam
- trifluoperazine
- trifluridine
- trihexyphenidyl
- trimethoprim
- trimipramine
- triprolidine
- trospium
- upadacitinib
- valbenazine
- valerian
- valproic acid
- valsartan
- vancomycin
- vardenafil
- venetoclax
- venlafaxine
- verapamil
- vigabatrin
- vilazodone
- viloxazine
- vinblastine
- vincristine
- vinorelbine
- vosoritide
- warfarin
- yohimbe
- zaleplon
- zanubrutinib
- ziconotide
- zidovudine
- ziprasidone
- ziv-aflibercept
- zolmitriptan
- zolpidem
- zonisamide
Caution Advised
- aceclidine ophthalmic
- acetazolamide
- acitretin
- alosetron
- ascorbic acid (vitamin C)
- atropine
- atropine ophthalmic
- barium
- belladonna alkaloids
- botulinum toxin
- cevimeline
- chasteberry
- chloroquine
- cisapride
- clidinium
- cyclopentolate ophthalmic
- dacomitinib
- dicyclomine
- diethylpropion
- disopyramide
- donepezil
- erenumab
- erythromycin
- flavoxate
- galantamine
- goserelin
- histrelin
- homatropine
- ipratropium nasal
- leuprolide
- loperamide
- magnesium citrate
- mavorixafor
- methacholine inhaled
- methoxsalen
- methscopolamine
- mexiletine
- mirabegron
- neostigmine
- pilocarpine
- pilocarpine ophthalmic
- polyethylene glycol
- polyethylene glycol/electrolytes
- potassium acid phosphate
- potassium gluconate
- potassium phosphate
- procainamide
- pyridostigmine
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- rifampin
- ritonavir
- rose hip
- sodium picosulfate
- solriamfetol
- St. John's wort
- sulfate bowel prep
- terbinafine
- tropicamide ophthalmic
- verteporfin
- vibegron
Adverse Reactions .
Serious Reactions
- seizures
- cerebral edema
- neuroleptic malignant syndrome
- tardive dyskinesia
- extrapyramidal symptoms
- myelosuppression
- aplastic anemia
- leukopenia
- neutropenia
- agranulocytosis
- blood dyscrasia
- cholestatic jaundice
- paralytic ileus
- arrhythmia
- heat stroke
- angioedema
- exfoliative dermatitis
- lupus erythematosus
- pigmentary retinopathy
- lens deposits
- corneal deposits
Common Reactions
- nausea
- anorexia
- dyspepsia
- headache
- peripheral edema
- depression
- leukopenia
- hyperprolactinemia
- gynecomastia
- galactorrhea
- impotence
- extrapyramidal symptoms
- tardive dyskinesia
- drowsiness
- hypotension, orthostatic
- blurred vision
- xerostomia
- constipation
- photosensitivity
- urinary retention
- menstrual irregularities
- pruritus
- erythema
- seborrhea
- weight gain
- tachycardia
- HTN
- nasal congestion
- impaired body temperature regulation
Safety/Monitoring .
Monitoring Parameters
LFTs; CBC with diff frequently during initial tx if pre-existing or history of leukopenia/neutropenia; BUN/Cr, ophthalmic exam if prolonged tx
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, especially in 1st and 3rd trimester; inadequate human data available, though risk of neonatal extrapyramidal and withdrawal symptoms based on human data with other antipsychotics; possible risk of fetal harm, including teratogenicity, decr. fetal wt, incomplete ossification, and dilated cerebral ventricles, based on conflicting animal data
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: for fluphenazine: liver extensively; CYP450: 2D6 substrate; Info: active metabolites
Excretion: for fluphenazine: urine, bile/feces; Half-life: 14.7-15.3h (6-10 days decanoate)
Subclass: Antipsychotics, 1st generation
Mechanism of Action
for fluphenazine: exact mechanism of action unknown; selectively antagonizes dopamine D2 receptors (phenothiazine)
Formulary .
No Formulary Selected
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