Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-27T18:20:20.891Z Has data issue: false hasContentIssue false
  • English
  • Français

Plasma Levels of Fluphenazine in Patients Receiving Fluphenazine Decanoate Relationship to Clinical Response

Published online by Cambridge University Press:  02 January 2018

Stephen R. Marder ,
Kamal K. Midha ,
Theodore Van Putten ,
Manickam Aravagiri ,
Edward M. Hawes ,
John W. Hubbard ,
Gordon Mckay  and
Jim Mintz
Stephen R. Marder*
Affiliation:
West Los Angeles V A Medical Center, Brentwood Division, and University of California, Los Angeles, USA
Kamal K. Midha
Affiliation:
College of Pharmacy, University of Saskatchewan, Saskatoon, Canada
Theodore Van Putten
Affiliation:
West Los Angeles V A Medical Center, Brentwood Division, and University of California, Los Angeles, USA
Manickam Aravagiri
Affiliation:
Department of Psychiatry, University of California, Los Angeles, USA
Edward M. Hawes
Affiliation:
College of Pharmacy, University of Saskatchewan, Saskatoon, Canada
John W. Hubbard
Affiliation:
College of Pharmacy, University of Saskatchewan, Saskatoon, Canada
Gordon Mckay
Affiliation:
College of Pharmacy, University of Saskatchewan, Saskatoon, Canada
Jim Mintz
Affiliation:
University of California, Los Angeles, USA
*
∗West LA V A Medical Center, Brentwood Division, 11301 Wilshire Boulevard, Los Angeles, CA 90073
Get access Rights & Permissions [Opens in a new window]

Abstract

The levels of fluphenazine and fluphenazine sulphoxide in schizophrenic patients who were randomly assigned to receive either 5 mg or 25 mg of fluphenazine decanoate every two weeks were monitored. Patients treated with 25 mg of fluphenazine decanoate required three months to reach a steady-state plasma level, indicating that those patients who are being converted from oral to depot fluphenazine should continue to receive oral supplementation during the first three months of treatment with fluphenazine decanoate. Plasma levels of fluphenazine sulphoxide were lower than levels of fluphenazine. At six and nine months following randomisation, there was a statistically significant relationship between lower fluphenazine plasma levels and an increased risk of psychotic exacerbations. A relatively weak relationship was found between fluphenazine plasma levels and akinesia, but non-significant relationships between fluphenazine levels and other neurological side-effects including akathisia, retardation, and tardive dyskinesia. Monitoring the plasma levels may be helpful to clinicians who are attempting to treat stabilised patients with the lowest effective dose of fluphenazine decanoate.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 158 , Issue 5 , May 1991 , pp. 658 - 665
Copyright
Copyright © Royal College of Psychiatrists, 1991 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
Brown, W. A., Laughren, T., Chisholm, E., et al (1982) Low serum neuroleptic levels predict relapse in schizophrenic patients. Archives of General Psychiatry, 39, 998–1000.CrossRefGoogle ScholarPubMed
Dudley, J., Rauw, G., Hawes, E. M. et al (1983) Correlation of fluphenazine plasma levels versus clinical response in patients: a pilot study. Progress in Neuro–Psychopharmacology and Biological Psychiatry, 7, 791–795.CrossRefGoogle ScholarPubMed
Dysken, M. W., Javaid, J. I., Chang, S. S. et al (1981) Fluphenazine pharmacokinetics and therapeutic response. Psychopharmacology, 73, 205–210.CrossRefGoogle ScholarPubMed
Ereshefsky, L., Sakalad, S. R., Jann, M. W., et al (1984) Future of depot neuroleptic therapy: pharmacokinetic and pharmacodynamic approachers. Journal of Clinical Psychiatry, 45 (suppl.), 50–59.Google Scholar
Gitlin, M. J., Midha, K. K., Fooelson, D., et al (1988) Persistence of fluphenazine in plasma after decanoate withdrawal. Journal of Clinical Psychopharmacology, 8, 53–56.CrossRefGoogle ScholarPubMed
Glazer, W. M. (1988) Fluphenazine Decanoate: its steady state pharmacologic profile and relationship to tardive dyskinesia. Schizophrenia Research, 1, 425–429.Google Scholar
Hogarty, G. E., McEvoy, J. P., Munetz, M., et al (1988) Dose of fluphenazine, familial expressed emotion, and outcome in schizophrenia: results of a two–year controlled study. Archives of General Psychiatry, 45, 797–805.Google Scholar
Kane, J. M., Rifkin, A., Woerner, M., et al (1983) Low dose neuroleptic treatment of outpatient schizophrenics: I. Preliminary results for relapse rates. Archives of General Psychiatry, 40, 893–896.CrossRefGoogle ScholarPubMed
Marder, S. R., Hawes, E. M., Van Putten, T., et al (1986) Fluphenazine plasma levels in patients receiving low and conventional doses of fluphenazine decanoate. Psychopharmacology, 88, 480–483.Google Scholar
Marder, S. R., Van Putten, T., Mintz, J., et al (1987) Low and conventional dose maintenance therapy with fluphenazine decanoate: two–year outcome. Archives of General Psychiatry, 44, 518–521.Google Scholar
Marder, S. R., Hubbard, J. W., Van Putten, T., et al (1989) The pharmacokinetics of long–acting injectable neuroleptic drugs: Clinical implications. Psychopharmacology, 98, 433–439.Google Scholar
Marder, S. R., Hubbard, J. W., Aravaoiri, M., et al (1989) Plasma levels of parent drug and metabolites in patients receiving oral and depot fluphenazine. Psychopharmacology Bulletin, 25, 479–482.Google Scholar
Mavroidis, M. L., Kanter, D. R., Hirschowitz, J., et al (1984) Fluphenazine plasma levels and clinical response. Journal of Clinical Psychiatry, 45, 370–373.Google Scholar
Midha, K. K., Cooper, J. K. & Hubbard, J. W. (1980) Radioimmunoassay for fluphenazine in human plasma. Communications in Psychopharmacology, 4, 107–114.Google Scholar
Midha, K. K., Lapierre, Y. D. & Hubbard, J. W. (1981) Fluphenazine, trifluoperazine, and perphenazine in Vacutainers. Canadian Medical Association Journal, 124, 263.Google Scholar
Midha, K. K., Hubbard, J. W., Marder, S. R., et al (1987) The sulfoxidation of fluphenazine in schizophrenic patients maintained on fluphenazine decanoate. Psychopharmacology, 93, 369–373.CrossRefGoogle ScholarPubMed
Overall, J. E. & Gorham, D. R. (1962) The brief psychiatric rating scale. Psychological Reports, 10, 799–812.Google Scholar
Parloff, M. B., Kelman, H. C. & Frank, J. D. (1954) Comfort, effectiveness and self–awareness as criterion for improvement in psychotherapy. American Journal of Psychiatry, 111, 343–351.Google Scholar
Reyntjens, A. J. M., Heykants, J. J. P., Woestenborohs, R. J. H., et al (1982) Pharmacokinetics of haloperidol decanoate: A 2–year followup. International Journal of Pharmacopsychiatry, 17, 238–246.CrossRefGoogle Scholar
Van Putten, T., Marder, S. R., Mintz, J., et al (1988) Haloperidol plasma levels and clinical response: a therapeutic window relationship. Psychopharmacology Bulletin, 24, 173–175.Google ScholarPubMed
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press.Google Scholar
Wistedt, B., Jorgensen, A. & Wiles, D. (1982) A depot neuroleptic withdrawal study: Plasma concentration of fluphenazine and fluphenthixol and relapse frequency. Psychopharmacology, 78, 301–304.Google Scholar
Yadalam, K. G. & Simpson, G. M. (1988) Changing from oral to depot fluphenazine. Journal of Clinical Psychiatry, 49, 346–348.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.