Trifluoperazine

FGA / Phenothiazine·Psychiatry - Oral Antipsychotics

Schizophrenia, severe behavioral disturbances

PBSFGAStelazine1 mg tabletS4+1

Max Dose

30 mg/day

Half-life

18 h

EPS Risk

CRITICAL

Anxiety

OFF-LABEL

Rapid Summary

Overview

High-potency phenothiazine. Structurally similar to prochlorperazine. Highly activating and non-sedating, but carries a brutal risk of extrapyramidal side effects.

Maximum Dose

Max 30 mg/day (For schizophrenia). Used in micro-doses (1-2 mg) for anxiety.

Clinical Focus

Causes intense Parkinsonism and dystonia. Almost always requires co-prescription of an anticholinergic (benztropine).

Bottom Line

Trifluoperazine is a high-potency first-generation antipsychotic for schizophrenia and severe anxiety, but causes marked extrapyramidal effects and tardive dyskinesia with long-term use.

Formulation & Access

Brand Names

Stelazine

Oral Routes

Tablets (1 mg, 5 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Schizophrenia, severe behavioral disturbances.

Off-Label

OFF

Severe generalized anxiety unresponsive to standard treatments, severe nausea.

Clinical Place

A high-potency alternative to Haloperidol. Rarely used as first-line today due to the safer profile of SGAs.

Quick reference

Class & Role

FGA / Phenothiazine — High-potency phenothiazine.

Route / Formulation

Tablets (1 mg, 5 mg). (Stelazine)

Usual Dose & Max

Start PO 5 mg BD. Titrate up to 15-20 mg/day. Max 30 mg/day.

Key Indication Doses

Schizophrenia: Start PO 5 mg BD. Titrate up to 15-20 mg/day. Max 30 mg/day. Severe Anxiety / Nausea (Off-Label): PO 1-2 mg BD. Elderly: Start at 1 mg. Highly sensitive to EPS.

Best Uses

Trifluoperazine is a high-potency first-generation antipsychotic for schizophrenia and severe anxiety, but causes marked extrapyramidal effects and tardive dyskinesia with long-term use.

Avoid / Cautions

Parkinson's disease, severe CNS depression, severe hepatic impairment. Pregnancy Category C.

Key Risks

Neurological: Severe EPS (Parkinsonism, acute dystonia, akathisia). Tardive Dyskinesia risk is exceptionally high. Neuroleptic Malignant Syndrome (NMS). Endocrine: Hyperprolactinemia (galactorrhea, amenorrhea). Ocular: Retinal pigmentation (with prolonged high-dose use).

Key Interactions

Avoid concurrent QTc prolonging drugs. SSRIs (Fluoxetine) increase levels, worsening EPS.

Monitoring

Monitor for rigidity and tremor. Chart PRN Benzatropine. Monitor serum Prolactin if symptoms develop.

Clinical Pearl

While most phenothiazines (like Chlorpromazine) turn patients into zombies, Trifluoperazine is 'activating' and alerting. It is useful for withdrawn, apathetic schizophrenic patients, but terrible for agitated ones.

Access

Stelazine1 mg tablet

Brand: Stelazine
Formulation: Tablets (1 mg, 5 mg)

Trifluoperazine

FGA / Phenothiazine·Psychiatry - Oral Antipsychotics

Schizophrenia, severe behavioral disturbances

PBSFGAStelazine1 mg tabletS4+1

Max Dose

30 mg/day

Half-life

18 h

EPS Risk

CRITICAL

Anxiety

OFF-LABEL

Rapid Summary

Overview

High-potency phenothiazine. Structurally similar to prochlorperazine. Highly activating and non-sedating, but carries a brutal risk of extrapyramidal side effects.

Maximum Dose

Max 30 mg/day (For schizophrenia). Used in micro-doses (1-2 mg) for anxiety.

Clinical Focus

Causes intense Parkinsonism and dystonia. Almost always requires co-prescription of an anticholinergic (benztropine).

Bottom Line

Trifluoperazine is a high-potency first-generation antipsychotic for schizophrenia and severe anxiety, but causes marked extrapyramidal effects and tardive dyskinesia with long-term use.

Formulation & Access

Brand Names

Stelazine

Oral Routes

Tablets (1 mg, 5 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Schizophrenia, severe behavioral disturbances.

Off-Label

OFF

Severe generalized anxiety unresponsive to standard treatments, severe nausea.

Clinical Place

A high-potency alternative to Haloperidol. Rarely used as first-line today due to the safer profile of SGAs.

Quick reference

Class & Role

FGA / Phenothiazine — High-potency phenothiazine.

Route / Formulation

Tablets (1 mg, 5 mg). (Stelazine)

Usual Dose & Max

Start PO 5 mg BD. Titrate up to 15-20 mg/day. Max 30 mg/day.

Key Indication Doses

Schizophrenia: Start PO 5 mg BD. Titrate up to 15-20 mg/day. Max 30 mg/day. Severe Anxiety / Nausea (Off-Label): PO 1-2 mg BD. Elderly: Start at 1 mg. Highly sensitive to EPS.

Best Uses

Trifluoperazine is a high-potency first-generation antipsychotic for schizophrenia and severe anxiety, but causes marked extrapyramidal effects and tardive dyskinesia with long-term use.

Avoid / Cautions

Parkinson's disease, severe CNS depression, severe hepatic impairment. Pregnancy Category C.

Key Risks

Key Interactions

Avoid concurrent QTc prolonging drugs. SSRIs (Fluoxetine) increase levels, worsening EPS.

Monitoring

Monitor for rigidity and tremor. Chart PRN Benzatropine. Monitor serum Prolactin if symptoms develop.

Clinical Pearl

Access

Stelazine1 mg tablet

Brand: Stelazine
Formulation: Tablets (1 mg, 5 mg)