Fluphenazine, Serum or Plasma

CPT: 80342
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Test Details

Synonyms

  • Prolixin®

Use

Fluphenazine is a phenothiazine derivative (piperazine) used in the treatment of psychotic disorders. Its dose in milligrams equivalent to 100 mg of chlorpromazine is 0.6−1.2 mg. A statistical evaluation1 of clinical studies found the near maximal effective dose of oral fluphenazine to be <6.9 mg/day. For the decanoate, the near-maximal effective dose was 25 mg/two weeks. As a high potency antipsychotic, it may have a high potential for causing extrapyramidal side effects. This would be in addition to the usual adverse effects of antipsychotic drugs (neurologic, anticholinergic, hypotension). Elderly patients should be observed for these occurrences. The half-life of fluphenazine is formulation-dependent. (The decanoate is 5 to 12 days; the hydrochloride 12 to 60 hours.) Fluphenazine is also used to alleviate pain and in childhood development disorders.

Methodology

Liquid chromatography/tandem mass spectrometry (LC/MS-MS)

Reference Interval

Therapeutic: 1.0−10.0 ng/mL

Additional Information

Time to maximum blood concentration after intramuscular injection of fluphenazine enanthate was two to four days, and the plasma half-life was 3.6 and 3.7 days in two patients compared to two to four hours and about 12 hours, respectively, for fluphenazine hydrochloride. Time to maximum blood concentration after intramuscular injection of the decanoate salt was 12 to 24 hours, and plasma half-life was 6.8 and 9.6 days in two patients.

Specimen Requirements

Specimen

Serum or plasma

Volume

2 mL

Minimum Volume

1 mL

Container

Red-top tube, lavender-top (EDTA) tube, or green-top (heparin) tube. Do not use a gel-barrier tube. The use of gel-barrier tubes is not recommended due to slow absorption of the drug by the gel. Depending on the specimen volume and storage time, the decrease in drug level due to absorption may be clinically significant.

Collection

Transfer serum or plasma to a transport tube with plastic stopper within 45 minutes of collection.

Storage Instructions

Room temperature

Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Causes for Rejection

Gel-barrier tube

Clinical Information

Footnotes

1. Davis JM, Chen N. Dose response and dose equivalence of antipsychotics. J Clin Psychopharm. 2004 Apr; 24(2):192-208. 15206667

References

American Medical Association, Division of Drugs and Toxicology. Drug Evaluations Subscription. Chicago, Ill: AMA, Winter 1992.
Hiemke C, Baumann P, Bergemann N, et al. AGNP consensus guidelines for therapeutic drug monitoring in psychiatry: Update 2011. Pharmacopsychiatry. 2011 Sep; 44(6):195-235. 22053351

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
706887 Fluphenazine (Prolixin(R)), S 3650-9 706887 Fluphenazine (Prolixin(R)), S ng/mL 3650-9

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