Trifluoperazine

Indications
 Oral
Psychoses
Adult: 2-5 mg bid gradually increased to 15-20 mg daily, or 40 mg daily in severe or resistant psychoses.
Child: Max: 5 mg daily in divided doses adjusted according to age, body weight and response.
Elderly: Initiate at lower dose and increase gradually.
Oral
Nausea and vomiting
Adult: 1-2 mg bid. Max 6 mg daily.
Child: 3-5 yrs: max 1 mg daily in divided doses; 6-12 yrs: max 4 mg daily.
Elderly: Initiate at lower dose and increase gradually.
Oral
Short-term management of anxiety
Adult: 1-2 mg bid. Max: 6 mg daily. Max duration: 12 wk.
Child: 3-5 yr: max 1 mg daily in divided doses; 6-12 yr: max 4 mg daily in divided doses.
Elderly: Initiate at lower dose and increase gradually.
Intramuscular
Acute psychosis
Adult: 1-2 mg by deep IM, repeated if necessary every 4-6 hr. Max: 6 mg daily.
Child: 1 mg by deep IM once or twice daily.
Elderly: Initiate at lower dose and increase gradually.
Contraindications
 Preexisting CNS depression and coma; bone marrow depression, blood dyscrasias, liver disease, hypersensitivity to phenothiazines, prolactin dependent tumours. Pregnancy (1st trimester), lactation.
Warnings / Precautions
 Cardiovascular disease, epilepsy, angle-closure glaucoma, exposure to extreme temperatures, elderly, parkinson's disease, myasthenia gravis, benign prostatic hyperplasia, DM, renal amd hepatic impairment. Discontinue trifluoperazine at least 48 hr before myelography and do not resume for at least 24 hr after procedure. Do not use trifluoperazine in control of nausea and vomiting occurring either prior to myelography or postprocedure with metrizamide. Pregnancy.
Adverse Reactions
 Drowsiness, dry mouth, blurred vision, dizziness, sedation, antimuscarinic affects, postural hypotension, akathisia, muscle weakness, anorexia, insomnia, rash, amenorrhoea, fatigue, increased prolactin levels, extrapyramidal side effects.
Potentially Fatal: Neuroleptic malignant syndrome, blood dyscrasias.
Overdose Reactions
 Symptoms: extrapyramidal side effects, CNS depression, somnolence, agitation, restlessness, convulsions, ECG changes, cardiac arrhythmias, fever, autonomic reactions such as hypotension, dry mouth and ileus. Management: Treatment is symptomatic and supportive. Maintain an open airway as dysphagia and respiratory difficulty may occur in severe overdosage. Gastric lavage may be performed. Do not induce emesis as dystonic reaction of the head or neck may develop and this may lead to aspiration of vomitus. Extrapyramidal symptoms may be treated with anti-parkinsonism drugs, barbiturates, or diphenhydramine hydrochloride. If pressor agents are required, norepinephrine bitartrate and phenylephrine HCl may be used but not epinephrine. This is because trifluoperazine may reverse the usual elevating action of these agents and cause a further drop in blood pressure. Haemodialysis is not likely to be useful.
Drug Interactions
 Increased CNS depression with CNS depressants such as opiates or other analgesics, barbiturates or other sedatives, general anaesthetics, or alcohol. Increased risk of side effects with drugs with antimuscarinic properties e.g. TCA, antiparkinsonian drugs. Antagonised effects of dopaminergic drugs such as levodopa. Increased risk of hypotension with antihypertensives, trazodone. Reverses antihypertensive effect of guanethidine. Increased risk of severe extrapyramidal side-effects or severe neurotoxicity with lithium. Possible decrease in absorption with antacids.
See Below for More trifluoperazine Drug Interactions
Mechanism of Actions
 Trifluoperazine inhibits dopamine D2 receptors in the brain. It has weak anticholinergic and sedative effects but strong extrapyramidal and antiemetic effects. It controls severely disturbed, agitated or violent behaviour but may also be used for nonpsychotic anxiety.
Absorption: Readily absorbed from GI tract. Peak plasma concentrations: 1.5-6 hr. Bioavailability: subject to interindividual variation.
Distribution: Protein binding: highly bound. Distributed into breast milk.
Excretion: Terminal half life: 22 hr.
Administration
 Should be taken with food.
Storage Conditions
 Oral: Store at 15-30°C
ATC Classification
 N05AB06 - trifluoperazine ; Belongs to the class of phenothiazine antipsychotics with piperazine structure.
Storage
 Oral: Store at 15-30°C
Available As
  • Trifluoperazine 1 mg
  • Trifluoperazine 1.5 mg
  • Trifluoperazine 10 mg
  • Trifluoperazine 2 mg
  • Trifluoperazine 2.5 mg
  • Trifluoperazine 5 mg

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