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Fluphenazine is a typical antipsychotic used for the symptomatic management of psychosis in patients with schizophrenia. There is a long-acting fluphenazine decanoate formulation used primarily as maintenance therapy for chronic schizophrenia and related psychotic disorders in patients who do not tolerate oral formulations or in patients where medication compliance is a concern of the provider. It is a first-generation antipsychotic. This activity outlines the indications, mechanism of action, dosing, significant adverse effects, contraindications, monitoring, and toxicity of fluphenazine, so providers can direct patient therapy to optimize outcomes in patient management. Objectives: Describe the mechanism of action of fluphenazine. Identify the indications, both approved and off-label, for fluphenazine. Outline the adverse event profile and necessary monitoring for therapy with fluphenazine. Review interprofessional team strategies for improving care coordination and communication to advance fluphenazine therapy and improve outcomes. Access free multiple choice questions on this topic.

Fluphenazine therapy is optimally managed by an interprofessional healthcare team comprised of physicians (MDs, DOs; including specialists), mid-level practitioners (NPs and PAs), nurses, and pharmacists. The drug is generally prescribed by a primary care provider, psychiatric nurse, or psychiatrist. It is essential to monitor patients receiving fluphenazine therapy because the drug is notorious for causing extrapyramidal side effects and adverse cardiac events. An ECG is a requirement before starting the medication to ensure that the patient does not have QT abnormalities. The Abnormal Involuntary Movement Scale is a well-studied, easy-to-administer assessment for the emergence of extrapyramidal effects. Nursing staff can provide valuable feedback in this area and serve as the primary contact point for the patient with the team, coordinating all team members. Complete blood counts and metabolic panels are also necessary to monitor changes in white blood cell counts, liver transaminases, and blood urea nitrogen and creatinine levels. Additionally, the pharmacist must keep track of patient medications to verify dosing, avoid potential drug-drug interactions, counsel the patient regarding possible adverse events, and tell the patient how to dose their medication optimally. This interprofessional team approach with open information sharing can drive better patient outcomes with fewer adverse events. [Level 5]