TRIFLUOPERAZINE HYDROCHLORIDE

TRIFLUOPERAZINE HYDROCHLORIDE
(trye-floo-oh-per'a-zeen)
Novoflurazine

, Solazine

, Stelazine, Terfluzine

Classifications: psychotherapeutic; antipsychotic, phenothiazide;
Therapeutic: antipsychotic
Prototype: Chlorpromazine
Pregnancy Category: C

Availability

1 mg, 2 mg, 5 mg, 10 mg tablets; 10 mg/mL liquid; 2 mg/mL injection

Action

Phenothiazine with antipsychotic effects thought to be related to blockade of postsynaptic dopamine receptors in the brain.

Therapeutic Effect

Effectiveness indicated by increase in mental and physical activity. Strong antipsychotic drug with prolonged action.

Uses

Management of manifestations of psychotic disorders; "possibly effective" control of excessive anxiety and tension associated with neuroses or somatic conditions.

Contraindications

Hypersensitivity to phenothiazines or sulfites; comatose states; CNS depression; ethanol intoxication; blood dyscrasias; children <6 y; bone marrow depression; preexisting liver disease; pregnancy (category C), lactation.

Cautious Use

Previously detected breast cancer; history of QT prolongation; significant cardiac disease or pulmonary disease; compromised respiratory function; seizure disorders.

Route & Dosage

Psychotic Disorders
Adult: PO 1–2 mg b.i.d., may increase up to 20 mg/d in hospitalized patients IM 1–2 mg q4–6h (max: 10 mg/d)
Child: PO 6–12 y, 1 mg 1–2 times/d, may increase up to 15 mg/d in hospitalized patients IM 6–12 y, 1 mg 1–2 times/d, may increase up to 15 mg/d

Dementia Behavior
Geriatric: PO 0.5–1 mg 1–2 times/d, may increase q4–7d (max: 40 mg in divided doses) IM 1 mg q4–6h (max: 6 mg/d)

Administration

Oral

Separate antacid and phenothiazine doses by at least 2 h.
Dilute oral concentrate just before administration with about 60–120 mL suitable diluent (e.g., water, fruit juices, carbonated beverage, milk, soups, puddings). Avoid coffee or tea near time of taking oral preparation. Explain dosage and dilution to patient if drug is to be self-administered.
Crush tablet and give with fluid or mix with food if patient will not or cannot swallow pill.
Monitor ingestion of tablet to ensure that patient does not hoard medication.

Intramuscular

Give IM injection deep into upper outer quadrant of buttock.
Note: Slight yellow discoloration of injectable drug reportedly does not alter potency. If color is markedly changed, discard solution.
Wash hands if undiluted concentrate is spilled on skin to prevent contact dermatosis.
Store in light-resistant container at 15°–30° C (59°–86° F) unless otherwise directed.

Adverse Effects (≥1%)

CNS: Drowsiness, insomnia, dizziness, agitation, extrapyramidal effects, neuroleptic malignant syndrome. Special Senses: Nasal congestion, dry mouth, blurred vision, pigmentary retinopathy. Hematologic: Agranulocytosis. Skin: Photosensitivity, skin rash, sweating. GI: Constipation. CV: Tachycardia, hypotension. Respiratory: Depressed cough reflex. Endocrine: Gynecomastia, galactorrhea.

Interactions

Drug: Alcohol and other cns depressants add to CNS depression. Herbal: Kava may increase risk and severity of dystonic reactions.

Pharmacokinetics

Absorption: Well absorbed from GI tract. Onset: Rapid onset. Peak: 2–3 h. Duration: Up to 12 h. Metabolism: In liver. Elimination: In bile and feces.

Nursing Implications

Assessment & Drug Effects

Monitor HR and BP. Hypotension is a common adverse effect.
Hypotension and extrapyramidal effects (especially akathisia and dystonia) are most likely to occur in patients receiving high doses or parenteral administration and in older adults. Withhold drug and notify physician if patient has dysphagia, neck muscle spasm, or if tongue protrusion occurs.
Monitor I&O ratio and bowel elimination pattern. Check for abdominal distention and pain. Encourage adequate fluid intake as prophylaxis for constipation and xerostomia. The depressed patient may not seek help for either symptom or for urinary retention.
Be aware that since trifluoperazine potentiates analgesics, its use may reduce amount of narcotic required in painful long-term illness such as cancer.
Agitation, jitteriness, and sometimes insomnia may simulate original neurotic or psychotic symptoms. These adverse effects may disappear spontaneously.
Expect maximum therapeutic response within 2–3 wk after initiation of therapy.

Patient & Family Education

Take drug as prescribed; do not alter dosing regimen or stop medication without consulting physician.
Consult physician about use of any OTC drugs during therapy.
Do not take alcohol and other depressants during therapy.
Avoid potentially hazardous activities such as driving or operating machinery, until response to drug is known. Drowsiness and dizziness may be prominent during this time.
Cover as much skin surface as possible with clothing when you must be in direct sunlight. Use a SPF >12 sunscreen on exposed skin.
Urine may be discolored or reddish brown and this is harmless.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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