Trifluoperazine is indicated for the management of anxiety states, helping control excessive anxiety, tension, and agitation associated with neurosis or physical (somatic) conditions. It is also used for the treatment and prevention of nausea and vomiting from various causes. In addition, it is used in the management of psychotic disorders, including acute or chronic catatonic, hebephrenic, and paranoid schizophrenia, psychosis related to organic brain damage, toxic psychosis, and the manic phase of manic-depressive illness.

Trifluoperazine belongs to the phenothiazine group of medicines. It has several pharmacological effects that contribute to both its therapeutic benefits and possible side effects. Its main action is blocking dopamine receptors in the central nervous system (CNS). This dopamine-blocking effect in the limbic system and related areas of the cerebral cortex is believed to produce its antipsychotic effect. In the medullary chemoreceptor trigger zone, this same action is thought to be responsible for its anti-nausea and anti-vomiting (antiemetic) effects.

Schizophrenia and other psychoses:

• Adults and child over 12 years: Recommended starting dose is 2-5 mg b.i.d, increased by 5 mg daily after 1 week then at interval of 3 days, according to response.
• Children (6-12 years): Dosage should be adjusted to the weight of the child and severity of the symptoms. The starting dosage is 1 mg b.i.d. Dosage may be increased gradually until symptoms are controlled or until side effects become troublesome. While it is usually not necessary to exceed dosages of 15 mg daily.
• Elderly: Reduce initial dose by at least half

Short-term management of severe anxiety:

• Adult and child over 12 years: 1-2 mg b.i.d, increased if necessary to 6 mg daily.
• Child (3-5 years): 1 mg daily
• Child (6-12 years): Up to 4 mg daily in divided dose.
• Elderly: Reduce initial dose by at least half

Antiemetic:

• Adult: 2-4 mg daily in divided doses; max. 6 mg daily;
• Child 3-5 years: up to 1 mg daily, 6-12 years up to 4 mg daily.

Trifluoperazine may reduce the effectiveness of oral anticoagulants. Concurrent use of propranolol with trifluoperazine may increase the plasma concentration of both medications. The antihypertensive effects of guanethidine and related compounds may be diminished when used together with phenothiazines. Increased sedative effects may occur when antipsychotic medicines are combined with central nervous system depressants such as alcohol, hypnotics, and anticonvulsants.

Trifluoperazine should not be used in patients who are in a coma, have existing blood disorders (blood dyscrasias), have known liver damage, or are allergic/hypersensitive to trifluoperazine or related compounds.

Common side effects of Trifluoperazine may include temporary restlessness, dystonic reactions (muscle spasms), or symptoms similar to Parkinsonism. Other effects on the central nervous system (CNS) can include drowsiness, dizziness, fatigue, blurred vision, and, in some cases, seizures. Less commonly, peripheral edema (swelling), blood disorders, and jaundice may occur. Rarely reported side effects include rapid heartbeat (tachycardia), constipation, difficulty or retention in urination, and hyperpyrexia (very high fever).

The safety of Trifluoperazine during pregnancy has not been fully established. For this reason, it is generally not recommended during pregnancy unless a physician considers it essential. The expected benefits should clearly outweigh any potential risks. In some reported cases, newborns whose mothers received phenothiazines during pregnancy showed prolonged jaundice, movement-related side effects (extrapyramidal symptoms), and abnormal reflexes such as increased or decreased reflex responses (hyperreflexia or hyporeflexia).

Trifluoperazine should be used with caution in elderly patients, and the initial dose should generally be reduced. Older patients may be especially sensitive to certain side effects, particularly extrapyramidal effects (movement-related side effects) and low blood pressure (hypotension). Caution is also advised in patients with cardiovascular disease, including heart rhythm disorders (arrhythmias). Extra care should be taken in patients with angina pectoris (chest pain due to heart disease).

In cases of overdose with Trifluoperazine, the main signs and symptoms are usually extrapyramidal effects. Low blood pressure (hypotension) may also occur.Management involves gastric lavage along with supportive and symptomatic treatment. Vomiting should not be induced. Extrapyramidal symptoms can be treated with anticholinergic or antiparkinsonian medications.Hypotension should be managed with fluid replacement. If it is severe or does not improve, noradrenaline may be considered. Adrenaline must not be used as it is contraindicated.

Phenothiazine group of drugs

Trifluoperazine should be stored at room temperature, between 15°C and 30°C. It must be kept away from direct light and moisture to maintain its stability and effectiveness.