Fluphenazine IM/SC Injection

Introduction

Fluphenazine decanoate is a long-acting antipsychotic medication used primarily in the management of schizophrenia. It is an ester of fluphenazine, a typical antipsychotic drug, and is formulated for intramuscular injection to provide extended-release effects over several weeks.

Uses

Fluphenazine decanoate is used for:

Schizophrenia: It is primarily prescribed for the treatment and management of schizophrenia, particularly in patients who require long-term antipsychotic therapy.
Psychotic Disorders: It may also be used to manage other psychotic disorders, as determined by a healthcare provider.

Brand Name	Fluphenazine
Type	IM/SC Injection
Weight	25 mg/ml
Generic	Fluphenazine Decanoate
Manufacturer	City Overseas Ltd. (Mfg. by: Rotexmedica GmbH, Germany)
Available in	English বাংলা

Mechanism of Action

Fluphenazine decanoate works by blocking dopamine receptors in the brain, particularly the D2 receptors. This antagonistic action helps to reduce the symptoms of psychosis, such as hallucinations and delusions. By modulating dopamine levels, it helps in stabilizing mood and cognitive function in patients with schizophrenia.

How Long Does It Take to Work?

The therapeutic effects of fluphenazine decanoate can take several weeks to become fully apparent. While some improvement in symptoms may be noticed within the first few days, it generally takes 2-4 weeks to observe substantial clinical benefits. The full impact on psychotic symptoms may take longer, depending on the individual.

Absorption

Fluphenazine decanoate is administered via intramuscular injection. The medication is designed to be slowly absorbed into the bloodstream from the injection site, leading to a prolonged release of the drug. This extended-release formulation ensures stable plasma levels over several weeks.

Route of Elimination

Fluphenazine decanoate is metabolized primarily in the liver. The drug and its metabolites are excreted mainly through the urine. A small portion of the drug is also excreted in the feces.

Dosage

Fluphenazine Decanoate by deep intramuscular injection into the gluteal muscle, test dose 12.5 mg (6.25 mg in elderly), then after 4-7 days 12.5-100 mg repeated at intervals of 14-35 days, adjusted according to response; it is not recommended for children.

The dosage of fluphenazine decanoate is individualized based on the patient’s needs and response to treatment. Common dosages are:

Initial Dose: 12.5 to 25 mg, administered every 2-3 weeks.
Maintenance Dose: Adjusted based on patient response, typically ranging from 25 to 100 mg every 3-4 weeks.

Dosage adjustments may be necessary based on therapeutic response and tolerability.

Administration

Fluphenazine decanoate is administered intramuscularly, typically in the gluteal or deltoid muscle. It is important to use proper injection techniques to ensure adequate absorption and minimize discomfort. The medication should be administered by a trained healthcare professional.

Side Effects

Common side effects include:

Extrapyramidal symptoms such as tremors, rigidity, and bradykinesia.
Weight gain and metabolic changes.
Dry mouth and blurred vision.
Constipation.

Less common but serious side effects may include neuroleptic malignant syndrome (NMS), tardive dyskinesia, and severe allergic reactions.

Toxicity

In cases of overdose or toxicity, symptoms may include severe sedation, extrapyramidal symptoms, cardiovascular effects, and altered mental status. Immediate medical attention is required in the event of an overdose.

Precautions

Precautions include:

Monitor for extrapyramidal symptoms and adjust dosage as needed.
Assess liver function periodically, as the drug is metabolized in the liver.
Use with caution in patients with a history of cardiovascular disease or seizures.
Regularly assess for signs of tardive dyskinesia and neuroleptic malignant syndrome.

Interaction

Fluphenazine decanoate may interact with other medications, including:

CNS Depressants: May enhance sedative effects.
Antihypertensives: May have additive effects on blood pressure.
Anticholinergics: May exacerbate anticholinergic side effects.

Disease Interaction

Use with caution in patients with:

Liver impairment or hepatic disease.
Cardiovascular conditions, including heart disease and hypertension.
Seizure disorders.

Drug Interaction

Drug interactions can occur with:

Other Antipsychotics: May increase the risk of side effects or alter efficacy.
Medications Affecting Liver Enzymes: May alter metabolism and clearance of fluphenazine.

Food Interactions

There are no significant food interactions with fluphenazine decanoate, but it is advisable to maintain a balanced diet and avoid alcohol, which can enhance sedative effects.

Pregnancy Use

Fluphenazine decanoate should be used during pregnancy only if the potential benefits outweigh the risks. It is classified as a Category C drug, meaning that risk to the fetus cannot be ruled out. Consult a healthcare provider for guidance.

Lactation Use

Fluphenazine decanoate is excreted in breast milk. Use during lactation should be avoided unless absolutely necessary, and a decision should be made based on the benefits versus risks. Consult a healthcare provider for advice.

Acute Overdose

Acute overdose may present with severe sedation, extrapyramidal symptoms, and cardiovascular effects. Immediate medical intervention is required to manage symptoms and provide supportive care.

Contraindication

Contraindications include:

Known hypersensitivity to fluphenazine or any component of the formulation.
Severe liver impairment or active liver disease.
Severe CNS depression or coma.

Use Direction

Follow the prescribed dosage and administration instructions. Regular follow-up with a healthcare provider is essential to monitor effectiveness and manage any side effects.

Storage Conditions

Store fluphenazine decanoate at room temperature, away from light and moisture. Keep it out of reach of children and dispose of any unused medication properly.

Volume of Distribution

The volume of distribution of fluphenazine decanoate is not specifically detailed, but it is distributed widely throughout the body, including the central nervous system, due to its lipophilic nature.

Half Life

The half-life of fluphenazine decanoate ranges from 2 to 5 days, depending on the individual’s metabolism and the formulation used. The extended-release formulation provides prolonged therapeutic effects.

Clearance

The clearance of fluphenazine decanoate is primarily through hepatic metabolism, with excretion occurring via the urine. The rate of clearance can be affected by liver function and other individual factors.

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