Fluphenazine long-acting

Fluphenazine A phenothiazine neuroleptic that is often formulated as a long-acting decanoate. 

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). 

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. 

Fluphenazine (Prolixin). Fluphenazine is another high potency antipsychotic. It is widely used to treat psychosis and comes in oral, injectable, and long-acting injectable (depot) forms. Its side effect profile is typical of the other high potency antipsychotics. 

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. 

Among the difficulties in pharmacological treatment is the frequent non-compliance. The biggest determinant of compliance is the quality of a patient s relationship with his doctor. But a further way to handle the issue has involved the development of long acting products (depot neuroleptics), even though their effectiveness in the absolute or compared to oral preparations has not been adequately explored. The most commonly used depot agents are fluphenazine and haloperidol decanoate (see David et al., 2004). 

For patients with chronic psychotic symptoms who do not comply with a daily medication regimen, a long-acting depot preparation should be considered after stabilization with oral medication. Fluphenazine, haloperidol, and risperidone are the only long-acting injectable antipsychotic medications currently available in the United States. 

Medication may be seen by the patient as intrusive and controlling or, alternatively, as comforting—a transitional, object-like extension of the therapist. Patients will be prone to interpret the medication in psychotic ways, especially when they are more symptomatic (and more in need of medication). When compliance remains a significant problem, consideration may be given to using one of the long-acting injectable forms of the antipsychotics (haloperidol decanoate or fluphenazine de-canoate). 

S9 Hirsch, S. R., Gaind, R., Rohde, P. D., Stevens, B. C., Wing, J. K. Outpatient maintenance of chronic schizophrenic patients with long-acting fluphenazine Double-blind Placebo Trial. Brit. Med. J. 1, 633 (1973). 

Geddes J, Freemantle N, Harrison P, Bebbington P. Atypical antipsychotics in the treatment of schizophrenia systematic overview and meta-regression analysis. BMJ 2000 321 1371-6 Hirsch S, Gaind R, Rohde PD et al. Outpatient maintenance of chronic schizophrenia patients with long-acting fluphenazine double-bhnd placebo trial. BMJ 1973 1 633-7 Johnstone E, Crow TJ, Frith CD etal. Mechanism of the antipsychotic effect in the treatment of schizophrenia. Lancet 1978 i 848-51... 

It is important to simplify the treatment regimen and to ensure that the patient is receiving the drug. In cases of suspected severe and dangerous noncompliance or with failure of oral treatment, the patient can be treated with injections of fluphenazine decanoate, haloperidol decanoate, or other long-acting preparations, including risperidone microspheres. 

Maintenance with injections of the decanoate ester of fluphenazine or haloperidol every 2—4 weeks, or with long-acting risperidone microspheres every 2—3 weeks, can be very effective. However, an expectation of superiority of long-acting injected antipsychotics is not well supported by available studies, most of which involve randomization of patients who already are largely cooperative with long-term oral treatment. 

Chapter 15. The molecule of chlorpromazine was subjected to many changes, one of which was to provide a long-acting form for discharged patients. Thus an injection of 25 mg of fluphenazine enanthate, dissolved in oil, provides maintenance therapy for 2 to 3 weeks. Fluphenazine is 10- 3-[4-(2-hydroxyethyl)-piperazin-l-yl]propyl -2-trifluoromethylphenothiazine, obviously derived from chlorpromazine which is 10-(3-dimethylaminopropyl)-2-chlorophenothiazine 12,110). 

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