Trifluoperazine

Registered South African indications:

• Anxiety
• Nausea and vomiting
• Psychotic disorders

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Greatly depressed states due to central nervous system depressants
• Existing blood dyscrasias, bone marrow depression, and pre-existing liver damage
• Closed-angle glaucoma
• Diabetes mellitus
• Hyperthyroidism
• Prostatic hypertrophy
• Contraindicated in comatose patients, particularly those under the influence of alcohol, barbiturates, narcotics, and other CNS depressants
• Contraindicated in patients with bone-marrow depression
• Use with caution in patients with cardiovascular or respiratory disease, phaechromocytoma, or other conditions in which a sudden drop in blood pressure would be undesirable
• Use with caution in patients with existing tachycardia or cardiac insufficiency
• Use with caution in patients with liver dysfunction or a history of jaundice
• Use with care in patients with Parkinsonism
• Use with caution in extremes of temperature due to impairment of the body’s temperature-regulating mechanism
• Patients should be examined periodically for abnormal skin pigmentation or eye changes
• Pregnancy
• Breastfeeding

Cautions

• Renal impairment 
• Elderly
• Cardiovascular disease
• Arrhythmia
• Angina pectoris
• Family history of QT prolongation
• Jaundice with a phenothiazine
• Epilepsy
• Myasthenia gravis
• Prostatic hypertrophy
• Risk factors for stroke
• Risk factors for venous thromboembolism
• Abrupt withdrawal
• Dementia
• May impair ability to drive and operate machinery 

Forms avail. in SA and covered in this monograph: tab

Anxiety
Nausea and vomiting

• Oral (tab): Initial: 1-2mg, 12hrly; Titrate gradually according to response; Max: 6mg/24hrs

Treatment duration for anxiety should not exceed 12 weeks

Psychotic disorders
- Acute and chronic schizophrenia
- Psychosis due to organic brain damage and toxic psychosis

• Oral (tab): Initial: 2-5mg, 12hrly; Titrate by 5mg, dly at intervals of 3 days; Maintenance: 15-20mg/day in divided doses

Once control has been achieved, dosage should be reduced gradually until an effective maintenance level has been established

Paed. forms avail. in SA and covered in this monograph: tab

Anxiety
Nausea and vomiting

Younger than 6 years

• Not established for use

Between 6 - 12 years

• Oral (tab): 1mg/20kg, dly; Max: 4mg/24hrs

Older than 12 years

• See adult dosages

Psychotic disorders
- Acute and chronic schizophrenia
- Psychosis due to organic brain damage and toxic psychosis

Younger than 6 years

• Not established for use

Between 6 - 12 years

• Oral (tab): Initial: 1mg, 12hrly; Uptitrate cautiously at intervals of 3 days; Max: 15mg/24hrs

Older than 12 years

• See adult dosages

Pregnancy

• Contraindicated

Breastfeeding

• Contraindicated

Renal Impairment

• Caution; no information available

Hepatic Impairment

• Contraindicated

Elderly

• Caution; dose adjustment recommended

Porphyria Information

• Probably not porphyrinogenic (PNP)

Central Nervous System Disorders

• Lassitude
• Drowsiness
• Dizziness
• Transient restlessness
• Insomnia
• Confusion
• Dullness
• Agitation
• Parkinsonism
• Akathisia
• Motor restlessness
• Acute dystonia
• Dyskinesia
• Tardive dyskinesia
• Neuroleptic malignant syndrome
• Neonatal withdrawal syndrome

Cardiovascular Disorders

• Mild postural hypotension
• Oedema
• Tachycardia
• Prolonged QT interval
• T wave changes
• Ventricular arrhythmias
• Cardiac arrest
• Torsades de pointes
• Pulmonary embolism
• Deep vein thrombosis

Gastrointestinal Disorders

• Dry mouth
• Anorexia
• Constipation

Hepatobiliary Disorders

• Mild cholestatic jaundice

Genitourinary Disorders

• Urinary hesitancy
• Urinary retention

Endocrine and Metabolic Disorders

• Increased weight
• Hyperprolactinaemia
• Galactorrhoea
• Amenorrhoea
• Gynaecomastia

Musculoskeletal Disorders

• Muscular weakness
• Torticollis
• Facial grimacing
• Trismus
• Tongue protrusion 

Skin and Subcutaneous Tissue Disorders

• Skin reactions
• Photosensitivity
• Skin pigmentation
• Lenticular opacities

Immune, Blood and Lymphatic System Disorders

• Hyperpyrexia
• Agranulocytosis
• Pancytopenia
• Leucopenia
• Thrombocytopenia

Sensory Disorders

• Blurred vision
• Oculogyric crises

• Barbiturates
• Narcotics
• Central nervous system depressants
• Antihypertensives or other agents with hypotensive activity
• Anticholinergics
• Antidepressants
• Levodopa
• Lithium
• Desferrioxamine
• Oral anticoagulants
• Antacids
• QT prolonging agents
• Agents causing electrolyte imbalances

Other interactions

• Alcohol

• Weight
• Height
• BMI
• Waist circumference
• Electrolytes
• Hepatic function
• Blood glucose
• HBA1C
• Lipid profile
• Ophthalmic examination

Specific cases may require

• Full blood count

• At Low dosage (1-2mg, 12hrly, with maximum 6mg/day): Trifluoperazine is indicated as an adjunct in the short-term management of anxiety states and in the symptomatic treatment of nausea and vomiting

• At High dosage (2-5mg, 12hrly, with maximum 15-20mg/day): Treatment of symptoms and prevention of relapse in schizophrenia and in other psychoses

Trifluoperazine is a typical antipsychotic which blocks dopamine D1 and D2 receptors in the mesolimbocortical and nigrostriatal regions of the brain. It is also thought to depress the reticular activating system, which results in its sedative and antiemetic effects.

Tablet 1mg 

• Stelazine (Litha) (Discontinued: 21/06/19)

Tablet 5mg 

• Stelazine (Litha) (Discontinued: 21/06/19)