Medication Information:
Trifluoperazine (generic) - Stelazine (brand)

Classification: High-potency phenothiazine antipsychotic
Common Usage: To reduce the symptoms of psychotic disorders. It also has been used for the short-term treatment of severe vomiting and for severe generalized anxiety disorder.

Important Side Effects: Most people given trifluoperazine will be drowsy after the first few doses, but this subsides with continued use. Taking the entire dose of trifluoperazine at bedtime is usually as effective as taking several daily doses, and can improve sleep and reduce sedation during the day. Some people may feel dizzy upon standing due to a drop in blood pressure. If you become dizzy, sit or lay down immediately and the dizziness should go away. Standing up slowly will reduce this problem in most people.

Trifluoperazine can cause dry mouth, blurry near vision, constipation, and occasionally a rapid heart rate. These side effects also can occur from other medications your doctor might prescribe to reduce movement disorders that trifluoperazine may cause. Sucking on sugarless candy or using artificial saliva, available at a pharmacy, can reduce dry mouth. Constipation can be relieved by drinking more water, exercising regularly and eating a high-fiber diet (whole grains and fruit, for example). If this isn’t effective ask your pharmacist for a stool softener or bulk-forming laxative.

Several types of movement disorders, sometimes called extrapyramidal symptoms or "BPS," are associated with the use of trifluoperazine. While common, they are rarely severe. Always bring this to the attention of the prescriber. Akathisia, is a feeling of restlessness, jumpiness, or the need to keep moving. It increases with the dose of trifluoperazine. Dystonias are severe muscle spasms of the neck, eyes, or other muscles. They occur within the first week of use or dose change and are rapidly treated with medications that can be given by injection, if needed. If you begin to have difficulty breathing, get medical assistance immediately. Younger people are more likely to have dystonias than older people, especially if large doses are started once daily instead of split up into several smaller doses.

Parkinsonism or pseudoparkinsonian symptoms may occur on trifluoperazine as well. Symptoms include trembling or shaking of the hands and fingers, difficulty speaking or swallowing, loss of balance, shuffling walk or stiffness in the arms or legs. These symptoms are more likely to occur in older people. Tardive dyskinesia is a movement disorder that causes jerky or writhing movements in the arms or legs or mouth movements, and is more common in the elderly or in patients without schizophrenia.

A very rare condition called neuroleptic malignant syndrome (NMS) can cause severe muscle rigidity, high fever, altered mental status, irregular or rapid pulse, and other problems. If untreated, it is sometimes fatal. Seek medical attention if any of these symptoms last more than a couple of hours. Always use a sunblock (SPF 15 or greater) as trifluoperazine can cause rapid sunburn and altered body temperature regulation. Avoid excessively hot or cold places, and drink plenty of water.

Sore or enlarged breasts may occur in men or women on trifluoperazine, as can lack of menstruation in women, lack of interest in sex, or failure to achieve orgasm. If you are

pregnant or plan to become pregnant, you should discuss this with all of your health care providers in advance. Avoid skin contact with the oral solution or broken tablets, as it may cause a rash. This is not a complete list of all known or potential adverse effects. Notify’ your prescriber or pharmacist of any symptoms that concern you that have started since taking this medication, changing its dose, or adding or changing another medication. Take care when performing any task (such as driving a car) that requires your attention, until you have experience with trifluoperazine and are confident you can perform the task safely.

Interactions with Other Medications: Many medications may interact with trifluoperazine. For example, medications for high blood pressure may worsen the dizziness when standing up. Phenobarbital (Luminal) or carbamazepine (Tegretol) can decrease the blood level of trifluoperazine. Conversely, antibiotics such as erythromycin (E-Mycin) can increase trifluoperazine levels. Alcohol may worsen the sedation and unsteadiness from trifluoperazine and make the original problem harder to treat. This is not a complete list of all known or potential drug interactions. To help prevent problems, always make sure your pharmacist and prescribers know about all medications you are taking, including over-the-counter drugs, and any dietary herbal supplements.

Common Dosages: The starting dose for adolescents and adults with psychotic disorders is 2 to 5 mg twice daily, with an optimum dose of 10 to 20 mg daily. Some people may need as much as 40 mg daily for severe psychosis. The starting dose for children with psychosis is 1 mg once or twice daily. If this drug is started after conventional anti-anxiety agents fail, the starting dose in adults for nonpsychotic anxiety is 1 to 2 mg twice daily, with an optimum dosage of 6 mg daily for no more than 12 weeks. If you forget to take a dose, take it when you remember.

Identification: Trifluoperazine is available in 1 mg, 2 mg, 5 mg, and 10 mg tablets, and in an oral solution at a concentration of 10 mg/mL. The oral solution should always be diluted in at least 4 ounces (120 mL) of juice to mask the bitter taste. The drug also is available in a short-acting injectable form.

Storage: Store at normal room temperature (590 F to 860 F) in a tightly closed, lightand moisture-resistant container. Keep out of direct sunlight and avoid storing in a warm and humid area, such as the bathroom or kitchen, to prevent deterioration. Keep all medications out of the reach of children to prevent accidental poisoning. Do not take an expired medication. Do not transfer medication from one container to another. Carefully discard discontinued medication where children cannot find it.

Edited by Stephen R. Sakiad, Pharm.D.

A SERVICE OF Psychopharmacology Update
Note: These guidelines are for general information only. For more specific information, consult your physician or pharmacist.