Fluphenazine

May be taken with or without food.

Comatose or severely depressed states; subcortical brain damage, phaeochromocytoma, marked cerebral atherosclerosis, blood dyscrasias, severe CNS depression; patient receiving large doses of hypnotics. Hepatic impairment. As fluphenazine decanoate: Children.

Patient with paralytic ileus, decreased gastrointestinal motility, xerostomia, urinary retention, benign prostatic hyperplasia, or visual problems; risk factors for blood dyscrasia (e.g. history of drug-induced leucopenia/neutropenia, pre-existing low WBC); risk factors for aspiration pneumonia (e.g. Alzheimer's disease); CV disease (e.g. mitral insufficiency), cerebrovascular disease, hypovolaemia or other conditions prone to hypotensive reactions; thyrotoxicosis, severe respiratory disease, Parkinson's disease, Lewy body dementia, diabetes, personal or family history of narrow-angle glaucoma, hypothyroidism, myasthenia gravis; history of seizures or conditions predisposing to epilepsy (e.g. brain damage, alcohol withdrawal). Patients subjected to strenuous exercise or dehydration; exposed to extreme heat or phosphorus insecticides; receiving large doses of phenothiazines who are undergoing surgery. Not indicated for the management of behavioural complications in patients with mental retardation. Avoid abrupt withdrawal. Renal impairment. Elderly (particularly with dementia-related psychosis). Pregnancy and lactation. Patient Counselling This drug may cause drowsiness and impair your mental and physical abilities, if affected, do not drive or operate machinery. Monitoring Parameters Monitor mental status; vital signs and CBC as clinically indicated; weight, height, BMI, waist circumference at baseline, every visit for the 1st 6 months then quarterly; electrolytes, renal and liver function annually then as clinically indicated; fasting plasma glucose level or HbA_1c at baseline then annually; lipid panel at baseline then as clinically indicated; ECG prior to treatment in patient at risk for CV disease. Monitor for anticholinergic and extrapyramidal symptoms; visual changes; signs of hypotension (IM). Perform ocular examination annually (in patients >40 years) or every 2 years (in younger patients).

Significant: Extrapyramidal symptoms including tardive dyskinesia, akathisia, acute dystonic reactions, pseudoparkinsonism, hyperreflexia, oculogyric crises, opisthotonos; liver damage (prolonged use), reactivation or aggravation of psychosis, silent pneumonia, venous thromboembolism; anticholinergic effects (e.g. constipation, xerostomia, blurred vision, urinary retention), ocular effects with prolonged use (e.g. pigmentary retinopathy, lenticular and corneal deposit), CNS depression, oesophageal dysmotility or aspiration, hyperprolactinaemia, orthostatic hypotension, impaired core body temperature regulation, falls, grand mal convulsions, withdrawal symptoms. Cardiac disorders: Tachycardia, QT interval prolongation. Eye disorders: Glaucoma. Gastrointestinal disorders: Vomiting, nausea, salivation, faecal impaction, paralytic ileus. General disorders and administration site conditions: Lethargy, peripheral oedema. Investigations: Transient LFT abnormalities, blood pressure fluctuations, weight change. Rarely, increased serum cholesterol. Metabolism and nutrition disorders: Hyponatraemia, loss of appetite. Nervous system disorders: Drowsiness, headache, agitation. Psychiatric disorders: Insomnia. Renal and urinary disorders: Urinary retention, polyuria. Reproductive system and breast disorders: Gynaecomastia, menstrual irregularities, erectile dysfunction. Respiratory, thoracic and mediastinal disorders: Nasal congestion. Skin and subcutaneous tissue disorders: Rash, erythema, urticaria, seborrhoea, photosensitivity, eczema, exfoliative dermatitis. Vascular disorders: Hypertension.
Potentially Fatal: Neuroleptic malignant syndrome (NMS), arrhythmias, blood dyscrasias (e.g. leucopenia, neutropenia, agranulocytosis).

May increase risk of QT interval prolongation with class IA (e.g. quinidine, disopyramide, procainamide) and class III (e.g. amiodarone, sotalol) antiarrhythmics; certain tetracyclic antidepressants (e.g. maprotiline), other antipsychotics (e.g. phenothiazines, pimozide), lithium, quinine, pentamidine, sparfloxacin, terfenadine. May potentiate CNS depressant effects of opioids, antihistamines, barbiturates, sedatives, hypnotics, or analgesics. Antagonise the effects of sympathomimetic agents (e.g. epinephrine) and adrenergic-blocking agents (e.g. guanethidine, clonidine). May impair the effects of anti-parkinsonian agents (e.g. levodopa) and anticonvulsant agents. May decrease the metabolism of TCAs. May increase the effect of anticoagulants. May enhance the adverse effects of anticholinergic agents. May enhance the absorption of corticosteroids, digoxin, neuromuscular blocking agents. May increase the risk of hypotension with ACE inhibitors, angiotensin II antagonists, thiazide diuretics, MAOIs, and β-blockers. May increase the risk of extrapyramidal effects with methyldopa.

Antipsychotics

N05AB02 - fluphenazine ; Belongs to the class of phenothiazine antipsychotics with piperazine structure.