Trifluoperazine

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Trifluoperazine
185px
Systematic (IUPAC) name
10-[3-(4-methylpiperazin-1-yl)propyl]-
2-(trifluoromethyl)-10H-phenothiazine
Clinical data
Pregnancy
category
  • AU: C
  • US: C (Risk not ruled out)
Routes of
administration
oral, IM
Legal status
Legal status
Pharmacokinetic data
Metabolism Hepatic
Biological half-life 10–20 hours
Identifiers
CAS Number 117-89-5
ATC code N05AB06 (WHO)
PubChem CID 5566
IUPHAR/BPS 214
DrugBank DB00831
Chemical data
Formula C21H24F3N3S
Molar mass 407.497[[Script error: No such module "String".]]
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Trifluoperazine (Eskazinyl, Eskazine, Jatroneural, Modalina, Stelazine, Terfluzine, Trifluoperaz, Triftazin) is a typical antipsychotic of the phenothiazine chemical class.

Uses

The primary indication of trifluoperazine is schizophrenia. Other official indications may vary country by country, but generally it is also indicated for use in agitation and patients with behavioural problems, severe nausea and vomiting as well as severe anxiety. 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 2006 study suggested that trifluoperazine may be able to reverse addiction to opioids.[1]

A multi-year UK study by the Alzheimer's Research Trust suggested that this and other antipsychotic drugs commonly given to Alzheimer's patients with mild behavioural problems often make their condition worse.[2] The study concluded that

For most patients with AD, withdrawal of neuroleptics had no overall detrimental effect on functional and cognitive status and by some measures improved functional and cognitive status. Neuroleptics may have some value in the maintenance treatment of more severe neuropsychiatric symptoms, but this possibility must be weighed against the unwanted effects of therapy. The current study helps to inform a clinical management strategy for current practice, but the considerable risks of maintenance therapy highlight the urgency of further work to find, develop, and implement safer and more effective treatment approaches for neuropsychiatric symptoms in people with AD.

Pharmacology

Trifluoperazine has central antiadrenergic,[3] antidopaminergic,[4][5] and minimal anticholinergic effects.[6] 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.[7]

Side effects

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.[7] It is also more likely to cause somnolence and anticholinergic side effects such as blurred vision and xerostomia (dry mouth).[7] All phenothiazines can cause the rare and sometimes fatal neuroleptic malignant syndrome.[8] Trifluoperazine can lower the seizure threshold.[9] The antimuscarinic action of trifluoperazine can cause excessive dilation of the pupils (mydriasis), which increases the chances of patients with hyperopia developing glaucoma.[10]

Contraindications

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

Formulations

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.

In the past, trifluoperazine was used in fixed combinations with the MAO inhibitor (antidepressant) tranylcypromine 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. Both combinations are not available any longer.

In Italy the first combination is still available, sold under the brand name Parmodalin (10mg of Tranylcypromine and 1mg of Trifluoperazine).

References

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fr:Trifluopérazine

ru:Трифлуоперазин

sv:Trifluoperazin
  1. Tang L, Shukla PK, Wang ZJ (2006). "Trifluoperazine, an orally available clinically used drug, disrupts opioid antinociceptive tolerance". Neuroscience Letters. 397 (1–2): 1–4. doi:10.1016/j.neulet.2005.11.050. PMID 16380209. Lay summaryScienceDaily (2006-02-13). 
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  5. Creese I, Burt DR, Snyder SH (1996). "Dopamine receptor binding predicts clinical and pharmacological potencies of antischizophrenic drugs". The Journal of Neuropsychiatry and Clinical Neurosciences. 8 (2): 223–6. doi:10.1126/science.3854. PMID 9081563. 
  6. Ebadi, Manuchair S (1998). "Trifluoperazine Hydrochloride". CRC desk reference of clinical pharmacology (illustrated ed.). CRC Press. ISBN 978-0-8493-9683-0. Retrieved 2009-06-21. 
  7. 7.0 7.1 7.2 Marques LO, Lima MS, Soares BG (2004). "Trifluoperazine for schizophrenia". Cochrane Database of Systematic Reviews (Online) (1): CD003545. doi:10.1002/14651858.CD003545.pub2. PMID 14974020. 
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