Penfluridol

Penfluridol
Clinical data
Trade names	Semap
AHFS/Drugs.com	International Drug Names
ATC code	N05AG03 (WHO) ;
Identifiers
	IUPAC name 1-[4,4-Bis(4-fluorophenyl)butyl]-4-[4-chloro-3-(trifluoromethyl)phenyl]piperidin-4-ol;
CAS Number	26864-56-2 ;
PubChem CID	33630;
ChemSpider	31017 ;
UNII	25TLU22Q8H;
KEGG	D02630 ;
ChEMBL	ChEMBL47050 ;
CompTox Dashboard (EPA)	DTXSID5049021 ;
ECHA InfoCard	100.043.689
Chemical and physical data
Formula	C28H27ClF5NO
Molar mass	523.965 g·mol−1
3D model (JSmol)	Interactive image;
	SMILES FC(F)(F)c1c(Cl)ccc(c1)C4(O)CCN(CCCC(c2ccc(F)cc2)c3ccc(F)cc3)CC4;
	InChI InChI=1S/C28H27ClF5NO/c29-26-12-7-21(18-25(26)28(32,33)34)27(36)13-16-35(17-14-27)15-1-2-24(19-3-8-22(30)9-4-19)20-5-10-23(31)11-6-20/h3-12,18,24,36H,1-2,13-17H2 ; Key:MDLAAYDRRZXJIF-UHFFFAOYSA-N ;
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Penfluridol (Semap, Micefal, Longoperidol) is a highly potent, first generation diphenylbutylpiperidine antipsychotic.^[1] It was discovered at Janssen Pharmaceutica in 1968.^[2] Related to other diphenylbutylpiperidine antipsychotics, pimozide and fluspirilene, penfluridol has an extremely long elimination half-life and its effects last for many days after single oral dose. Its antipsychotic potency, in terms of dose needed to produce comparable effects, is similar to both haloperidol and pimozide. It is only slightly sedative, but often causes extrapyramidal side-effects, such as akathisia, dyskinesiae and pseudo-Parkinsonism. Penfluridol is indicated for antipsychotic treatment of chronic schizophrenia and similar psychotic disorders, it is, however, like most typical antipsychotics, being increasingly replaced by the atypical antipsychotics. Due to its extremely long-lasting effects, it is often prescribed to be taken orally as tablets only once a week (q 7 days). The once-weekly dose is usually 10–60 mg. A 2006 systematic review examined the use of penfluridol for people with schizophrenia:

Penfluridol compared to typical antipsychotics (oral) for schizophrenia^[3]

Summary

Although there are shortcomings and gaps in the data, there appears to be enough overall consistency for different outcomes. The effectiveness and adverse effects profile of penfluridol are similar to other typical antipsychotics; both oral and depot. Furthermore, penfluridol is shown to be an adequate treatment option for people with schizophrenia, especially those who do not respond to oral medication on a daily basis and do not adapt well to depot drugs. One of the results favouring penfluridol was a lower drop out rate in medium term when compared to depot medications. It is also an option for people with long-term schizophrenia with residual psychotic symptoms who nevertheless need continuous use of antipsychotic medication. An additional benefit of penfluridol is that it is a low-cost intervention.^[3]

Outcome	Findings in words	Findings in numbers	Quality of evidence
Global state
No marked improvement (CGI) Follow-up: 3 to 12 months	Penfluridol does not clearly change the chance of experiencing 'no marked improvement' when compared with receiving typical antipsychotic drugs. These findings are based on data of low quality.	RR 0.92 (0.68 to 1.24)	Low
Global state - needing additional antipsychotic Follow-up: less than 3 months	There is no clear difference between people given penfluridol and those receiving typical antipsychotics. These findings are based on data of low quality.	RR 1.35 (0.90 to 2.01)	Low
Mental state
Average score (BPRS) Follow-up: 3 to 12 months	On average, people receiving penfluridol scored higher than people treated with typical antipsychotics (oral) but there was no clear difference between the groups and this finding is based on data of low quality. The meaning of this in day-to-day care is unclear.	MD 1.24 higher (4.4 lower to 6.88 higher)	Low
Adverse events
Needing antiparkinsonism medication Follow-up: less than 3 months	There is no clear difference between people given penfluridol and those receiving typical antipsychotics (oral). These findings are based on data of low quality.	RR 1.09 (0.61 to 1.97)	Low
Insomnia Follow-up: less than 3 months	There is no clear difference between people given penfluridol and those receiving typical antipsychotics (oral). These findings are based on data of low quality.	RR 1.07 (0.51 to 2.24)	Low
	No study reported any data on outcomes such as quality of life and information relating to time in services

References[]

^ van Praag HM, Schut T, Dols L, van Schilfgaarden R (December 1971). "Controlled trial of penfluridol in acute psychosis". British Medical Journal. 4 (5789): 710–3. doi:10.1136/bmj.4.5789.710. PMC 1799991. PMID 4943034.
^ Janssen PA, Niemegeers CJ, Schellekens KH, Lenaerts FM, Verbruggen FJ, Van Nueten JM, Schaper WK (July 1970). "The pharmacology of penfluridol (R 16341) a new potent and orally long-acting neuroleptic drug". European Journal of Pharmacology. 11 (2): 139–54. doi:10.1016/0014-2999(70)90043-9. PMID 5447800.
^ ^a ^b Soares BG, Lima MS (April 2006). "Penfluridol for schizophrenia". The Cochrane Database of Systematic Reviews. 2 (2): CD002923. doi:10.1002/14651858.CD002923.pub2. PMID 16625563.

v t Antipsychotics (N05A)
Typical	Butyrophenones: Benperidol Bromperidol Bromperidol decanoate Droperidol Haloperidol^# Haloperidol decanoate Moperone Pipamperone Spiperone Timiperone Trifluperidol Diphenylbutylpiperidines: Fluspirilene Penfluridol Pimozide Phenothiazines: Acepromazine Acetophenazine Butaperazine Carphenazine (carfenazine)^‡ Chlorpromazine Cyamemazine Dixyrazine Fluphenazine Fluphenazine decanoate Fluphenazine enanthate Levomepromazine (methotrimeprazine) Mesoridazine Perazine Periciazine Perphenazine BL-1020 Perphenazine decanoate Perphenazine enanthate Piperacetazine Pipotiazine Pipotiazine palmitate Pipotiazine undecylenate Prochlorperazine Promazine Sulforidazine Thiopropazate Thioproperazine Thioridazine Trifluoperazine Triflupromazine Thioxanthenes: Chlorprothixene Clopenthixol Clopenthixol decanoate Flupentixol Flupentixol decanoate Tiotixene (thiothixene) Zuclopenthixol Zuclopenthixol acetate Zuclopenthixol decanoate
Disputed	Benzamides: Amisulpride Levosulpiride Nemonapride Remoxipride^‡ Sulpiride Sultopride Tiapride Veralipride^‡ Butyrophenones: Melperone Tricyclics: Carpipramine Clocapramine Clorotepine Clotiapine Loxapine Mosapramine Oxyprothepin decanoate Others: Molindone
Atypical	Benzisoxazole/benzisothiazoles: Iloperidone Lurasidone Paliperidone Paliperidone palmitate Perospirone Risperidone^# Ziprasidone Butyrophenones: Lumateperone Phenylpiperazines/quinolinones: Aripiprazole Aripiprazole lauroxil Brilaroxazine^† Brexpiprazole Cariprazine Tricyclics: Asenapine Clozapine^# Olanzapine Quetiapine Zotepine Others: Blonanserin Pimavanserin Sertindole
Others	Monoamine-depleting agents: Oxypertine Reserpine Tetrabenazine Others/unknown: Azacyclonol
^#WHO-EM ^‡Withdrawn from market Clinical trials: ^†Phase III ^§Never to phase III

Penfluridol

See also[]

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