Trifluoperazine HCl

A to Z Drug Facts

(try-flew-oh-PURR-uh-zeen HIGH-droe-KLOR-ide)

Stelazine, Stelazine Concentrate,  Apo-Trifluoperazine, Novo-Flurazine, Novo-Trifluzine, PMS-Trifluoperazine, Terfluzine

Class: Antipsychotic/phenothiazine

 Action Effects apparently related to dopamine receptor blocking in CNS.

 Indications Management of psychotic disorders, short-term treatment (< 12 wk) f nonpsychotic anxiety.

 Contraindications Sensitivity to phenothiazines; comatose or severely depressed states; resence of large amount of other CNS depressants; bone marrow depression or blood dyscrasias; liver disease; cerebral arteriosclerosis; coronary artery disease; severe hypotension or hypertension; subcortical brain damage.

 Route/Dosage

Individualize dose.

Psychotic Disorder

ADULTS: PO 2–5 mg bid initially. Maintenance: 15–20 mg/day in single or divided doses. Few patients may require ³ 40 mg/day. IM 1–2 mg by deep injection q 4–6 hr prn. More than 6 mg in 24 hr is rarely needed. CHILDREN: Individualize dosage based on weight of child and severity of symptoms. CHILDREN 6–12 YR: PO 1 mg qd or bid initially. Maintenance: Rarely > 15 mg/day in single or divided doses. IM 1 mg daily or bid.

Nonpsychotic Anxiety

ADULTS: PO 1–2 mg bid (maximum 6 mg/day).

 Interactions

Alcohol and other CNS depressants (eg, narcotics, sedatives): May result in increased CNS depression and may precipitate dystonic reactions. Anticholinergics: May reduce therapeutic effects of trifluoperazine and worsen anticholinergic effects of trifluoperazine. May lead to tardive dyskinesia. Barbiturate anesthetics: May increase frequency and severity of neuromuscular excitation and hypotension. Guanethidine: May inhibit hypotensive action of guanethidine. Metrizamide: Possibility of seizure may be increased when subarachnoid metrizamide injection is used.

 Lab Test Interferences Drug may discolor urine pink to red-brown. False-positive pregnancy tests may occur but are less likely to occur with serum test. Increases in protein-bound iodine have been reported.

 Adverse Reactions

CV: Orthostatic hypotension; tachycardia; syncope; cardiac arrest; irculatory collapse; lightheadedness; faintness; ECG changes. CNS: Headache; weakness; tremor; fatigue; slurring of speech; insomnia; sedation; ertigo; seizures; twitching; ataxia; tardive dyskinesia; drowsiness; lethargy; aradoxical excitement; pseudoparkinsonism; motor restlessness; oculogyric crises; opisthotonos; hyperreflexia; tardive dyskinesia. DERM: Photosensitivity; skin pigmentation; dry skin; exfoliative dermatitis; rticarial rash; maculopapular hypersensitivity reaction; seborrhea; contact dermatitis. EENT: Pigmentary retinopathy; glaucoma; photophobia; blurred vision; miosis; ydriasis; increased intraocular pressure; dry mouth or throat; nasal congestion. GI: Dyspepsia; constipation; adynamic ileus (may result in death). GU: Urinary hesitancy or retention; impotence; sexual dysfunction; menstrual irregularities. HEPA: Cholestatic jaundice. HEMA: Agranulocytosis; eosinophilia; leukopenia; hemolytic anemia; hrombocytopenic purpura. META: Decreased cholesterol. RESP: Laryngospasm; bronchospasm; shortness of breath. OTHER: Increases in appetite and weight; polydipsia; breast enlargement; galactorrhea; eat-illness; neuroleptic malignant syndrome.

 Precautions

Pregnancy: Pregnancy category undetermined. Lactation: Excreted in breast milk. Children: In general, not recommended for children < 12 yr. When drug is used in children with acute illnesses (eg, chickenpox, measles, gastroenteritis or dehydration), they are more susceptible to neuromuscular reactions than adults. Avoid use of drug in children and adolescents with signs and symptoms suggestive of Reye's syndrome. Elderly, debilitated or emaciated patients: More susceptible to hypotensive and neuromuscular effects. Require lower initial dosage and more gradual increase in dosage. Special risk patients: Use drug with caution in patients with cardiovascular disease or mitral insufficiency, history of glaucoma, EEG abnormalities or seizure disorders, prior brain damage, hepatic or renal impairment. CNS effects: Drug may impair mental or physical abilities, especially during first few days of therapy. Hepatic effects: Jaundice usually occurs between second and fourth weeks of treatment and is considered hypersensitivity reaction. Usually reversible. Neuroleptic malignant syndrome: Has occurred with agents in this class and is potentially fatal. Signs and symptoms are hyperpyrexia, muscle rigidity, altered mental status, irregular pulse, irregular BP, tachycardia and diaphoresis. Pulmonary effects: Cases of bronchopneumonia, some fatal, have occurred. Renal impairment: Use with caution, lower dose may be necessary. Sudden death: Has been reported. Predisposing factors may be seizures or previous brain damage. Flare-ups of psychotic behavior may precede death. Sulfite sensitivity: Some of these products contain sulfites, which may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible persons.

 Administration/Storage

• Administer at bedtime to minimize effects of sedation and orthostatic hypotension.
• Ensure that patient swallows medication and is not hoarding it.
• For IM administration, inject deeply into well-developed muscle.
• For concentrate, dilute just prior to administration. Add desired dose to 60 ml or more of following diluents: tomato or fruit juice, milk, simple syrup, orange syrup, carbonated beverages, decaffeinated coffee or tea or water. May also add dose to semisolid foods such as soups or puddings.
• Store liquid concentrates in amber bottles at room temperature and protect from light.
• Store tablets and injection at room temperature protected from light.
• Avoid freezing oral concentrate and injection.
• Slight yellowish discoloration of injection will not affect potency or efficacy.
• Do not use injection if markedly discolored.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess for high-risk factors (cardiac history, hepatic or renal impairment, neurologic damage).
• Inquire about patient's alcohol intake.
• Assess efficacy of antipsychotic response during initial dosing.
• Take BP measurements after IM injections of medication.
• Monitor patient carefully for acute neurologic changes after drug administration.
• Monitor for extrapyramidal symptoms.
• Periodically monitor hepatic function.
• Monitor renal function at start of therapy and periodically during therapy. If creatinine is abnormal, notify physician. Dosage adjustment may be necessary.
• Monitor WBC periodically. If significant drop in granulocytes occurs, dosage decrease or discontinuation of therapy may be necessary.
• If fever with flu-like symptoms occurs, obtain LFTs.

 Patient/Family Education

• Advise patient not to change dose unless instructed by physician.
• Instruct patient not to discontinue medication abruptly.
• Inform patient that urine may change to pink or redbrownish color.
• Advise female patients of possibility of false-positive urine pregnancy test results.
• Inform patient of possibility of yellowing of skin after several weeks of drug therapy.
• Instruct patient to report these symptoms to physician: abnormal movements, involuntary muscle twitching or jaundice.
• Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
• Instruct patient to avoid intake of alcoholic beverages.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
• Caution patient to minimize exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts