Nurses Compass
Drug Guide
Triflupromazine Hydrochloride
Classification
Therapeutic: Antipsychotic, typical (first-generation antipsychotic)
Pharmacological: Phenothiazine class
FDA Approved Indications
- Schizophrenia
- Other psychotic disorders
Mechanism of Action
Triflupromazine works by antagonizing dopamine D2 receptors in the brain, leading to a reduction in psychotic symptoms. It also possesses antihistaminic, anticholinergic, and antiadrenergic properties.
Dosage and Administration
Adult: Dosage varies; typically 25-75 mg/day in divided doses, adjusted based on response and tolerability.
Pediatric: Use in children is limited; dosing should be individualized and monitored closely.
Geriatric: Start at lower doses due to increased sensitivity; monitor for extrapyramidal symptoms and sedation.
Renal Impairment: Use with caution; no specific adjustments established, monitor closely.
Hepatic Impairment: Use with caution; consider dose reduction and close monitoring.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed, crosses the blood-brain barrier.
Metabolism: Extensively metabolized in the liver via oxidative pathways.
Excretion: Excreted mainly in urine as metabolites; some fecal excretion.
Half Life: Approximately 20-30 hours.
Contraindications
- Known hypersensitivity to phenothiazines or other components
- Coma
- Bone marrow suppression
Precautions
- History of seizure disorders
- Cardiovascular diseases
- Leukopenia or blood dyscrasias
- Pregnancy category C; use only if potential benefit justifies risk
- Lactation: Caution; may pass into breast milk
Adverse Reactions - Common
- Sedation (Common)
- Dizziness (Common)
- Dry mouth (Common)
- Orthostatic hypotension (Common)
Adverse Reactions - Serious
- Extrapyramidal symptoms (EPS) (Serious)
- Tardive dyskinesia (Serious)
- Neuroleptic malignant syndrome (NMS) (Serious)
- Blood dyscrasias (Serious)
- QT prolongation / arrhythmias (Serious)
Drug-Drug Interactions
- CNS depressants (additive sedative effects)
- Other QT-prolonging agents
- Anticholinergic drugs (potentiation of anticholinergic side effects)
Drug-Food Interactions
- Caution with alcohol, which may increase sedation and risk of hypotension
Drug-Herb Interactions
- No well-documented interactions; caution with herbal products affecting CYP enzymes
Nursing Implications
Assessment: Monitor mental status, blood pressure, signs of EPS, and cardiac rhythm.
Diagnoses:
- Risk of movement disorders
- Risk for falls
- Potential for sedation
Implementation: Administer with meals to reduce GI upset; monitor for side effects.
Evaluation: Assess effectiveness in symptom control; monitor for adverse reactions.
Patient/Family Teaching
- Take medication exactly as prescribed; do not stop abruptly.
- Rise slowly to minimize orthostatic hypotension.
- Report signs of EPS, NMS, or unusual movements promptly.
- Avoid alcohol and depressants.
Special Considerations
Black Box Warnings:
- Elderly patients with dementia-related psychosis are at increased risk of death.
Genetic Factors: CYP2D6 activity may influence drug metabolism; poor metabolizers may experience increased effects.
Lab Test Interference: None significant.
Overdose Management
Signs/Symptoms: Sedation, hypotension, extrapyramidal symptoms, QT prolongation, coma.
Treatment: Supportive care; administer activated charcoal if early; manage hypotension with fluids, treat arrhythmias; consider physostigmine for anticholinergic toxicity under specialist guidance.
Storage and Handling
Storage: Store at room temperature away from light and moisture.
Stability: Stable under recommended storage conditions; check expiration date.