Fluphenazine decanoate

Fluphenazine decanoate, Pipothiazine palmitate, FFaloperidol decanoate, Flupenthixol decanoate, Clopenthixol decanoate Psychosis... 

Across the sites, an average of 15% of inpatients received depot antipsychotic drugs (Sim etal, 2004b). This was most common in Singapore (75%) followed by Taiwan (20%), Japan and China (6%). The depot antipsychotic drugs used were fluphenazine decanoate, flupenthixol decanoate, zuclopenthixol decanoate, haloperidol decanoate, pipothiazine palmitate, and fluphenazine enanthate. 

J. Freyfuss, J. M. Shaw, and J. J. Ross, Jr., Fluphe-nazine enanthate and fluphenazine decanoate intramuscular injection and esterification as requirements for slow-release characteristics in dogs, J. Pharm. Sci., 65, 1310-1315 (1976). 

Depot antipsychotics (e.g., haloperidol decanoate, fluphenazine decanoate, and risperidone long-acting injection) can be used for maintenance therapy of bipolar disorder with noncompliance or treatment resistance. 

If partial or poor adherence is an issue, a long-acting or depot injectable antipsychotic should be considered (e.g., risperidone microspheres, halo-peridol decanoate, fluphenazine decanoate). 

For fluphenazine decanoate, an esterified formulation in sesame seed oil, the simplest conversion is the Stimmel method, which uses 1.2 times the oral daily dose for stabilized patients, rounding up to the nearest 12.5-mg interval, administered IM in weekly doses for the first 4 to 6 weeks (1.6 times the oral daily dose for patients who are more acutely ill). Subsequently, fluphenazine decanoate may be administered once every 2 to 3 weeks. Oral fluphenazine may be overlapped for 1 week. 

Haloperidol and fluphenazine decanoate should be administered by a deep, Z-track IM method. Long-acting risperidone is injected by deep IM injection in the gluteus maximus, but Z-tracking is not necessary. 

Luo JP, Hubbard JW, Midha KK. 1997. Sensitive method for the simultaneous measurement of fluphenazine decanoate and fluphenazine in plasma by high-performance liquid chromatography with coulometric detection. J Chromatogr B Biomed Sci Appl 688(2) 303-308. 

For psychotic patients stabilized on a fixed daily dosage of orally administered fluphenazine, conversion from oral therapy to the long-acting injectable fluphenazine decanoate may be indicated. 

No precise formula can be given to convert to fluphenazine decanoate use. However, in a controlled multicenter study, oral 20 mg/day fluphenazine hydrochloride was equivalent to 25 mg fluphenazine... 

Once conversion to fluphenazine decanoate is made, careful clinical monitoring of the patient and appropriate dosage adjustment should be made at the time of each injection. 

Severely agitated patients - Initially treat with a rapid-acting phenothiazine. When acute symptoms subside, administer 25 mg of the fluphenazine decanoate adjust subsequent dosage as necessary. 

Poor risk patients - In poor risk patients (known phenothiazine hypersensitivity or with disorders predisposing to undue reactions), cautiously initiate oral or parenteral fluphenazine. When appropriate dosage is established, give equivalent dose of fluphenazine decanoate. 

Huphenazine is a short acting agent. Eor the management of agitated and potentially violent patients its hydrochloride formulation is frequently used for parenteral administration. Fluphenazine decanoate is a widely used depot preparation. Although its principal pharmacological activities are similar to those of the other phenothiazines fluphenazine displays only weak sedative action and it shows little anticholinergic and hypotensive effect. 

David A, Adams CE, Eisenbruch M, Quraishi S, Rath-bone J. Depot fluphenazine decanoate and enanthate for schizophrenia. Cochrane Database Syst Rev 2004. Issue 2. 

A high risk of relapse is inherent to schizophrenic psychoses. A relapse is often triggered by emotional stress. It is very important to prevent a relapse by either maintaining low-dose oral medication or by switching to a depot antipsychotic. In some cases, this cannot be avoided. Especially when compliance is a problem, a depot medication may help to keep the patient free of psychotic symptoms. Frequently used depot antipsy-chotics are haloperidol-decanoate, fluphenazine-decanoate, and fluspirilene, which are given in relatively low dosages (see Table 41.4). In EOS, relapse prevention is more important than in adulthood, as the majority of patients have not yet finished school or started a professional career. 

Phenothiazines, piperazine fluphenazine decanoate fluphenazine enanthate fluphenazine hydrochloride perphenazine prochlorperazine thioproperazine mesylate trifuoperazine hydrochloride... 

Odejide, D.A., Aderoumnu, A.F. Double-blind placebo substitution withdrawal of fluphenazine decanoate in schizophrenic patients. J. Clin. Psychiatry 43, 195-196, 1982. 

Several longitudinal studies have also found that patients stabilized on depot fluphenazine relapsed when switched to an oral antipsychotic preparation ( 264). Mirror-image studies also found depot fluphenazine (decanoate or enanthate) reduced the incidence of relapse, as well as the number of days hospitalized, when compared with oral therapy. These open, crossover studies switched patients from oral to depot forms, and the outcome with each approach was evaluated. 

Kissling et al. (27,9) evaluated both fluphenazine and haloperidol decanoate in a 6-month double-blind study involving 31 schizophrenic patients. These authors found both were equally effective in preventing relapse, with a slight advantage for haloperidol decanoate as reflected by fewer adverse effect-related dropouts and a decreased need for antiparkinsonian medications with this latter agent. Wistedt ( 280) compared fluphenazine decanoate with haloperidol decanoate in a double-blind... 

Fluphenazine decanoate may cause more acute EPS than haloperidol decanoate due to a phenomenon known as dose dumping. Here, a small amount of depot formulation is released into the systemic circulation shortly after an injection. There may be a tendency for haloperidol to be more effective for a subset of schizophrenic symptoms, less depressogenic, and slightly less likely to exacerbate extrapyramidal symptoms. These effects, however, are not large, may not be clinically significant, and are not consistently evident in all studies. 

Faiioon i. Watt DC, Sheperd M. A comparative controiied trial of pimozide and fluphenazine decanoate in the continuation therapy of schizophrenia. Psychoi Med 1978 8 59-70. 

Marder SR, Van Putten T, Mintz J, et ai. Low- and conventional-dose maintenance therapy with fluphenazine decanoate. Two-year outcome. Arch Gen Psychiatry 1987 44 518-521. 

Rifkin A, Quitkin F, Rabiner CJ, et al. Fluphenazine decanoate, fluphenazine hydrochloride given orally, and placebo in remitted schizophrenics. I. Relapse rates after one year. Arch Gen Psychiatry 1977 34 43-47. 

Hogarty GE, Schooler NR, Ulrich R, et al. Fluphenazine and social therapy in the aftercare of schizophrenic patients. Relapse analyses of a two-year controlled study of fluphenazine decanoate and fluphenazine hydrochloride. Arch Gen Psychiatry 1979 36 1283-1294. 

Schooler NR, Levine J, Severe JB, et al. Prevention of relapse in schizophrenia. An evaluation of fluphenazine decanoate. Arch Gen Psychiatry 1980 37 16-24. 

Kissling W, Moller HJ, Walter K, et al. Double-blind comparison of haloperidol decanoate and fluphenazine decanoate effectiveness, adverse effects, dosage and serum levels during a six months treatment for relapse prevention. Pharmacopsychiatry 1985 18 240-245. 

Wistedt B, Persson T, Hellbom E. A clinical double-blind comparison between haloperidol decanoate and fluphenazine decanoate. Curr Ther Res 1984 35 804-814. 

Chouinard G, Annable L, Campbell W, et al. A double-blind, controlled clinical trial of haloperidol decanoate and fluphenazine decanoate in the maintenance treatment of schizophrenia. Psychopharmacol Bull 1984 20 108-109. 

Chang SS, Javaid Jl, Dysken MW, et al. Plasma levels of fluphenazine during fluphenazine decanoate treatment in schizophrenia. Psychopharmacology 1985 87 55-58. 

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