Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever and primary central nervous system (CNS) pathology.The management of NMS should include 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy, 2) intensive symptomatic treatment and medical monitoring, and 3) treatment of any concomitant serious medical problems for which specific treatments are available. Patients receiving fluphenazine decanoate long-acting injection may notice some pain at the site of the injection. Continued treatment is needed to achieve maximum therapeutic benefits; further adjustments in dosage may be necessary during the course of therapy to meet the patient's requirements.For psychotic patients who have been stabilized on a fixed daily dosage of orally administered Fluphenazine Hydrochloride dosage forms, conversion to the long-acting injectable Fluphenazine Decanoate may be indicated [see package insert for Fluphenazine Decanoate Injection for conversion information].When the Oral Concentrate dosage form is to be used, the desired dose (measured by a calibrated device only) should be added to at least 60 mL (2 fl oz) of a suitable diluent Fluphenazine Hydrochloride Injection USP is useful when psychotic patients are unable or unwilling to take oral therapy.Fluphenazine Hydrochloride Oral Solution USP (Concentrate), a colorless, unflavored concentrated liquid is available in the following oral dosage form:NDC 0121-0653-04: 4 fl oz (120 mL) bottle with a 1 mL safety-cap dropper calibrated at 0.1 mL and in 0.2 mL increments. Patients with a preexisting low WBC and history of drug induced leukopenia/neutropenia should have their complete blood count (CBC) monitored frequently during the first few months of therapy and should discontinue Fluphenazine Decanoate Injection, USP at the first sign of a decline in WBC in the absence of other causative factors. The esterification of fluphenazine markedly prolongs the drug’s duration of effect without unduly attenuating its beneficial action.Fluphenazine decanoate has activity at all levels of the central nervous system as well as on multiple organ systems. An elevated risk of acute dystonia is observed in males and younger age groups.Extrapyramidal reactions may be alarming, and the patient should be forewarned and reassured. Chronic neuroleptic treatment should generally be reserved for patients who suffer from a chronic illness that, 1) is known to respond to neuroleptic drugs, and, 2) for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate. The possibility of anaphylactoid reactions occurring in some patients should be borne in mind.Routine blood counts are advisable during therapy since blood dyscrasias including leukopenia, agranulocytosis, thrombocytopenic or nonthrombocytopenic purpura, eosinophilia, and pancytopenia have been observed with phenothiazine derivatives. Previous brain damage or seizures may be predisposing factors; high doses should be avoided in known seizure patients. Avoid freezing. The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown.Given these considerations, neuroleptics should be prescribed in a manner that is most likely to minimize the occurrence of tardive dyskinesia. The possibility of anaphylactoid reactions occurring in some patients should be borne in mind.Routine blood counts are advisable during therapy since blood dyscrasias including leukopenia, agranulocytosis, thrombocytopenic or nonthrombocytopenic purpura, eosinophilia, and pancytopenia have been observed with phenothiazine derivatives. Patients with severe neutropenia (absolute neutrophil count <1000/mm Given the likelihood that some patients exposed chronically to neuroleptics will develop tardive dyskinesia, it is advised that all patients in whom chronic use is contemplated be given, if possible, full information about this risk. If severe hypotension should occur, supportive measures including the use of intravenous vasopressor drugs should be instituted immediately. However, the syndrome can develop although much less commonly, after relatively brief treatment periods at low doses.There is no known treatment for established cases of tardive dyskinesia, although the syndrome may remit, partially or completely, if neuroleptic treatment is withdrawn. Chronic neuroleptic treatment should generally be reserved for patients who suffer from a chronic illness that, 1) is known to respond to neuroleptic drugs, and, 2) for whom alternative, equally effective, but potentially less harmful treatments are If signs and symptoms of tardive dyskinesia appear in a patient on neuroleptics, drug discontinuation should be considered.