Management of Schizophrenia using Prolixin

Prolixin (fluphenazine) is a typical, high-potency antipsychotic used for the management of psychosis in patients with schizophrenia. This medication acts primarily via antagonism of  postsynaptic dopamine-2 receptors in the mesolimbic, nigrostriatal, and tuberoinfundibular neural pathways. The blockage of dopamine targets the positive symptoms in schizophrenia, including: hallucinations, delusions, and disorganized speech. Though Prolixin is frequently prescribed off-label for psychosis or psychotic symptoms related to major neurocognitive disorders and dementing illnesses, all antipsychotics (including Prolixin) are not FDA-approved for these purposes; this particular medication is not FDA-approved for augmentation of mood stabilization or treating concurrent psychotic symptoms in patients with bipolar disorder but used to manage chronic tic disorders and Huntington disease by controlling unusual movements and chorea. Common side effects of Prolixin include sedation, anticholinergic effects (dry eyes, dry mouth, constipation), blurred vision, dizziness, hypotension, rebound tachycardia, and EPS. Some severe adverse effects include neuroleptic malignant syndrome, liver function abnormalities and jaundice, seizures, and agranulocytosis. Similar to many other antipsychotics, Prolixin comes with a black box warning for increased risk for cerebrovascular events and death in elderly patients with psychosis. Dosing for Prolixin range from 1 mg – 40 mg; however, typical dosing is 2.5 mg – 10 mg PO daily every 6-8 hours and elderly patients should begin at 1 mg – 2.5 mg PO daily. Oral fluphenazine has a half-life of 14-16 hours with no pediatric dosing available. Baseline electrocardiograms has to be obtained in all patients with preexisting cardiac conduction abnormalities and assessing for EPS should be routine. Providers should obtain complete blood counts and metabolic panels to monitor for changes in white blood cell counts, liver transaminases, blood urea nitrogen levels, and creatinine levels (Siragusa et al., 2022).