Caution/Monitor.xylometazolineMonitor Closely (2)fluphenazine, xylometazoline. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. fluphenazine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbeSerious - Use Alternative (1)yohimbe decreases effects of fluphenazine by pharmacodynamic antagonism. Contraindicated.yohimbineMonitor Closely (2)fluphenazine, yohimbine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only. fluphenazine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotideMonitor Closely (1)fluphenazine and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (2)fluphenazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. fluphenazine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)fluphenazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.zolmitriptanMonitor Closely (1)zolmitriptan, fluphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).zolpidemMonitor Closely (1)fluphenazine will increase the level or effect of zolpidem by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Additive effect of decreased alertness and psychomotor performancezotepineMonitor Closely (2)fluphenazine and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. fluphenazine and zotepine both increase sedation. Use Caution/Monitor. Frequency Not Defined Confusion Decreased gag reflex Extrapyramidal symptoms Akathisia Dystonia Dyskinesia Muscle stiffness Neuroleptic malignant syndrome (NMS; infrequent but serious) Parkinsonism Tardive dyskinesia Common Anticholinergic effects Sedation Weight gain Erectile dysfunction Oligomenorrhea or amenorrhea Less common Orthostatic hypotension (after IM injection), tachycardia Agitation, anxiety, cerebral edema, depression, dizziness, euphoria, headache, poikilothermia, restlessness, weakness Anorexia, constipation, dyspepsia, ileus Lens opacities (with prolonged use) Uncommon ECG changes Photosensitivity Pruritus Diarrhea Blood dyscrasia Galactorrhea Ejaculatory disorder Rare Seizure Priapism Cholestatic jaundice Black Box Warnings Patients with dementia-related psychosis who are treated with antipsychotic drugs are at increased risk for death, as shown in short-term controlled trials; deaths in these trials appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature This drug is not approved for treatment of patients with dementia-related psychosisContraindications Documented hypersensitivity Coma, severe hypotension, severe central nervous system (CNS) depression, concurrent use of large amounts of CNS depressants, subcortical brain damage, poorly controlled seizure disorder Blood dyscrasias, severe cardiovascular disease, coma, patients receiving large doses of hypnotics, children <12 years (decanoate dosage form only) Cautions Use caution in glaucoma, prostatic hypertrophy, stenosing peptic ulcer disease (PUD), history of NMS, Parkinson disease, hypocalcemia, renal or hepatic impairment, history of severe reaction to insulin or electroconvulsive therapy (ECT), history of seizures, asthma, respiratory tract infections, cardiovascular disease May affect cardiac conduction, which may result in life-threatening arrhythmias Mild leukocytosis, leukopenia, and eosinophilia occasionally occur Antipsychotic use has been associated with aspiration and esophageal dysmotility; risk increases with age; use caution in patients at risk for aspiration pneumonia May be associated with neuroleptic malignant syndrome; monitor for fever, mental status changes, muscle rigidity, and /or autonomic instability Dermatologic reactions are common May cause pigmentary retinopathy, and lenticular and corneal deposits, especially in prolonged therapy May impair core body temperature regulation; caution with strenuous exercise, dehydration, heat exposure, and concomitant medication possessing anticholinergic effects CNS depression may impair physical or mental abilities; use caution operationg heavy machinery Watch for urinary retention, blurred vision, dry mouth, and constipation as result of anticholinergic effects Risk of extrapyramidal symptoms (EPS), NMS, hypotension; hypotension may be particularly severe in patients with pheochromocytoma or mitral insufficiency May need anticholinergic antiparkinsonian agent to counter EPS; in case of severe hypotension, use norepinephrine or phenylepinephrine, and do not use epinephrine or dopamine Use caution in patients with urinary retention, paralytic ileus, decreased gastrointestinal motility, BPH, visual problems or xerostomia Depresses hypothalamic thermoregulatory mechanism; exposure to extreme temperatures may cause hypo- or hyperthermia May increase risk of falls, resulting from orthostatic hypotension, somnolence, and motor sensory instability; complete fall risk assessment patients on medications or with diseases that may increase fall risk Use associated with increased prolactin levels; clinical significance in patients with breast cancer or other prolactin-dependent tumors unknown US Food and Drug Administration (FDA) warning regarding off-label use for dementia in elderly Pregnancy category: C Lactation: Drug enters breast milk; not recommendedPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Phenothiazine; antagonizes dopaminergic D1 and D2 receptors; depresses release of hypothalamic and hypophyseal hormones Absorption Bioavailability: Rapidly absorbed Onset: Hydrochloride salt, 1 hr; decanoate, 24-72 hr Duration: Hydrochloride salt, 6-8 hr; decanoate, 4 weeks Peak plasma time: Hydrochloride salt, 2 hr; decanoate, 8-10 hr Peak effect: Decanoate, 48-96 hr Elimination Half-life: Hydrochloride salt, 14-16 hr; decanoate, 14 days Excretion: Urine, feces No images available for this drug. No images available for this drug.A Patient Handout is not currently available for this monograph.Print FormularyPatient DiscountsAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.Create Your List of PlansAdding plans allows you to:View the formulary and any restrictions for each plan.Manage and view all your plans together – even plans in different states.Compare formulary status to other drugs in the same class.Access your plan list on any device – mobile or desktop. The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. View explanations for tiers and restrictions Tier Description 1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs. 2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs. 3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs. 4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. NC NOT COVERED – Drugs that are not covered by the plan. Code Definition PA Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription. QL Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered. ST Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription. 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