Comprehensive medication guide to Fluphenazine including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$30 copay for generic on most plans; typically Tier 1–2 on commercial insurance and Medicare Part D; Medicaid covers it with minimal or no copay.
Estimated Cash Pricing
$226–$274 retail for generic 5 mg tablets (30-day supply); as low as $22–$27 with GoodRx or SingleCare discount coupons.
Medfinder Findability Score
72/100
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Fluphenazine is a high-potency, first-generation (typical) antipsychotic medication in the phenothiazine drug class. It was FDA-approved in September 1959, making it one of the earliest antipsychotics approved in the United States, and is on the World Health Organization's List of Essential Medicines in its injectable form.
Previously sold under the brand names Prolixin and Permitil (both discontinued), fluphenazine is now available only as a generic medication. It is used primarily for the management of schizophrenia — both acute episodes and long-term maintenance therapy, with the long-acting decanoate injection widely used for patients where daily adherence is a concern.
Fluphenazine is available in multiple formulations: oral tablets (1 mg, 2.5 mg, 5 mg, 10 mg), oral elixir (2.5 mg/5 mL), oral concentrate (5 mg/mL), short-acting injectable solution (2.5 mg/mL), and the long-acting fluphenazine decanoate injection (25 mg/mL) given every 3–4 weeks.
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Fluphenazine works primarily by blocking dopamine D2 and D1 receptors in the brain. The dopamine hypothesis of schizophrenia suggests that overactivity in certain dopamine pathways — particularly the mesolimbic pathway — contributes to positive symptoms like hallucinations, delusions, and disorganized thinking. By blocking D2 receptors in this pathway, fluphenazine reduces these psychotic symptoms.
In addition to dopamine receptor blockade, fluphenazine also blocks alpha-1 adrenergic receptors (contributing to orthostatic hypotension), muscarinic M1 receptors (causing anticholinergic effects like dry mouth and constipation), and histamine H1 receptors (causing sedation). These additional receptor effects explain many of the medication's side effects.
Oral fluphenazine is rapidly absorbed, reaching peak plasma levels in approximately 2 hours, with a half-life of 14–16 hours. The long-acting decanoate form is dissolved in sesame oil and forms a depot when injected intramuscularly, slowly releasing fluphenazine over 3–4 weeks. Fluphenazine is primarily metabolized by the liver enzyme CYP2D6.
1 mg — tablet
Lowest strength oral tablet; used for geriatric dosing
2.5 mg — tablet
Starting dose tablet
5 mg — tablet
Most commonly prescribed tablet strength
10 mg — tablet
Higher strength oral tablet
2.5 mg/5 mL — oral elixir
Liquid form for patients who cannot swallow tablets
5 mg/mL — oral concentrate
Must be diluted in juice or milk before use
2.5 mg/mL — injectable solution (HCl)
Short-acting IM injection for acute use; given every 6–8 hours
25 mg/mL — fluphenazine decanoate injection
Long-acting IM/SC injection; given every 3–4 weeks for maintenance
Fluphenazine is not currently listed as a national FDA shortage as of 2026, but it can be difficult to find at many pharmacies. Several structural factors contribute to this: the brand names (Prolixin, Permitil) have been discontinued, prescription volume has declined approximately 40% since 2010, and only a small number of generic manufacturers produce it.
Oral tablets are generally more available than liquid or injectable formulations. The fluphenazine decanoate injection (25 mg/mL) is the hardest to find and typically requires a specialty pharmacy or clinic pharmacy rather than a retail chain. Pharmacies can often order fluphenazine tablets within 1–2 business days if they don't have it on the shelf.
If you're struggling to locate fluphenazine, medfinder can help by calling pharmacies near you to find which ones have your medication in stock — saving you the time of making calls yourself.
Fluphenazine is not a controlled substance, so any licensed prescriber with standard prescribing authority can write for it — without any special DEA registration. There are no federal restrictions on who can prescribe antipsychotic medications.
Psychiatrists: Most common prescribers; specialize in schizophrenia and psychotic disorders
Primary care physicians (PCPs): Can prescribe, especially for stable patients or in areas with limited psychiatric access
Neurologists: May prescribe for off-label uses (Huntington's chorea, tic disorders)
Nurse practitioners (NPs) and physician assistants (PAs): Can prescribe independently in most states, particularly psychiatric-mental health NPs (PMHNPs)
Fluphenazine can also be prescribed via telehealth since it is not a controlled substance. Psychiatric telehealth platforms can evaluate and prescribe it for appropriate patients. Note that the long-acting decanoate injection must still be administered in person by a healthcare provider.
No. Fluphenazine is not a DEA-controlled substance. Antipsychotic medications, including all phenothiazines, are not scheduled under the Controlled Substances Act. This means there are no special DEA prescribing restrictions on fluphenazine beyond standard requirements.
Practical implications: Prescriptions can be called in, faxed, or transmitted electronically. There are no limits on refills from a federal standpoint (state laws vary but are generally not restrictive for non-controlled antipsychotics). Any licensed prescriber — including primary care physicians, nurse practitioners, and physician assistants — can prescribe fluphenazine without special DEA registration beyond their standard license.
Sedation and drowsiness
Dry mouth
Blurred vision
Constipation
Orthostatic hypotension (dizziness when standing)
Extrapyramidal symptoms: akathisia, parkinsonism (tremor, stiffness), acute dystonia
Weight gain (less than some other antipsychotics)
Photosensitivity (increased sun sensitivity)
Tardive dyskinesia: Potentially irreversible involuntary movements of the face, tongue, or body — risk increases with duration and dose
Neuroleptic malignant syndrome (NMS): Rare but life-threatening — fever, severe muscle rigidity, altered mental status. Medical emergency — call 911
Blood disorders: Agranulocytosis, neutropenia (fever, chills, unusual infections — call doctor promptly)
QT prolongation: Risk of dangerous heart rhythm abnormalities, especially with other QT-prolonging drugs
BOXED WARNING: Increased mortality in elderly patients with dementia-related psychosis — not approved for this use
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Haloperidol (Haldol)
Most similar first-generation antipsychotic; available in oral and decanoate injection forms; widely stocked at pharmacies
Risperidone (Risperdal)
Second-generation antipsychotic; lower EPS risk; available in generic oral and long-acting injectable; widely available
Quetiapine (Seroquel)
Second-generation antipsychotic; very low EPS risk; inexpensive generic; covers both schizophrenia and mood symptoms
Olanzapine (Zyprexa)
Second-generation antipsychotic; effective for both positive and negative symptoms; generic available; higher metabolic side-effect risk
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Alcohol / CNS depressants
majorAdditive CNS and respiratory depression; can be life-threatening. Avoid all alcohol and minimize concurrent CNS depressant use.
Opioids (codeine, morphine, oxycodone, fentanyl)
majorProfound sedation and respiratory depression risk. Reserve concurrent use only when alternatives inadequate; monitor closely.
QT-prolonging drugs (amiodarone, sotalol, erythromycin, azithromycin)
majorAdditive QT prolongation; risk of torsades de pointes and sudden death. Avoid or use with cardiac monitoring.
Other antipsychotics (aripiprazole, risperidone)
majorIncreased risk of NMS, abnormal muscle contractions, QT prolongation. Avoid concurrent antipsychotic use.
CYP2D6 inhibitors (fluoxetine, paroxetine, bupropion)
moderateSlows fluphenazine metabolism, increasing blood levels and side effects. Monitor for increased EPS and sedation.
Lithium
moderateFluphenazine may increase lithium levels; monitor lithium levels and signs of toxicity.
Anticholinergic drugs (diphenhydramine, atropine, oxybutynin)
moderateAdditive anticholinergic effects: excessive dry mouth, constipation, urinary retention, confusion.
Fluphenazine is a well-established first-generation antipsychotic that has been an important tool in schizophrenia management for over 65 years. While its use has declined with the advent of atypical antipsychotics, it remains clinically valuable — particularly the long-acting decanoate injection for adherence-challenged patients, and for those who have responded well to it over many years of treatment.
For patients prescribed fluphenazine, the two most practical concerns in 2026 are availability and cost. On cost: with free discount cards like GoodRx or SingleCare, most patients can get a 30-day supply for $22–$27 — making fluphenazine tablets one of the most affordable antipsychotic options available. On availability: oral tablets are generally findable with some searching, while the injectable decanoate requires a specialty pharmacy relationship.
If you're having difficulty locating fluphenazine at your pharmacy, medfinder can call pharmacies near you to find which ones have your medication in stock and text you the results — so you don't have to spend hours on the phone.
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