Trifluoperazine

Clinical data
Trade names	Eskazinyl, Eskazine, Jatroneural, others
AHFS/Drugs.com	Monograph
MedlinePlus	a682121
Pregnancy category	AU: C US: C (Risk not ruled out)
Routes of administration	By mouth, IM
ATC code	N05AB06 (WHO)
Legal status
Legal status	UK: POM (Prescription only) US: ℞-only
Pharmacokinetic data
Metabolism	Liver
Elimination half-life	10–20 hours
Identifiers
IUPAC name 10-[3-(4-methylpiperazin-1-yl)propyl]- 2-(trifluoromethyl)-10H-phenothiazine
CAS Number	117-89-5 Y
PubChem CID	5566
IUPHAR/BPS	214
DrugBank	DB00831 Y
ChemSpider	5365 Y
UNII	214IZI85K3
ChEBI	CHEBI:45951 Y
ChEMBL	ChEMBL422 Y
PDB ligand	TFP (PDBe, RCSB PDB)
ECHA InfoCard	100.003.837
Chemical and physical data
Formula	C21H24F3N3S
Molar mass	407.497 g/mol
3D model (JSmol)	Interactive image
SMILES FC(F)(F)c2cc1N(c3c(Sc1cc2)cccc3)CCCN4CCN(C)CC4
InChI InChI=1S/C21H24F3N3S/c1-25-11-13-26(14-12-25)9-4-10-27-17-5-2-3-6-19(17)28-20-8-7-16(15-18(20)27)21(22,23)24/h2-3,5-8,15H,4,9-14H2,1H3 Y Key:ZEWQUBUPAILYHI-UHFFFAOYSA-N Y
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Trifluoperazine, sold under a number of brand names, is a typical antipsychotic primarily used to treat schizophrenia.^[1] It may also be used short term in those with generalized anxiety disorder but is less preferred to benzodiazepines.^[1] It is of the phenothiazine chemical class.

Medical uses[edit]

Schizophrenia[edit]

Trifluoperazine is an effective antipsychotic for people with schizophrenia.^[2] There is low-quality evidence that trifluoperazine increases the chance of being improved when compared to placebo when people are followed up for 19 weeks.^[2] There is low-quality evidence that trifluoperazine reduces the risk of relapse when compared with placebo when people are followed for 5 months.^[2] As of 2014 there was no good evidence for a difference between trifluoperazine and placebo with respect to the risk of experiencing intensified symptoms over a 16-week period nor in reducing significant agitation or distress.^[2]

There is no good evidence that trifluoperazine is more effective for schizophrenia than lower-potency antipsychotics like chlorpromazine, chlorprothixene, thioridazine and levomepromazine, but trifluoperazine appears to cause more adverse effects than these drugs.^[3]

Other[edit]

It appears to be effective for people with generalized anxiety disorder but the benefit–risk ratio was unclear as of 2005.^[4]

Side effects[edit]

Its use in many parts of the world has declined because of highly frequent and severe early and late tardive dyskinesia, a type of extrapyramidal symptom. The annual development rate of tardive dyskinesia may be as high as 4%.^{[citation needed]}

A 2004 meta-analysis of the studies on trifluoperazine found that it is more likely than placebo to cause extrapyramidal side effects such as akathisia, dystonia, and Parkinsonism.^[5] It is also more likely to cause somnolence and anticholinergic side effects such as red eye and xerostomia (dry mouth).^[5] All antipsychotics can cause the rare and sometimes fatal neuroleptic malignant syndrome.^[6] Trifluoperazine can lower the seizure threshold.^[7] The antimuscarinic action of trifluoperazine can cause excessive dilation of the pupils (mydriasis), which increases the chances of patients with hyperopia developing glaucoma.^[8]

Contraindications[edit]

Trifluoperazine is contraindicated in CNS depression, coma, and blood dyscrasias. Trifluoperazine should be used with caution in patients suffering from renal or hepatic impairment.

Pharmacology[edit]

Trifluoperazine has central antiadrenergic,^[9]antidopaminergic,^[10][11] and minimal anticholinergic effects.^[12] It is believed to work by blockading dopamine D₁ and D₂ receptors in the mesocortical and mesolimbic pathways, relieving or minimizing such symptoms of schizophrenia as hallucinations, delusions, and disorganized thought and speech.^[5]

Names[edit]

Brand names include Eskazinyl, Eskazine, Jatroneural, Modalina, Stelazine, Terfluzine, Trifluoperaz, Triftazin.

In the United Kingdom and some other countries, trifluoperazine is sold and marketed under the brand 'Stelazine'.

The drug is sold as tablet, liquid and 'Trifluoperazine-injectable USP' for deep intramuscular short-term use.
GP studying pharmacological data has indicated cases of neck vertebrae irreversible fusing leading to NHS preparations being predominantly of the liquid form trifluoperazine as opposed to the tablet form as in Stela zine etc.

In the past, trifluoperazine was used in fixed combinations with the MAO inhibitor (antidepressant) tranylcypromine (tranylcypromine/trifluoperazine) to attenuate the strong stimulating effects of this antidepressant. This combination was sold under the brand name Jatrosom N. Likewise a combination with amobarbital (potent sedative/hypnotic agent) for the amelioration of psychoneurosis and insomnia existed under the brand name Jalonac. In Italy the first combination is still available, sold under the brand name Parmodalin (10 mg of tranylcypromine and 1 mg of trifluoperazine).

References[edit]