Review question: Is sluphenazine effective for the treatment of schizophrenia compared with placebo?

Background

Fluphenazine is one of the first drugs to be classed as an ‘antipsychotic’ and has been widely available for decades.

Searching for evidence

We updated the electronic search in December 2017 for trials that randomised people with schizophrenia to receive oral fluphenazine or placebo. No new studies were found to be added in this update.

Evidence found

Seven trials met the review requirements and provided useable data.The evidence currently available is of poor quality and suggests that whilst fluphenazine is a potent and effective antipsychotic, it has considerable side effects.

Conclusions

Antipsychotic drugs are the first line and mainstay of treatment for schizophrenia. They help to effectively treat psychotic symptoms such as hearing voices and seeing things (hallucinations) and having strange beliefs (delusions). Fluphenazine was one of the first antipsychotics and has been available for around 50 years. Fluphenazine is inexpensive and in developing countries, may be one of the only drug treatments available. In most of Europe and North America, despite still being available, the arrival of newer antipsychotic drugs has reduced the use of fluphenazine and its market share. Fluphenazine has debilitating side effects, including: dizziness; movement disorders such as involuntary movements or spasms; shaking and tremors; inner restlessness and the inability to sit still; and problems with blood pressure, fever and muscle stiffness.

This review included seven studies and compared the effects of fluphenazine taken by mouth with placebo (‘dummy’ treatment).  In the main, the findings of the review support the widespread view that fluphenazine is a potent and effective antipsychotic but has considerable side effects, other antipsychotic drugs may well be preferable. Fluphenazine is an imperfect treatment with serious side effects, so other inexpensive antipsychotic drugs with fewer side effects may be better for people with schizophrenia. Despite this, fluphenazine has a low cost and is widely available, so is likely to remain one of the most widely used treatments for schizophrenia worldwide. However, some of fluphenazine’s side effects could be expensive in terms of human suffering and personal cost of treatment. Even though fluphenazine has been used as an antipsychotic drug for decades, there are still a surprisingly small number of well-conducted studies measuring its effectiveness and potential to cause side effects. Future large-scale research should report on important outcomes such as improvement in mental health, relapse, hospital discharge and admission, levels of satisfaction with treatment and quality of life.

This plain language summary has been written by a consumer Ben Gray from RETHINK.