Clinical Overview
Trifluoperazine is a high-potency typical antipsychotic indicated for schizophrenia and other psychotic disorders. As a phenothiazine derivative, it has strong dopamine-blocking activity with relatively less sedation than low-potency antipsychotics, but higher risk of extrapyramidal side effects. It may also be used for severe anxiety in some cases.
Primary Clinical Applications
Trifluoperazine is indicated for the treatment of schizophrenia and other psychotic disorders. It may also be used for severe anxiety when other treatments are ineffective, though this is less common with the availability of safer alternatives. Its high potency makes it effective for positive symptoms of psychosis.
Mechanism and Clinical Profile
Trifluoperazine blocks dopamine D2 receptors in the brain, particularly in the mesolimbic pathway, providing antipsychotic effects. As a high-potency typical antipsychotic, it has strong dopamine blockade with less antihistaminergic and alpha-adrenergic activity, resulting in less sedation but higher risk of movement disorders.
Clinical Considerations
While effective for psychotic symptoms, trifluoperazine has a high incidence of extrapyramidal side effects including dystonia, akathisia, and parkinsonism. Long-term use carries risk of tardive dyskinesia. The medication has largely been superseded by atypical antipsychotics due to better tolerability profiles, but may still be used when other treatments fail or are not available.
Prescribing Information
Dosing & Administration
Schizophrenia – Adults (Outpatients):
- Initial: 2-5 mg twice daily
- Range: 15-20 mg daily in divided doses
- Maximum: 40 mg daily
Schizophrenia – Adults (Hospitalized):
- Initial: 5 mg twice daily
- Range: 15-40 mg daily
- Maximum: 40 mg daily (some patients may need higher doses)
Anxiety (short-term):
- Dose: 1-2 mg twice daily
- Maximum: 6 mg daily
- Duration: Should not exceed 12 weeks
Elderly:
- Initial: 1-2 mg daily
- Titrate slowly based on response and tolerance
Administration:
- Divide daily dose into 2-3 administrations
- Take with food to reduce GI upset
- Consistent timing each day
Indications
- Treatment of schizophrenia
- Treatment of other psychotic disorders
- Short-term treatment of severe anxiety (when other treatments inadequate)
Contraindications
- Hypersensitivity to phenothiazines
- Severe CNS depression or comatose states
- Blood dyscrasias
- Liver damage
- Subcortical brain damage
Warnings & Precautions
- Boxed Warning: Increased mortality in elderly patients with dementia-related psychosis
- Extrapyramidal symptoms: High incidence with high-potency antipsychotics
- Tardive dyskinesia: Risk increases with duration of treatment
- Neuroleptic malignant syndrome: Rare but potentially fatal
- QT prolongation: Monitor ECG in patients with cardiac risk factors
- Hypotension: Particularly with parenteral administration
- Seizure threshold: May be lowered
Drug Interactions
- CNS depressants: Enhanced sedation and respiratory depression
- Anticholinergics: Increased anticholinergic effects
- Lithium: Increased risk of extrapyramidal symptoms and neurotoxicity
- QT-prolonging drugs: Additive cardiac effects
- Antihypertensives: Enhanced hypotensive effects
Adverse Reactions
Common:
- Extrapyramidal symptoms (dystonia, akathisia, parkinsonism)
- Drowsiness, dizziness, dry mouth, constipation
Serious:
- Tardive dyskinesia, neuroleptic malignant syndrome
- Agranulocytosis, liver toxicity
- QT prolongation, sudden death (rare)
Special Populations
- Elderly: Increased mortality risk in dementia-related psychosis
- Hepatic Impairment: Use with caution, may require dose reduction
- Pregnancy: Category C – use only if benefits outweigh risks
- EPS monitoring: Regular assessment for movement disorders
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.
