Nurses Compass
Drug Guide
Trifluoperazine Hydrochloride
Classification
Therapeutic: Antipsychotic, typical
Pharmacological: Phenothiazine antipsychotic
FDA Approved Indications
- Schizophrenia
- Short-term treatment of hyperactivity in children
Mechanism of Action
Trifluoperazine works by blocking dopamine receptors in the brain, particularly D2 receptors, reducing psychotic symptoms.
Dosage and Administration
Adult: Initial dose: 1-2 mg 2-3 times daily; titrate based on response, typically up to 10-15 mg daily in divided doses.
Pediatric: Use is primarily for behavioral disturbances; dosing varies, usually starting at 0.5-1 mg twice daily, titrated cautiously.
Geriatric: Start at lower doses (e.g., 0.5-1 mg daily) due to increased sensitivity and risk of adverse effects.
Renal Impairment: Adjust dosing as necessary; limited data, monitor closely.
Hepatic Impairment: Use with caution; dose adjustments may be necessary.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed, crosses blood-brain barrier.
Metabolism: Primarily hepatic via CYP450 enzymes.
Excretion: Renal and biliary pathways.
Half Life: Approximately 14-20 hours.
Contraindications
- Comcomitant use with other central nervous system depressants or Parkinson’s disease.
Precautions
- Use cautiously in elderly, Parkinson’s disease, seizure history, cardiac conduction abnormalities.
- Pregnancy category C; use only if clearly needed.
Adverse Reactions - Common
- Extrapyramidal symptoms (dystonia, Parkinsonism) (Common)
- Sedation (Common)
- Dizziness (Common)
- Dry mouth (Common)
Adverse Reactions - Serious
- Neuroleptic malignant syndrome (Rare)
- QT prolongation and arrhythmias (Rare)
- Blood dyscrasias (Rare)
Drug-Drug Interactions
- CNS depressants, anticholinergic drugs, other dopamine antagonists.
Drug-Food Interactions
- Alcohol may enhance sedative effects.
Drug-Herb Interactions
- Potential interactions with herbs affecting CYP450 enzymes.
Nursing Implications
Assessment: Monitor mental status, extrapyramidal symptoms, vital signs, and ECG (for QT prolongation).
Diagnoses:
- Risk for falls due to sedation or orthostatic hypotension.
- Risk of extrapyramidal symptoms.
Implementation: Administer with food to minimize GI irritation; observe for adverse effects; adjust dose as needed.
Evaluation: Assess therapeutic response and adverse effects regularly.
Patient/Family Teaching
- Avoid alcohol and other CNS depressants.
- Report any signs of abnormal movements, fever, or irregular heartbeat.
- Take medication exactly as prescribed.
Special Considerations
Black Box Warnings:
- Increase risk of death in elderly patients with dementia-related psychosis.
Genetic Factors: CYP450 polymorphisms may affect metabolism.
Lab Test Interference: May cause false-positive for urinary catecholamines.
Overdose Management
Signs/Symptoms: Sedation, hypotension, extrapyramidal symptoms, possibly coma.
Treatment: Supportive care, activated charcoal if ingestion is recent, vasopressors for hypotension, bromocriptine or diphenhydramine for extrapyramidal symptoms.
Storage and Handling
Storage: Store at room temperature, protected from light and moisture.
Stability: Stable for 2-3 years when stored properly.