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trifluoperazine

trifluoperazine
Brand names: Stelazine
Form Strength
TABLET, ORAL 1 mg; 2 mg; 5 mg
Display Phenothiazines Class: 28160824
Medication comments:
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication: trifluoperazine (Stelazine)
May be required to treat concurrent schizophrenia, bipolar disorder, and other selected mental health and neuropsychiatric conditions but should be prescribed in the lowest effective dose and for the shortest possible duration.
 
Criteria 1: Potentially inappropriate medication use in older adults. (Table 2)
Drug(s) antipsychotics, first- (typical) and second- (atypical) generation
Rationale Increased risk of stroke and greater rate of cognitive decline and mortality in persons with dementia. Additional evidence suggests an association of increased risk between antipsychotic medication and mortality independent of dementia.
Avoid antipsychotics for behavioral problems of dementia or delirium unless documented nonpharmacologic options (e.g., behavioral interventions) have failed and/or the patient is threatening substantial harm to self or others. If used, periodic deprescribing attempts should be considered to assess ongoing need and/or the lowest effective dose.
Recommendation Avoid, except in FDA-approved indications such as schizophrenia, bipolar disorder, Parkinson disease psychosis (see Table 3), adjunctive treatment of major depressive disorder, or for short-term use as an antiemetic.
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome antipsychotics ⇄ Delirium
Rationale Avoid in older adults with or at high risk of delirium because of the potential of inducing or worsening delirium.
Avoid for behavioral problems of dementia or delirium unless nonpharmacologic options (eg, behavioral interventions) have failed or are not possible and the older adult is threatening substantial harm to self or others. If used, periodic deprescribing attempts should be considered to assess ongoing need and/or the lowest effective dose.
Recommendation Avoid, except in situations listed under the rationale statement.
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome antipsychotics, chronic use or persistent as-needed use. ⇄ Dementia or cognitive impairment
Rationale Avoid because of adverse CNS effects. Antipsychotics: increased risk of stroke and greater rate of cognitive decline and mortality in people with dementia. Avoid antipsychotics for behavioral problems of dementia or delirium unless documented nonpharmacologic options (e.g., behavioral interventions) have failed and/or the patient is threatening substantial harm to self or others. If used, periodic deprescribing attempts should be considered to assess ongoing need and/or the lowest effective dose.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome antipsychotics ⇄ History of falls or fractures
Rationale May cause ataxia, impaired psychomotor function, syncope, or additional falls. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation Avoid unless safer alternatives are not available.
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug(s) ⇆ disease or syndrome antipsychotics (except cloZAPine, pimavanserin, and QUEtiapine) ⇄ Parkinson disease
Rationale DOPamine-receptor antagonists with the potential to worsen Parkinsonian symptoms Exceptions: cloZAPine, pimavanserin, and QUEtiapine appear to be less likely to precipitate the worsening of Parkinson disease than other antipsychotics.
Recommendation Avoid
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 3: Potentially inappropriate medications: drugs to be used with caution in older adults. (Table 4)
Drug(s) antipsychotics
Rationale May exacerbate or cause SIADH or hyponatremia; monitor sodium levels closely when starting or changing dosages in older adults.
Recommendation Use with caution
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 4: Potentially clinically important drug-drug interactions that should be avoided in older adults. (Table 5)
Interacting drug(s) or class(es) antipsychotics ⇄ CNS-active agents
Risk Rationale Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
 Quality of evidence: High, Strength of Recommendation: Strong
Pediatric Pharmacy Association 2025 KIDs List of Key Potentially Inappropriate Drugs in Pediatrics 
Medication: trifluoperazine (Stelazine)
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug dopamine antagonists: 1st generation antipsychotics
Risk/Rationale Acute dystonic reactions (e.g., oculogyric crisis, torticollis)
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Strong
 
Drug dopamine antagonists: 1st generation antipsychotics
Risk/Rationale Hyperprolactinemia
Recommendation Avoid in 18 yr of age and younger
 Quality of evidence: High, Strength of Recommendation: Weak
Last updated: Sep. 25, 2025
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