Fluphenazine decanoate LAI
PROLIXIN DECANOATE
Pronunciation: floo-FEN-a-zeen
“Prolix Fluffy hen”
Spooky greyscale mascot → high-potency first generation antipsychotic (FGA)
Prolix (adjective) - speaking at great length, wordy, redundant
What it isLong-acting injectable D2 antagonist for schizophrenia maintenance (PROLIXIN DECANOATE, ~1972).
Why this oneIts q2-3-week sesame-oil depot is an economical first-generation alternative to haloperidol decanoate; single-dose apparent half-life ~7-10 days.
What limits itParkinsonism, akathisia and tardive dyskinesia dominate; neuroleptic malignant syndrome and prolactin elevation also occur.
FDA-approved for
- schizophrenia (maintenance) (~1972)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Prolonged parenteral antipsychotic therapy (e.g., chronic schizophrenia) | Adults (not for use in children under 12 years) | 12.5–25 mg (0.5–1 mL) IM or SC to initiate | Adjust interval/dose to response; a single injection may control symptoms up to 4 weeks or longer | 100 mg |
Renal Undefined
Hepatic Undefined
If doses greater than 50 mg are needed, increase in 12.5 mg increments; dosage should not exceed 100 mg.
Instructions
- Give IM or SC using a dry syringe and needle of at least 21 gauge
- Consider initiating with shorter-acting fluphenazine to establish response before using the decanoate
- Monitor hepatic/renal function and blood counts on long-term therapy
Available strengths
- inj 25 mg/mL
Contraindications
- Suspected or established subcortical brain damage
- Patients receiving large doses of hypnotics
- Comatose or severely depressed states
- Presence of blood dyscrasia or liver damage
- Children under 12 years of age
Cautions
- Tardive dyskinesia (potentially irreversible)
- Neuroleptic malignant syndrome (NMS)
- Falls (somnolence, postural hypotension, motor/sensory instability)
- Leukopenia, neutropenia, and agranulocytosis
- Lowered seizure threshold; use caution in convulsive disorders
- Hepatic damage; hypotension
- Elevated prolactin; anticholinergic potentiation; caution with heat exposure
Adverse reactions
- Extrapyramidal symptoms (pseudoparkinsonism, dystonia, dyskinesia, akathisia, oculogyric crises)
- Tardive dyskinesia
- Drowsiness/lethargy
- Hypotension, autonomic effects (dry mouth, constipation, blurred vision)
- Blood dyscrasias; cholestatic jaundice
Pregnancy Use during pregnancy only if potential benefit justifies potential risk; third-trimester exposure risks neonatal extrapyramidal and/or withdrawal symptoms.
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 25 mg/mL | inj | per unit | $10.84/mL | not offered |
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Classes and tags
Clinical profile
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