Fluphenazine decanoate의 治療經驗 : 安全한 維特治療를 위한 豫備報告

CLINICAL EXPERIENCE OF FLUPHENAZINE DECANOATE： A PRELIMINARY REPORT FOR THE SUCCESSFUL M AINTENANCE THERAPY.

Clinical experience of fluphenazine decanoate therapy was reported with special reference to safety dos? ge regimen for the successful maintenance therapy. The experiement was conducted by two successive steps; a full dosage regimen during the first half of the period, and a low dosage regimen during the later half. During the initial phase of trial, full estimated doses of fluphenazine decanoate were given to 15 schizophrenic patients (9 acute and 6 chronic cases) who had been treated with oral neuroleptics, for converting oral medication to the depot. Usual dosage was ranged from 0. 5cc (12. 5 mg) to 2cc (50mg). Akathisia with parkinsonian rigidity was noticed in 13 cases (86.7% ) and moderate and severe degrees of the side effects was seen in 12 cases(80. 096). Three cases were uncontrollable by high dose of antiparkinsonian agents and bydiscontinuation of depot injection. This side effect in one case who had been given 2cc of the depot has persisted over 6 months after the discontinuation. Eighty percent of drop-out rate could be detected in these cases and the main reason was painful distress of the side effects. With the above experience the author gave up such a method of conversion and a new dosage regimen has been tried for the safe use. Oral medication was switched to the depot after acute symptoms subsided and after considerable improvement ensued when the required dose of fluphenazine decanoate was less than lcc(25m g). Two hours after initial shot of 0. Ice, an additional 0.1 or 0. 2cc is given if further dosage is needed with the condition that there is no side effect. When further dosage is required, the remainder is given on the 7th day with careful evaluation of side effects. The above dosage regimen has been tried to 30 schizophrenic patients (21 convalescent and 9 chronic cases). Sixty seven percent was given less than 0 .3cc(7.5mg) and only two cases needed lcc. Fourty three percent could be reduced in their dosage during maintenance. Intervals of injection were 14 days in 10 percent, 18 days in 3.3 percent, 21 days in 69.7 percent and 28 days in 20 percent. The intervals could be extended in 20 percent of the cases and was constant in 76.7 percent. Side effects were noticed in 33.3 percent, but mostly mild and subjective. Only 3 cases (10%) manifested moderate degree of akathisia with parkinsonian rigidity, akathisia with dystonia and hand tremor respecti vely that required concomitant medication of anti parkinsonian agents. The other cases could be easily managed by dosage reduction of the next shot. Drop-out rate was only 10 percent (3cases). According to the author’s experience, high dosage regimen seems to be troublesome both for the patient and for the physician due to high frequency of side effects especially extrapyramidal symptoms, even in the case of converting oral medication to fluphenazine decanoate. Initial very low dosage with gradual increase up to lcc of the depot could be recommanded as a safe dosage regimen even for the maintenance therapy.