Trifluoperazine
STELAZINE
What it isD2-predominant phenothiazine antagonist; schizophrenia and short-term treatment of severe anxiety.
Why this oneCompared with low-potency phenothiazines, it causes less sedation, hypotension, and antimuscarinic toxicity.
What limits itAkathisia, parkinsonism, and tardive dyskinesia commonly limit use; photosensitivity and QT prolongation also matter.
FDA-approved for
- schizophrenia (~1959)
- anxiety (~1959)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Schizophrenia / psychotic disorders | Adults | 2–5 mg BID | 15–20 mg/day | 40 mg/day or more |
| Non-psychotic anxiety | Adults | 1–2 mg BID | — | 6 mg/day (≤12 weeks) |
| Psychotic disorders | Children 6–12 yr (hospitalized/supervised) | 1 mg QD–BID | — | 15 mg/day (higher in severe cases) |
Renal Undefined
Hepatic Contraindicated in pre-existing liver damage
Instructions
- Usually BID (long-acting); some patients maintained once daily
- Equivalent oral dose may replace IM once symptoms are controlled
- Use lowest effective dose; increase more gradually in debilitated/emaciated or elderly patients
Contraindications
- Comatose or greatly depressed states due to CNS depressants
- Existing blood dyscrasias or bone marrow depression
- Pre-existing liver damage
Cautions
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- Extrapyramidal symptoms: dystonia, akathisia, pseudo-parkinsonism
- Increased mortality in elderly with dementia-related psychosis
- Hypotension (sometimes fatal)
- Blood dyscrasias including agranulocytosis
- Seizures
- Hepatic effects (jaundice, biliary stasis)
- EKG/QT changes
- Photosensitivity and skin/ocular pigmentation with prolonged use
- Anticholinergic effects
Adverse reactions
- Drowsiness
- Dizziness
- Skin reactions/rash
- Dry mouth
- Insomnia
- Amenorrhea
- Fatigue
- Muscular weakness
- Anorexia
- Lactation/galactorrhea
- Blurred vision
- Extrapyramidal (neuromuscular) reactions
Pregnancy Undefined
Lactation Undefined
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Cost, est. cash$20–$1,500/dose or month
Generic entry1982
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.
Mechanism of action: Trifluoperazine ballicule
Open Trifluoperazine in the interactive console ↗
Memory aids: mascots and interaction avatars
Spooky greyscale mascot → high-potency first generation antipsychotic (FGA)
