Formulary
Trifluoperazine: Indications, Dosing, Side Effects and Interactions
Trifluoperazine clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Trifluoperazine: Indications, Dosing, Side Effects and Interactions
Trifluoperazine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Schizophrenia and other psychoses,Short-term adjunctive management of psychomotor agitation, excitement, and violent or dangerously impulsive behaviour**
- **Adult** (By Mouth): Initially 5 mg twice daily, daily dose may be increased by 5 mg after 1 week. If necessary, dose may be further increased in steps of 5 mg at intervals of 3 days. When satisfactory control has been achieved, reduce gradually until an effective maintenance level has been established.
- **Elderly** (By Mouth): Initially up to 2.5 mg twice daily, daily dose may be increased by 5 mg after 1 week. If necessary, dose may be further increased in steps of 5 mg at intervals of 3 days. When satisfactory control has been achieved, reduce gradually until an effective maintenance level has been established.
**Short-term adjunctive management of severe anxiety**
- **Adult** (By Mouth): 2-4 mg daily in divided doses, increased if necessary to 6 mg daily.
- **Elderly** (By Mouth): Up to 2 mg daily in divided doses, increased if necessary to 6 mg daily.
**Severe nausea and vomiting**
- **Adult** (By Mouth): 2-4 mg daily in divided doses; maximum 6 mg per day.
**Schizophrenia and other psychoses, Short-term adjunctive management of psychomotor agitation, excitement, and violent or dangerously impulsive behaviour for trifluoperazine**
- **Child 12-17 years (under expert supervision)** (By mouth): Initially 5 mg twice daily, daily dose may be increased by 5 mg after 1 week. If necessary, dose may be further increased in steps of 5 mg at intervals of 3 days. When satisfactory control has been achieved, reduce gradually until an effective maintenance level has been established.
**Short-term adjunctive management of severe anxiety for trifluoperazine**
- **Child 3-5 years (under expert supervision)** (By mouth): Up to 500 micrograms twice daily.
- **Child 6-11 years (under expert supervision)** (By mouth): Up to 2 mg twice daily.
- **Child 12-17 years (under expert supervision)** (By mouth): 1-2 mg twice daily, increased if necessary to 3 mg twice daily.
**Severe nausea and vomiting unresponsive to other antiemetics for trifluoperazine**
- **Child 3-5 years** (By mouth): Up to 500 micrograms twice daily.
- **Child 6-11 years** (By mouth): Up to 2 mg twice daily.
- **Child 12-17 years** (By mouth): 1-2 mg twice daily (max. per dose 3 mg twice daily).
Cautions
For all antipsychotic drugs Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes (may raise blood glucose); epilepsy; history of jaundice; myasthenia gravis; Parkinson's disease (may be exacerbated); photosensitisation (may occur with higher dosages); prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma Cautions, further information Cardiovascular disease An ECG may be required, particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: for all antipsychotics (other than quetiapine and clozapine) in patients with parkinsonism or Lewy Body Disease (risk of severe extrapyramidal symptoms) in behavioural and psychological symptoms of dementia (BPSD), unless symptoms are severe and other non-pharmacological treatments have failed (increased risk of stroke) for use as a hypnotic, unless sleep disorder is due to psychosis or dementia (risk of confusion, hypotension, extrapyramidal side-effects, and falls) in patients prone to falls (may cause gait dyspraxia, parkinsonism) if prescribed a phenothiazine (other than prochlorperazine for nausea, vomiting, or vertigo; chlorpromazine for relief of persistent hiccups; levomepromazine as an antiemetic in palliative care) as first-line treatment (sedative, significant antimuscarinic (anticholinergic) toxicity in older people, and safer and more efficacious alternatives exist) if prescribed an antipsychotic drug with moderate or marked antimuscarinic effects (e.g. chlorpromazine, clozapine, flupenthixol, fluphenazine, pipothiazine, promazine, and zuclopenthixol) in patients with a history of prostatism or urinary retention (high risk of urinary retention) Cautions For trifluoperazine Susceptibility to QT interval prolongation
Contraindications
CNS depression; comatose states; phaeochromocytoma
Side effects
For all antipsychotic drugs Common or very common Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; fatigue; galactorrhoea; gynaecomastia; hyperglycaemia; hyperprolactinaemia; hypersalivation; hypotension (dose-related); insomnia; leucopenia; movement disorders; muscle rigidity; neutropenia; parkinsonism; postural hypotension (dose-related); QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased Uncommon Agranulocytosis; confusion; neuroleptic malignant syndrome (discontinue-potentially fatal) Rare or very rare Sudden death; withdrawal syndrome neonatal Side-effects, further information For depot antipsychotics-side-effects may persist until the drug has been cleared from its depot site. Overdose Phenothiazines cause less depression of consciousness and respiration than other sedatives. Hypotension, hypothermia, sinus tachycardia, and arrhythmias may complicate poisoning. For details on the management of poisoning see Antipsychotics under Emergency treatment of poisoning . Side-effects For trifluoperazine Frequency not known Alertness decreased; anxiety; appetite decreased; blood disorder; cardiac arrest; embolism and thrombosis; hyperpyrexia; jaundice cholestatic; lens opacity; muscle weakness; oedema; pancytopenia; photosensitivity reaction; skin reactions; thrombocytopenia; urinary hesitation; vision blurred; withdrawal syndrome Side-effects, further information Extrapyramidal symptoms are more frequent at doses exceeding 6 mg daily. Acute dystonias are more common with potent first generation antipsychotics. The risk is increased in men, young adults, children, antipsychotic-nave patients, rapid dose escalation, and abrupt treatment discontinuation.
Interactions
**Other interactions (3):**
- Medicinal products affected by serum potassium disturbances Periodic monitoring of serum potassium and ECG is recommended when olmesartan/hydrochlorothiazide is administered with medicinal products...
- Combinations requiring precautions for use Torsades de pointes-inducing drugs (such as but not limited to): class Ia antiarrhythmics agents ( e.g.quinidine, hydroquinidine, disopyramide), class...
- Medicinal products affected by serum potassium disturbances Periodic monitoring of serum potassium and ECG is recommended when losartan/hydrochlorothiazide is administered with medicinal products...
Pregnancy
For all antipsychotic drugs Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress.
Breast feeding
For all antipsychotic drugs There is limited information available on the short- and long-term effects of antipsychotic drugs on the breast-fed infant. Animal studies indicate possible adverse effects of antipsychotic medicines on the developing nervous system. Chronic treatment with antipsychotic drugs whilst breast-feeding should be avoided unless absolutely necessary. Phenothiazine derivatives are sometimes used in breast-feeding women for short-term treatment of nausea and vomiting.
Hepatic impairment
Manufacturer advises avoid.
Medicinal forms
Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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