trifluoperazine

ROUTE	ONSET	PEAK	DURATION
PO	unknown	unknown	12–24 hr

Contraindicated in:

Hypersensitivity;
Cross-sensitivity with other phenothiazines may exist;
Angle-closure glaucoma;
Bone marrow depression;
Severe liver or cardiovascular disease;
Lactation: Lactation.

Use Cautiously in:

Diabetes mellitus;
Respiratory disease;
Prostatic hyperplasia;
CNS tumors;
Seizure disorder;
Intestinal obstruction;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Pedi: Children 6 yr (safety and effectiveness not established);
Geri: Dose recommended in older adults; risk of mortality in older adults treated for dementia-related psychosis.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, tachycardia

Derm: photosensitivity, pigment changes, rash

EENT: blurred vision, dry eyes, lens opacities

Endo: amenorrhea, galactorrhea

GI: constipation, anorexia, dry mouth, hepatitis, ileus

GU: urinary retention, priapism

Hemat: AGRANULOCYTOSIS, leukopenia

Metab: hyperthermia

Neuro: extrapyramidal reactions, sedation, NEUROLEPTIC MALIGNANT SYNDROME, tardive dyskinesia

Misc: allergic reactions

Interactions ⬆ ⬇

Drug-drug:

Additive hypotension with antihypertensives, acute ingestion of alcohol, or nitrates.
Additive CNS depression with other CNS depressants, including alcohol, antihistamines, opioids, sedative/hypnotics, and general anesthetics.
Additive anticholinergic effects with other drugs having anticholinergic properties, including antihistamines, antidepressants, other phenothiazines, quinidine, and disopyramide.
Acute encephalopathy may occur with lithium.
May ↓ the effectiveness of levodopa.
↑risk of agranulocytosis with antithyroid drugs.
Lithium↓ absorption and may ↑ risk of extrapyramidal reactions.

Route/Dosage ⬆ ⬇

PO (Adults ): Psychoses: 2–5 mg 1–2 times daily (up to 40 mg/day). Anxiety: 1–2 mg bid (not to exceed 6 mg/day or treatment longer than 12 wk).
PO (Children 6–12 yr): 1 mg once or twice daily (up to 15 mg/day).

Availability ⬆ ⬇

(Generic available)

Tablets: 1 mg; 2 mg; 5 mg; 10 mg; 20 mg

Assessment ⬆ ⬇

Assess mental status (orientation, mood, behavior) and degree of anxiety prior to and periodically during therapy.
Assess weight and BMI initially and throughout therapy.
Assess positive (hallucinations, delusions, agitation) and negative (social withdrawal) symptoms of schizophrenia.
Monitor BP (sitting, standing, lying), ECG, pulse, and respiratory rate prior to and frequently during the period of dosage adjustment. May cause Q-wave and T-wave changes in ECG.
Observe patient carefully when administering medication to ensure that medication is actually taken and not hoarded or cheeked.
Assess patient for level of sedation following administration.
Monitor intake and output ratios and daily weight. Notify health care provider if significant discrepancies occur.
Monitor patient for onset of akathisia (restlessness or desire to keep moving) and extrapyramidal side effects (parkinsonian: difficulty speaking or swallowing, loss of balance control, pill rolling of hands, mask-like face, shuffling gait, rigidity, tremors; and dystonic: muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs) every 2 mo during therapy and 8–12 wk after therapy has been discontinued. Notify health care professional if these symptoms occur, because reduction in dosage or discontinuation of medication may be necessary. Trihexyphenidyl, diphenhydramine, or benztropine may be used to control these symptoms. Benzodiazepines may alleviate akathisia.
Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue; excessive eye blinking). Notify health care professional immediately if these symptoms occur, because they may be irreversible.
Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, convulsions, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Notify health care professional immediately if these symptoms occur.
Monitor for symptoms related to hyperprolactinemia (menstrual abnormalities, galactorrhea, sexual dysfunction).

Lab Test Considerations:

CBC, liver function tests, and ocular examinations should be evaluated periodically during therapy. Obtain fasting blood glucose and cholesterol levels initially and throughout therapy. May cause ↓ hematocrit, hemoglobin, leukocytes, granulocytes, platelets. May cause ↑ bilirubin, AST, ALT, and alkaline phosphatase. Agranulocytosis occurs at 4–10 wk of therapy, with recovery 1–2 wk following discontinuation. May recur if medication is restarted. Liver function abnormalities may require discontinuation of therapy.
- May cause false-positive or false-negative pregnancy test results and false-positive urine bilirubin test results.
- Monitor serum prolactin prior to and periodically during therapy. May cause ↑ serum prolactin levels.

Implementation ⬆ ⬇

PO: Administer oral doses with food, water, or milk to minimize GI irritation. Tablets may be crushed and mixed with food or fluids for patients with difficulty swallowing.

Patient/Family Teaching ⬆ ⬇

Advise patient to take medication as directed and not to skip doses or double up on missed doses. Take missed doses as soon as remembered unless almost time for the next dose. If more than 2 doses a day are ordered, the missed dose should be taken within 1 hr of the scheduled time or omitted. Abrupt withdrawal may lead to gastritis, nausea, vomiting, dizziness, headache, tachycardia, and insomnia.
Inform patient of possibility of extrapyramidal symptoms and tardive dyskinesia. Instruct patient to report these symptoms immediately to health care provider.
May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Advise patient to make position changes slowly to minimize orthostatic hypotension.
Advise patient to use sunscreen and protective clothing when exposed to the sun to prevent photosensitivity reactions. Extremes in temperature should also be avoided, because this drug impairs body temperature regulation.
Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.
Instruct patient to use frequent mouth rinses, good oral hygiene, and sugarless gum or candy to minimize dry mouth. Consult health care professional if dry mouth continues for >2 wk.
Advise patient that increasing activity and bulk and fluids in the diet helps minimize the constipating effects of this medication.
Inform patient that this medication may turn urine pink to reddish brown.
Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
Instruct patient to notify health care professional promptly if sore throat, fever, unusual bleeding or bruising, rash, weakness, tremors, visual disturbances, dark-colored urine, or clay-colored stools occur.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy. Monitor neonates exposed to trifluoperazine during the 3rd trimester of pregnancy for extrapyramidal and/or withdrawal symptoms following delivery. There have been reports of agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorders in these neonates.
Emphasize the importance of routine follow-up examinations to monitor response to medication and detect side effects. Periodic ocular examinations are indicated.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇