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Active metabolites has not been studied. Fluphenazine binds to plasma proteins more than 90%. Fluphenazine as high molecular weight fatty acid ester and the oil solution is absorbed slowly and accumulate in fat depots, is released slowly. After intramuscular administration buy testosterone propionate of the maximum concentration is reached after about 24 hours. Fluphenazine passes through the blood-brain barrier, easily penetrates through the placental barrier and is not removed from the body by hemodialysis.

Indications
Long-term maintenance treatment of chronic schizophrenia. Prevention of exacerbations of schizophrenia.

Contraindications

  • Hypersensitivity to fluphenazine, as well as any component, part of the drug.
  • Severe cardiovascular disease (asthma, chronic circulatory failure, hypotension).
  • Severe depression of the central nervous system and comatose states from any cause; brain trauma, progressive systemic brain and spinal cord.
  • Violations of the liver and the blood system.
  • Pregnancy, lactation.
  • Children’s age (12 years).

 

With care
Alcoholism (increased susceptibility to hepatotoxic reactions), blood dyscrasias (impaired hematopoiesis), breast cancer (as a result of induced phenothiazines prolactin increases the risk of disease progression and resistance to the treatment of endocrine and cytotoxic drugs), angle-closure glaucoma, prostatic hyperplasia with clinical manifestations, liver and / or renal failure, peptic ulcer and 12 duodenal ulcer (in the period of exacerbation); diseases accompanied by an increased risk of thromboembolic complications; Parkinson’s disease (amplified extrapyramidal effects); epilepsy, seizures in history; myxedema; chronic diseases accompanied by buy testosterone propionate respiratory disorders (especially in children); Reye syndrome (increased risk of hepatotoxicity in children and adolescents); cachexia, vomiting (antiemetic effect of phenothiazines may mask vomiting associated with an overdose of other medications), advanced age.

Dosing and Administration
The drug is not intended for treatment courses of less than 3 months. Starting dose: For most patients, it is recommended initial dose of 12.5 to 25 mg (0.5 – 1 ml). Subsequent doses and intervals between injections are determined depending on the response to treatment. The starting dose for patients previously untreated preparations from the group of phenothiazines, should be selected by introducing fluphenazine Fast (fluphenazine hydrochloride). Maintenance therapy: One injection allows control for 4 weeks of the symptoms of schizophrenia . During maintenance therapy effect of a single dose stored in some patients 6 weeks. Dose should not exceed 100 mg. If you want the introduction of more than 50 mg of the drug, each subsequent dose should be increased with caution by no more than 12.5 mg.Patients with a pronounced excitation: treatment should be started with a rapid-acting fluphenazine, such as fluphenazine hydrochloride for injection. After calming down of the acute manifestations may be administered 25 mg (1 mL), fluphenazine decanoate solution for injection; subsequent doses if necessary, adjusted. Patients with “an increased risk of complications”: at a known hypersensitivity to phenothiazines or disorders predisposing to adverse reactions, treatment should be started cautiously with fluphenazine hydrochloride orally or parenterally. After the evaluation of pharmacological effect, and determining the optimal dose can be administered fluphenazine decanoate in injectable dose equivalent. Subsequent dosage adjustment is carried out, depending on the response to treatment. Children 12 years and over: 6.25 – 18.75 mg per week, if necessary and taking into account the tolerance dose was increased to 12.5 – 25 mg administered every 1-3 weeks . There is no single scheme of transition from fluphenazine quick action to impose a solution of fluphenazine decanoate. . However, it is known that a dose of 20 mg per day fluphenazine hydrochloride equivalent to a single injection of 1 ml (25 mg), fluphenazine decanoate solution every three weeks for most elderly patients require lower doses – 1/4 to 1/3 the dose assignable young patients, and monitoring the response to treatment. If necessary, the dose can be gradually increased.

 

Side effects Central nervous system (CNS) in the treatment of most phenothiazines extrapyramidal disorders such as parkinsonian syndrome, dystonia, dyskinesia, akathisia, oculogyric crises, opisthotonos, and hyperreflexia. Typically, extrapyramidal symptoms are reversible, but may be stable. The probability of occurrence and severity of undesirable side reactions is largely dependent on individual sensitivity than other factors, but relevant dose size and age of the patient. The patient should be warned in advance about such manifestations and their reversibility. Typically, to remove these undesirable phenomena sufficiently destination anticholinergic or antiparkinsonian drugs and / or dose reduction. Tardive dyskinesia syndrome manifested by involuntary choreoathetoid movements of the tongue, the face muscle of the mouth, lips or jaws (e.g., protruding tongue inflating cheeks Extruding lips, chewing movements), trunk muscles and limbs. Severity of this syndrome and the consequent deterioration of conditions can vary considerably. This syndrome manifests itself or during treatment at lower doses, or after cessation of therapy. Early detection of tardive dyskinesia is important. For the detection of this syndrome in the initial stage it is recommended periodical neuroleptic dose reduction (if possible as the patient), and observation of the patient during this period. This approach is extremely important, because the treatment of neuroleptic drugs may mask symptoms of tardive dyskinesia. Other neurological disorder: the treatment of neuroleptic-described development of neuroleptic malignant syndrome (CIP). Leukocytosis, fever, elevated creatine phosphokinase (CPK) may be associated with CIP, liver dysfunction and acute renal failure. Perhaps the development of drowsiness or confusion. Possible changes of electroencephalogram and protein levels in the spinal fluid; in rare cases, swelling of the brain is described. The autonomic nervous system: the treatment of fluphenazine described orthostatic hypertension and fluctuations in blood pressure. Hypotension during treatment with fluphenazine rare. Meanwhile, in patients with pheochromocytoma, cerebrovascular, renal and severe heart failure (e.g., patients with mitral insufficiency) amid hypotension  and often develops Depot; these patients should be closely monitored. If severe hypotension, prompt intravenous vasopressors. It is best suited for levarterenola bitartrate injection. Adrenaline used should not, as on the background of  and Depo celebrated perversion reaction to adrenaline to an even greater decrease in blood pressure. Also, nausea, loss of appetite, salivation, polyuria, sweating, dry mouth, headache, and constipation. As a rule, these adverse reactions occur after dose reduction or discontinuation of therapy. A number of patients in the treatment of drug buy testosterone propionatem Depot may be blurred vision, increased intraocular pressure, bladder atony, constipation, ileus, tachycardia, swelling of the nasal mucosa. Metabolic and endocrine disorders: in some patients during treatment th Depot may experience changes in body weight, peripheral edema, hyponatremia, syndrome of inappropriate secretion of antidiuretic hormone, abnormal lactation, gynecomastia, menstrual irregularities, false positive pregnancy test, impotence in men, and changes in libido in women. Allergic reactions: pruritus, erythema, urticaria, seborrhea, photosensitivity, eczema and exfoliative dermatitis. Be aware of the possibility of anaphylactic reactions. May develop bronchospasm, angioedema (including laryngeal). Hematologic disorders: leukopenia, agranulocytosis, thrombocytopenia and thrombocytopenic purpura, eosinophilia, and pancytopenia. With the development of diseases of the mouth, gums or throat, or upper respiratory tract infection in conjunction with the change in the number of white blood cells, confirming inhibition of blood, therapy should be canceled and immediately initiated the necessary remedial measures. Violations of the liver: the treatment of fluphenazine described the development of cholestatic jaundice, especially in the first few months of therapy. In such cases, treatment should be discontinued. In some patients, in patients receiving fluphenazine had changes in laboratory parameters of liver function tests and clinical signs of hepatitis. Other side effects: seizures, in patients with a history of seizures should not be given high doses of phenothiazines. Prolonged treatment may occur fever, vomiting, lupus-like syndrome, ECG changes. When long-term therapy for skin pigmentation, clouding of the lens and cornea, impaired renal function, pigmentary retinopathy, the development of mold closure glaucoma, irreversible diskenenziya may develop asymptomatic form of pneumonia.

Overdose
extrapyramidal disorder, hypotension, excessive sedation, depression of consciousness up to coma with areflexia. In such cases it is necessary to cancel a drug and supportive symptomatic treatment to start.
If severe hypotension requires immediate intravenous vasopressors. Epinephrine (adrenaline) should not be used as a background on the phenothiazines marked perverse reaction (even greater reduction in blood pressure). If severe extrapyramidal disorders appointed antiparkinsonian agents for several weeks. Antiparkinsonian agents should be lifted gradually in order to avoid recurrence of extrapyramidal disorders. Hemodialysis, peritoneal dialysis, exchange transfusions, and forced diuresis in poisoning drug buy testosterone propionatet ineffective.

Interaction with other drugs CNS depressants / Alcohol / Analgetiki: during treatment with fluphenazine increases the effects of alcohol, drugs, CNS depressants (hypnotics, sedatives) and strong analgesics. Co-administration of narcotic analgesics may cause hypotension, depression of the central nervous system and respiratory. Tricyclic antidepressants: phenothiazines disrupt the metabolism of tricyclic antidepressants. Increase in serum and phenothiazines and tricyclic antidepressants. May enhance or prolong the sedative and antimuscarinic effects, and arrhythmogenic effects of tricyclic antidepressants. Lithium preparations , while the appointment with fluphenazine can increase neurotoxicity. ACE inhibitors / Thiazide diuretics may increase the hypotensive action. Antihypertensives:antigipretenzivnoe effect of guanethidine, clonidine and possibly other antiadrenergic agents can be reduced. Clonidine may reduce the antipsychotic effects of phenothiazines. Beta-blockers may increase the concentration of beta-blockers and fenatiazina plasma. Metrizamide can cause seizures during treatment with fluphenazine. It is recommended to cancel the fluphenazine for 48 hours before myelography and not assign it at least 24 hours after myelography. Epinephrine and other agonists: phenothiazines are pharmacological antagonists, as a result may develop severe hypotension. Levodopa:phenothiazines may reduce the anti-Parkinsonian effect of the drug. Anticholinergic / antimuscarinic agents: fluphenazine when administered in combination with anticholinergic may increase blocking cholinergic receptors, especially in the elderly. Antimuscarinic effects are potentiated or rolled over. Anticonvulsants: fluphenazine can reduce their anticonvulsant effect. Antidiabetics: phenothiazines cause decompensation of diabetes. Cimetidine may reduce the concentration of phenothiazines in blood plasma. Antacids / Antidiarrheal agents may interfere with the absorption fluphenazine. Amphetamine / Anorectics funds are pharmacological antagonists fluphenazine. When using  together with anticholinergic or antimuscarinic agents should be closely monitored and the selection of doses of drugs. When odnovermennom use of beta-blockers and fenatiazina recommended dose reduction in both groups.

Specific guidance
In connection with a possible cross-sensitivity fluphenazine should be carefully used in patients with cholestatic jaundice, dermatitis and other allergic reactions to phenothiazine derivatives. During surgery, patients taking high severe hypotensive reactions may develop. You may need to decrease doses of anesthetics or neyroleptkov.
In some patients, the treatment of fluphenazine may potentiate the effect of anticholinergics as fluphenazine has anticholinergic action. Caution should be prescribed the drug in very hot weather or poisoning phosphorus insecticides, patients with seizures in history (since during treatment with fluphenazine cases of large seizures are described), as well as patients with mitral valve insufficiency or other disorders of the cardiovascular system or pheochromocytoma.
The drug okazyvatsya profound effect on psychomotor reaction of the patient, so the period of treatment prohibited from working with machinery or drive a car, as well as the reception of alcohol. how much to inject for weight loss

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