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fluphenazine

AntipsychoticLAI available

Brands: Prolixin

Last reviewed 2025-12-29

Reviewed by PsychMed Editorial Team.

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Quick answers

  • What is fluphenazine?

    Fluphenazine is a high-potency first-generation antipsychotic available in oral and depot formulations for schizophrenia maintenance, offering potent D2 blockade with minimal metabolic burden.

  • What is Prolixin?

    Prolixin is a brand name for fluphenazine.

  • What is Prolixin (fluphenazine) used for?

    Label indications include: Schizophrenia (oral/injectable).

  • What drug class is Prolixin (fluphenazine)?

    Antipsychotic.

  • What is the mechanism of action of Prolixin (fluphenazine)?

    High-potency phenothiazine antipsychotic with strong dopamine D2 antagonism; long-acting decanoate available for depot dosing.

  • What strengths does Prolixin (fluphenazine) come in?

    Oral tablets 1–10 mg, oral elixir 2.5 mg/5 mL, lactate injection 2.5 mg/mL, decanoate depot 25 mg/mL (IM every 2–4 weeks).

  • Is Prolixin (fluphenazine) a controlled substance?

    No — it is not scheduled as a controlled substance under U.S. federal law.

  • How is fluphenazine started as a long-acting injectable (LAI)?

    Decanoate: typical initiation is 12.5–25 mg IM every 2 weeks with oral overlap; maintenance 12.5–50 mg IM every 2–4 weeks.

Snapshot

  • Class: Antipsychotic
  • Common US brands: Prolixin
  • Long-acting injectable formulation available.
  • Therapeutic drug monitoring not routinely recommended.
  • Last reviewed: 2025-12-29

Clinical Highlights

Fluphenazine is a high-potency first-generation antipsychotic available in oral and depot formulations for schizophrenia maintenance, offering potent D2 blockade with minimal metabolic burden. High potency can mean less weight gain than many SGAs, but it also means higher risk of akathisia, dystonia, and parkinsonism; EPS monitoring and rescue options are commonly planned early.

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  • Depot fluphenazine decanoate remains a cost-effective option when long-acting coverage is needed and extrapyramidal risk can be managed.
  • LAI success often depends on logistics: clinic injection scheduling, contingency planning for travel or missed doses, and caregiver/team involvement to keep visits on track.
  • The compare view and fluphenazine evidence feed can help contrast EPS profiles, metabolic burdens, and LAI intervals when altering depot regimens.
  • Depot planning can be supported by the LAI Navigator and the schizophrenia hub; administration tips can be shared via the fluphenazine print page.
  • Used for maintenance in resource-limited settings and for patients responsive to typical antipsychotics; EPS prophylaxis and tardive dyskinesia monitoring are key safety considerations.
  • Schizophrenia (oral/injectable) (FDA 1959)
  • Generic: All formulations available generically.

Dosing & Formulations

Oral tablets 1–10 mg, oral elixir 2.5 mg/5 mL, lactate injection 2.5 mg/mL, decanoate depot 25 mg/mL (IM every 2–4 weeks). Oral: typical start is 2.5–5 mg/day divided; titrate to 5–20 mg/day; rarely exceed 40 mg/day.

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  • Decanoate: typical initiation is 12.5–25 mg IM every 2 weeks with oral overlap; maintenance 12.5–50 mg IM every 2–4 weeks.

Monitoring & Risks

Boxed warning: Increased mortality in elderly patients with dementia-related psychosis. Extrapyramidal symptoms: >30% without prophylaxis; anticholinergic coverage is often considered during initiation.

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  • Tardive dyskinesia: Risk increases with cumulative exposure; routine monitoring is common.
  • Hyperprolactinemia: Galactorrhea, amenorrhea, gynecomastia due to potent D2 blockade; counseling often covers prolactin-related symptoms.
  • Sedation: Less than low-potency agents but present.
  • Orthostatic hypotension: From α1 antagonism.
  • Serious but rare risks include neuroleptic malignant syndrome and QTc issues; urgent evaluation is warranted for fever/rigidity/confusion, fainting, or new palpitations.

Drug Interactions

CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine, bupropion) elevate levels—EPS monitoring and dose adjustment may be needed. CYP3A4 inducers (carbamazepine, rifampin) lower exposure—efficacy is monitored.

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  • Additive CNS depression with alcohol or sedatives.

Practice Notes

AIMS assessments are commonly used to detect tardive dyskinesia early. Counseling often covers EPS symptoms; rescue medications may be used (e.g., benztropine).

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  • Metabolic labs are still commonly obtained despite lower metabolic risk, to maintain comprehensive care.
  • For depot therapy, conversion strategy, injection technique, and attendance are commonly tracked; risk/benefit is reassessed if EPS or abnormal movements appear over time.
  • Injection appointments and transportation plans are often confirmed before discharge.
  • Depot logistics can be supported by the LAI Navigator and the schizophrenia hub; injection counseling can be shared via the fluphenazine print page.

Long-acting injectable (LAI) options

  • Fluphenazine decanoate
    Interval
    q2–4wk
    Oral overlap
    Consider during conversion
    Injection site
    Gluteal
    Notes
    • Approximate conversion often cited ~1.2× daily oral dose every 2–3 weeks; verify in label

References

  1. Fluphenazine decanoate prescribing information — DailyMed (2024)
  2. Triple advantages of injectable long acting second generation antipsychotics: relapse prevention, neuroprotection, and lower mortality — Schizophrenia Research (2018)
  3. Ravaris1973 Fluphenazine Placebo
  4. The CANMAT and ISBD Guidelines for the Management of Patients With Bipolar Disorder: 2021 Update — Bipolar Disorders (2021)Guidelinebipolarclinical
Fluphenazine (Prolixin) — Summary — PsychMed