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Antipsychotic  ·  First-Generation Antipsychotic, Phenothiazine

Trifluoperazine

Also known as: Stelazine, Eskazine, Triflurin

A first-generation antipsychotic used for schizophrenia and, at low doses, for short-term anxiety, one of the older phenothiazines still in use across Kenya.

ATC CodeN05AB06
Kenya EML 2023Listed
Level of UseLevel 4-6
This is health education, not medical advice. Never start, stop, or change a medication without speaking to a qualified healthcare professional first.
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Prescription Only Medicine

Available on prescription. A medicine to manage movement side effects such as biperiden is frequently needed alongside this antipsychotic.

What it treats

Which conditions is Trifluoperazine used for?

SchizophreniaAcute PsychosisSevere Anxiety (short-term, low dose)

Overview

What is Trifluoperazine?

Trifluoperazine is a first-generation antipsychotic from the phenothiazine family, related to chlorpromazine. It has a more potent antipsychotic effect per milligram and somewhat less sedation.

It is listed in Kenya's Essential Medicines List 2023 and is used mainly for schizophrenia and other psychotic disorders.

Like all first-generation antipsychotics, trifluoperazine carries a significant risk of extrapyramidal side effects, movement problems including stiffness, restlessness, and in the long term, involuntary movements.

How it works

What does it do in the brain?

Trifluoperazine is a potent dopamine D2 receptor blocker. By reducing dopamine activity in the mesolimbic pathways, it decreases the hallucinations, delusions, and disorganised thinking associated with psychosis. The same mechanism in the nigrostriatal pathway accounts for the movement side effects.

Formulations in Kenya

How is it available?

Tablet
1 mg, 2 mg, 5 mg
Taken by mouth
Available
Injection
1 mg/mL
Given by healthcare professional
Available at hospital level

Availability across Africa

Where is it available in Africa and what is it called?

Names and availability vary by country. Always confirm with a local pharmacist or healthcare provider.
CountryCommon Brand Name(s)Notes
UgandaStelazine, Trifluoperazine (generic)Available at Butabika National Psychiatric Hospital and larger regional hospitals.
South AfricaStelazine, Trifluoperazine (generic)Available in public and private sectors.
NigeriaStelazineAvailable at federal and state teaching hospitals.
GhanaTrifluoperazine (generic)Available at Accra Psychiatric Hospital and select regional hospitals.
TanzaniaTrifluoperazine (generic)Available at referral hospitals; limited supply at lower facilities.

Side effects

What might you feel while taking it?

These are the most commonly reported effects. Not everyone experiences them, and many settle within the first few weeks.

  • Extrapyramidal side effects, stiffness, slowed movement, restlessness, common and often requiring biperiden
  • Sedation, though less pronounced than chlorpromazine
  • Dizziness on standing
  • Dry mouth and constipation
  • Hormonal changes, menstrual irregularities, breast changes
  • Sensitivity to sunlight
Go to a doctor or emergency room straight away if you notice any of the following.
  • Tardive dyskinesia, involuntary repetitive movements developing after long-term use. Report any new involuntary movements immediately.
  • Neuroleptic Malignant Syndrome, high fever, extreme muscle rigidity, and confusion together is a medical emergency
  • Rare blood disorders, report fever, sore throat, or unusual infections promptly

Who should not take it

Important warnings before starting

Tell your doctor about all your medical conditions, allergies, and other medicines before starting Trifluoperazine.
  • CNS depression or coma
  • Known allergy to phenothiazines
  • Bone marrow suppression

Special care needed

Situations that need extra attention

  • Biperiden is usually co-prescribed to manage movement side effects
  • Elderly patients with dementia carry significantly higher risks on antipsychotics
  • Use sunscreen and protective clothing in Kenya's sun
  • Do not drive or operate machinery until you know how the medicine affects you
  • Tell your doctor about any history of heart problems
Pregnancy
Specialist advice is required. The risks of uncontrolled psychosis in pregnancy must be weighed carefully with your doctor.
Breastfeeding
Present in breast milk. Specialist guidance required.

Other medicines

Medicines and substances that can interact with it

Always tell your doctor and pharmacist about every medicine, supplement, and herbal remedy you take, including those bought without a prescription.
  • Alcohol and sedating medicines: Sedation is amplified. Avoid alcohol.
  • Anticholinergic medicines including biperiden: Additive effects on dry mouth, constipation, and urinary function.
  • Antihypertensive medicines: May enhance blood pressure lowering.

Tests and follow-up

What your doctor will monitor

  • Movement side effects assessed at every appointment
  • Blood pressure at initiation and periodically
  • Annual AIMS assessment for tardive dyskinesia in long-term users
  • Full blood count if unexplained fever or infection occurs

Stopping this medicine

What happens if you stop taking it?

Do not stop trifluoperazine suddenly. Gradual tapering under medical supervision is needed to prevent rebound psychosis and withdrawal effects.

In Kenya

What you should know about this medicine in Kenya

Trifluoperazine is available in Kenya at Level 4 and above. It remains in use particularly where haloperidol and chlorpromazine are the primary first-generation options.

As with all first-generation antipsychotics in Kenya, co-prescription of biperiden is standard practice to manage the predictable movement side effects.

Sun sensitivity is an important practical concern in Kenya's climate. Patients on trifluoperazine should use sunscreen daily and wear protective clothing.

Sources

References

  1. Ministry of Health, Kenya. (2023). Kenya Essential Medicines List 2023. Nairobi: Ministry of Health.
  2. Ministry of Health, Kenya. (2023). Kenya National Medicines Formulary, 1st Edition. Nairobi: Ministry of Health.
  3. World Health Organization. (2023). Model List of Essential Medicines, 23rd Edition. Geneva: WHO.