PsychRounds: The Psychiatry Podcast The Antipsychotics: Fluphenazine (Prolixin)
Sep 4, 2024
Dive into the world of Fluphenazine, a potent D2 blocker with a fascinating history in psychiatry. Learn about its FDA approval, off-label uses, and crucial dosage guidelines. Hear about the challenges of acute dystonia and essential safety concerns, especially for elderly patients. Explore Fluphenazine's role as a second-line treatment for hard-to-treat psychotic and mood disorders. Gain insights into its formulations, potential side effects, and the importance of monitoring to ensure efficacy and safety.
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Fluphenazine’s Strong D2 Blockade
- Fluphenazine and chlorpromazine share the phenothiazine class but differ in receptor profiles significantly.
- Fluphenazine is a very strong D2 blocker, even stronger than haloperidol, making it potent against psychosis.
Start Low and Monitor Drug Interactions
- Start fluphenazine at low doses, especially in naïve or elderly patients.
- Watch for CYP2D6 and CYP3A4 interactions, but overall it has fewer drug interactions than some antipsychotics.
Manage EPS Risk with IM Injection
- Intramuscular fluphenazine peaks rapidly, useful in agitation but can cause acute EPS like dystonia.
- Always have anticholinergic medication ready during IM administration for EPS prevention and treatment.