Nurses Compass
Drug Guide
Triflupromazine
Classification
Therapeutic: Antipsychotic, typical (phenothiazine derivative)
Pharmacological: Dopamine receptor antagonist
FDA Approved Indications
- Schizophrenia
- Nausea and vomiting (off-label)
Mechanism of Action
Blocks dopamine D2 receptors in the brain, reducing hallucinations, delusions, and nausea.
Dosage and Administration
Adult: Dosage varies based on condition; typically 25-50 mg 2-3 times daily, adjustable based on response.
Pediatric: Use is not well-established; consult specific guidelines.
Geriatric: Start at lower doses due to increased sensitivity; monitor closely.
Renal Impairment: Adjust dose as necessary; consult clinician.
Hepatic Impairment: Use with caution; monitor for increased effects.
Pharmacokinetics
Absorption: Well absorbed from gastrointestinal tract.
Distribution: Wide distribution; crosses blood-brain barrier.
Metabolism: Hepatic via CYP enzymes.
Excretion: Primarily renal.
Half Life: Approximately 10-20 hours, varies among individuals.
Contraindications
- Comatose states
- Bone marrow suppression
- Known hypersensitivity to phenothiazines
Precautions
- Use with caution in elderly, those with cardiovascular disease, those with Parkinson's disease, or history of seizure disorders.
Adverse Reactions - Common
- Sedation (Common)
- Dry mouth (Common)
- Dizziness (Common)
Adverse Reactions - Serious
- Extrapyramidal symptoms (EPS) (Less common)
- Neuroleptic malignant syndrome (NMS) (Rare)
- QT prolongation and arrhythmias (Rare)
Drug-Drug Interactions
- CNS depressants
- Levodopa and dopamine agonists (antagonistic effects)
- Other drugs prolonging QT interval
Drug-Food Interactions
- Alcohol may enhance sedative effects
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor mental status, extrapyramidal symptoms, cardiovascular status.
Diagnoses:
- Risk for falls due to sedation or orthostatic hypotension.
- Impaired physical mobility due to EPS.
Implementation: Administer with meals to decrease GI effects; monitor for side effects.
Evaluation: Assess therapeutic response and side effects regularly.
Patient/Family Teaching
- Advise to avoid alcohol and CNS depressants.
- Report any signs of EPS, NMS, or allergic reactions.
- Explain the importance of adherence and regular follow-up.
Special Considerations
Black Box Warnings:
- Increase the risk of death in elderly patients with dementia-related psychosis.
Genetic Factors: Patients with CYP2D6 poor metabolizer status may experience increased plasma levels.
Lab Test Interference: May cause false-positive for certain drug screens.
Overdose Management
Signs/Symptoms: Excess sedation, hypotension, extrapyramidal symptoms, coma.
Treatment: Supportive care, activated charcoal if within a short time of ingestion, symptomatic management, and potentially IV fluids and medications for severe reactions.
Storage and Handling
Storage: Store at room temperature away from light and moisture.
Stability: Stable under recommended conditions.