Nurses Compass
Drug Guide
Piperacetazine
Classification
Therapeutic: Antipsychotic
Pharmacological: Phenothiazine derivative, typical antipsychotic
FDA Approved Indications
- Schizophrenia
Mechanism of Action
Piperacetazine works by antagonizing dopamine D2 receptors in the brain, reducing psychotic symptoms; it may also have antihistamine and anticholinergic effects.
Dosage and Administration
Adult: Dosage varies; typically 25-75 mg three times daily, titrated based on response and tolerance.
Pediatric: Not commonly used in pediatric patients; consult specific guidelines.
Geriatric: Start at lower doses due to increased sensitivity and risk of adverse effects.
Renal Impairment: Adjust dosage as needed; closely monitor.
Hepatic Impairment: Use caution; hepatic dosing adjustments may be necessary.
Pharmacokinetics
Absorption: Well absorbed after oral administration.
Distribution: Widely distributed, crosses blood-brain barrier.
Metabolism: Hepatic via CYP450 enzymes.
Excretion: Primarily in urine as metabolites.
Half Life: Approximately 10-20 hours.
Contraindications
- Comatose states, severe central nervous system depression, severe liver disease, hypersensitivity to phenothiazines.
Precautions
- Use cautiously in patients with cardiovascular disease, history of seizure, or intraocular pressure issues; monitor for EPS and tardive dyskinesia.
Adverse Reactions - Common
- Extrapyramidal symptoms (EPS) (Common)
- Drowsiness (Common)
- Weight gain (Common)
Adverse Reactions - Serious
- QT prolongation / arrhythmias (Serious)
- Neuroleptic malignant syndrome (NMS) (Serious)
- Agranulocytosis (Serious)
Drug-Drug Interactions
- Other CNS depressants, antihypertensives, drugs prolonging QT interval
Drug-Food Interactions
- Alcohol may enhance sedative effects.
Drug-Herb Interactions
- Use with caution: St. John’s Wort, valerian, kava (may increase sedation and risk of EPS).
Nursing Implications
Assessment: Monitor mental status, EPS signs, cardiac status (ECG), and blood counts.
Diagnoses:
- Risk for falls, risk for extrapyramidal side effects, risk for cardiac arrhythmias.
Implementation: Administer with food to minimize gastrointestinal upset; monitor for adverse effects.
Evaluation: Assess therapeutic response and adverse effects regularly.
Patient/Family Teaching
- Do not stop medication suddenly.
- Report signs of EPS, fever, sore throat, or signs of infection.
- Avoid alcohol and CNS depressants.
- Attend regular follow-up appointments.
Special Considerations
Black Box Warnings:
- Increased mortality in elderly patients with dementia-related psychosis.
Genetic Factors: Individual response may vary; consider genetic testing if indicated.
Lab Test Interference: May cause false positives in certain drug screening tests.
Overdose Management
Signs/Symptoms: Drowsiness, hypotension, extrapyramidal symptoms, potential coma.
Treatment: Supportive care, stabilize vital signs, activated charcoal if recent ingestion, and consider anticholinergic agents for EPS; dialysis generally not effective.
Storage and Handling
Storage: Store at room temperature, away from light and moisture.
Stability: Stable under recommended storage conditions for specified shelf life.