The depot injection is given by a trained healthcare professional. It cannot be self-administered.
What it treats
Which conditions is Fluphenazine used for?
Overview
What is Fluphenazine?
Fluphenazine is a first-generation antipsychotic available as a daily oral tablet and as a long-acting depot injection given into the muscle every two to four weeks. The depot releases medicine gradually, providing continuous antipsychotic coverage without daily tablets.
It is listed in Kenya's Essential Medicines List 2023. The long-acting injection form is particularly valued where daily oral adherence is challenging.
Because the medicine cannot be stopped once an injection has been given, the decision to use the depot form is made together with a psychiatrist after a period of stabilisation on oral medicine.
How it works
What does it do in the brain?
Formulations in Kenya
How is it available?
Availability across Africa
Where is it available in Africa and what is it called?
| Country | Common Brand Name(s) | Notes |
|---|---|---|
| Kenya | Modecate, generic | On KEML 2023. Available at mental health facilities. |
| South Africa | Modecate, Fluanxol, generic | Widely available. On South Africa EML. |
| Nigeria | Modecate, generic | Available at psychiatric hospitals. |
| Uganda | Modecate, generic | Available at Butabika Hospital and larger facilities. |
| Tanzania | Modecate, generic | Available at Muhimbili and regional referral hospitals. |
| Ghana | Modecate, generic | Available at Accra Psychiatric Hospital. |
| Zambia | Modecate, generic | Available at psychiatric units. |
Side effects
What might you feel while taking it?
These are the most commonly reported effects. Not everyone experiences them, and many settle within the first few weeks.
- Movement side effects, including stiffness, slowness, restlessness, or involuntary movements
- Sedation
- Dizziness on standing
- Hormonal changes including menstrual changes and breast changes in both men and women
- Local discomfort at the injection site
- Involuntary repetitive movements developing after long-term use. Risk is higher with first-generation antipsychotics.
- Very high fever, extreme muscle rigidity, and confusion at the same time. A medical emergency.
- Any serious side effect after a depot injection cannot be reversed by stopping a tablet
Risks
Important risks you should understand before taking this medicine
- Movement side effects (extrapyramidal symptoms) are more common with fluphenazine than with second-generation antipsychotics. Biperiden is almost always co-prescribed to manage these.
- Tardive dyskinesia risk is higher with first-generation antipsychotics. Long-term depot use requires regular formal movement assessment. Once tardive dyskinesia develops, it may not be reversible.
- Because the depot lasts weeks, any serious side effect that develops after an injection cannot be quickly reversed by stopping a daily tablet. This is why the decision to start depot treatment requires careful discussion.
- Neuroleptic Malignant Syndrome can occur with any antipsychotic. The high fever, extreme muscle rigidity, and confusion triad requires immediate emergency care.
- Elderly patients with dementia carry significantly higher risks on antipsychotics including fluphenazine.
Who should not take it
Important warnings before starting
- Parkinson's disease
- Heavy sedation from other medicines or substances
- Known allergy to phenothiazine medicines
Special care needed
Situations that need extra attention
- A test dose is given before starting the full depot course to assess tolerance
- Biperiden is usually co-prescribed to manage movement side effects
- Once a depot injection is given, it cannot be undone. Careful planning before starting is important.
- Elderly patients carry higher risk and need careful assessment
Specialist advice is essential before continuing depot treatment through pregnancy.
Present in breast milk. Specialist guidance required.
Other medicines
Medicines and substances that can interact with it
- Medicines that cause drowsiness including alcohol: Sedation is significantly amplified.
- Biperiden (co-prescribed): Used intentionally to reduce movement side effects.
Tests and follow-up
What your doctor will monitor
- Movement side effects at every injection appointment
- Blood pressure at each visit
- Weight and metabolic parameters periodically
- Formal movement assessment at least every six months
Stopping this medicine
What happens if you stop taking it?
In Kenya
What you should know about this medicine in Kenya
Fluphenazine decanoate is a cornerstone of long-term schizophrenia management in Kenya, converting the challenge of daily oral adherence into a scheduled clinic appointment.
Community psychiatric nurses and mental health officers at county hospital level are trained to administer depot injections, extending access beyond specialist psychiatrists.
For families who have watched a loved one relapse repeatedly due to stopping oral medicine, the depot form often provides significant stability.
Sources
References
- Ministry of Health, Kenya. (2023). Kenya Essential Medicines List 2023. Nairobi: Ministry of Health.
- Ministry of Health, Kenya. (2023). Kenya National Medicines Formulary, 1st Edition. Nairobi: Ministry of Health.
- World Health Organization. (2023). Model List of Essential Medicines, 23rd Edition. Geneva: WHO.