Fluphenazine and Nortriptyline

Antidepressant · Phenothiazine/Selective noradrenaline reuptake inhibitor

Indications

Mild to moderate mixed anxiety/depression.

Dosage

Adults: 1 tab two to three times daily for max 3 mth. Children: Not recommended.

Adverse Effects

Leucopenia, hyperprolactinaemia, acute dystonias and dyskinesias, akathisia, Parkinsonism, drowsiness, insomnia, agitation, tachycardia, arrhythmias, ECG changes, hypotension, anticholinergic effects (e.g. dry month, blurred vision), respiratory depression, nasal stuffiness, rash, photosensitivity, hyperglycaemia, impaired temperature regulation, male sexual dysfunction. Rarely, agranulocytosis, tardive dyskinesia, jaundice, neuroleptic malignant syndrome, pigmentary retinopathy.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Positive evidence of risk: Use only when no safer alternative exists for a serious problem. Lactation: Caution advised or effect undetermined. Contraindications: Pheochromocytoma, renal or hepatic failure, marked cerebral atherosclerosis, severe cardiac insufficiency, comatose states, severe depression, blood dyscrasias. Heart block, arrhythmias, mania, severe hepatic impairment. Porphyria. Precautions: Liver, respiratory or cardiac disease, cardiac arrhythmias, thyrotoxicosis, epilepsy, glaucoma, hypothyroidism, Myasthaenia gravis, prostatic hypertrophy. Parkinson's disease; reduce dose or use anti-Parkinsonian drugs in patients showing extra-pyramidal reactions. Very hot weather. Epilepsy, concurrent ECT, hyperthyroidism, psychosis. Suicidal tendencies. Anaesthesia. Withdraw gradually. Elderly.

Interactions

Adrenaline, alcohol, barbiturates, CNS depressants, other antipsychotics, anticholinergics, antacids, dopaminergics, lithium, oral hypoglycaemics, antihypertensives, anticonvulsants, drugs that prolong the QT interval (e.g. anti-arrhythmics), sibutramine, metoclopramide, sympathomimetics, carbamazepine, barbiturates, cimetidine.

Pharmacokinetics

FLUPHENAZINE: Onset: Oral/IM (HCl): <1 hr. IM (other): 24-72 hrs. Duration: Oral/IM (HCl): 6-8 hrs. IM depot: 1-6 wks. Absorption: Oral: Well-absorbed. SC/IM: Slowly absorbed from site of administration. Metabolism: Hepatic. Half-life elimination: Oral: 14-15 hrs. IM: 6-9 days. Time to peak, plasma: Oral: 30 mins. IM (HCl): 1.5-2 hrs. Excretion: Urine. Faeces. NORTRIPTYLINE: Onset of action: Depression: Individual responses may vary; however, 4 to 8 weeks of treatment are needed before determining if a patient with depression is partially or nonresponsive. Absorption: Oral: Rapid. Metabolism: Primarily hepatic; extensive first-pass effect. Bioavailability: 46% to 70%. Half-life elimination: Adults: 14 to 51 hours (mean: 26 hours); Elderly: 23.5 to 79 hours (mean: 45 hours). Time to peak, serum: 4 to 9 hours. Excretion: Urine (as metabolites and small amounts of unchanged drug).

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.