Rowland Dustin
Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48105, US.
Curr Psychiatry Rep. 2025 Apr 28. doi: 10.1007/s11920-025-01610-y.
This review critically examines the clinical utility, efficacy, and tolerability of fluphenazine long-acting injectable (LAI) relative to contemporary alternatives. It further evaluates whether fluphenazine LAI confers substantive advantages over other available formulations for the management of schizophrenia, particularly in light of its long-standing use.
The extant literature demonstrates that the tolerability and side effect profile of fluphenazine LAI are comparable to other FGA LAIs but likely less favorable than available second-generation antipsychotic (SGA) LAIs. Although fluphenazine trends towards the higher end of the efficacy scale in meta-analyses, there is a lack of robust evidence showing a true statistical superiority for relapse prevention in schizophrenia. Social determinants of health (SDoH), such as race and economic factors, significantly influence its prescribing patterns. Fluphenazine LAI continues to be utilized primarily due to its low cost and widespread clinical familiarity rather than evidence-based superiority in efficacy or tolerability. Its prescribing is disproportionately influenced by healthcare inequities and resource limitations. Clinicians should employ a rigorous, individualized approach to antipsychotic selection, incorporating shared decision-making and patient education to ensure optimal therapeutic outcomes.
本综述批判性地考察了氟奋乃静长效注射剂（LAI）相对于当代其他药物的临床实用性、疗效和耐受性。鉴于其长期使用情况，本综述还进一步评估了氟奋乃静LAI在治疗精神分裂症方面是否比其他现有剂型具有实质性优势。
现有文献表明，氟奋乃静LAI的耐受性和副作用情况与其他第一代抗精神病药物长效注射剂相当，但可能不如现有的第二代抗精神病药物长效注射剂。虽然在荟萃分析中氟奋乃静的疗效倾向于较高水平，但缺乏有力证据表明其在预防精神分裂症复发方面具有真正的统计学优势。健康的社会决定因素，如种族和经济因素，对其处方模式有显著影响。氟奋乃静LAI仍被广泛使用，主要是因为其成本低且临床应用广泛，而非在疗效或耐受性方面具有循证优势。其处方受到医疗保健不公平和资源限制的不成比例影响。临床医生应采用严格、个性化的抗精神病药物选择方法，纳入共同决策和患者教育，以确保获得最佳治疗效果。
