Fluphenazine + Nortriptyline: Brands, Price & Uses in Bangladesh

Fluphenazine + Nortriptyline is a fixed-dose combination of a phenothiazine antipsychotic (fluphenazine) and a tricyclic antidepressant (nortriptyline), marketed in some countries, including Bangladesh, for short-term symptomatic management of mixed anxiety-depressive states. It is not an FDA-approved product in the United States, and its use should be guided by a registered physician's assessment of the individual patient.

Regionally labeled use (combination product)

• Mild to moderate mixed anxiety and depression, particularly where anxiety and depressive symptoms occur together.
• Emotional disturbance associated with depressive symptoms, including associated sleep disturbance.
• Psychosomatic complaints (e.g., functional gastric symptoms) occurring in the context of mixed anxiety-depression, as an adjunct to overall management.

Evidence from individual components

• Nortriptyline alone is established for relief of symptoms of major depressive disorder.
• Fluphenazine alone is established for management of manifestations of psychotic disorders.

Because this is an older fixed combination, it is generally reserved for cases where combination therapy is specifically judged appropriate rather than used as first-line treatment; single-agent therapy is preferred first-line in most current guidelines for depression and anxiety.

Dosage of Fluphenazine + Nortriptyline must be individualized by a registered physician based on symptom severity and response.

Tablets should be swallowed whole, with or without food, as directed by the prescriber. Treatment should be reviewed periodically; abrupt discontinuation after prolonged use should be avoided and should instead be tapered under medical supervision.

Because Fluphenazine + Nortriptyline combines an antipsychotic and a tricyclic antidepressant, side effects reflect both components.

• Central nervous system: Sedation, drowsiness, extrapyramidal symptoms (tremor, rigidity, akathisia, dystonia), and with prolonged use, tardive dyskinesia (potentially irreversible).
• Anticholinergic: Dry mouth, blurred vision, constipation, urinary retention, confusion (especially in the elderly).
• Cardiovascular: Orthostatic hypotension, tachycardia, and cardiac conduction changes.
• Metabolic/Endocrine: Weight gain, amenorrhea, galactorrhea, sexual dysfunction.
• Rare but serious: Neuroleptic malignant syndrome, agranulocytosis/blood dyscrasia, and (rarely) sudden death - seek immediate medical attention if these occur.