trifluoperazine

Antipsychotic

Brands: Stelazine

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

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Quick answers

What is trifluoperazine?
Trifluoperazine (brand Stelazine) is a high-potency phenothiazine FGA used for psychotic disorders. Unusually for an antipsychotic, the label also includes short-term treatment of generalized non-psychotic anxiety (label).
What is Stelazine?
Stelazine is a brand name for trifluoperazine.
What is Stelazine (trifluoperazine) used for?
Label indications include: Psychotic disorders; short-term treatment of generalized non-psychotic anxiety (label-dependent).
What drug class is Stelazine (trifluoperazine)?
Antipsychotic.
What is the mechanism of action of Stelazine (trifluoperazine)?
High-potency phenothiazine first-generation antipsychotic (D2 antagonism). Has a label indication for short-term treatment of non-psychotic anxiety, but carries antipsychotic-class risks including tardive dyskinesia.
What strengths does Stelazine (trifluoperazine) come in?
Tablets: 1 mg, 2 mg, 5 mg, 10 mg (label/manufacturer-dependent).
Is Stelazine (trifluoperazine) a controlled substance?
No — it is not scheduled as a controlled substance under U.S. federal law.

Snapshot

Class: Antipsychotic
Common US brands: Stelazine
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-30

Label indications

Psychotic disorders; short-term treatment of generalized non-psychotic anxiety (label-dependent).

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Clinical Highlights

Trifluoperazine (brand Stelazine) is a high-potency phenothiazine FGA used for psychotic disorders. Unusually for an antipsychotic, the label also includes short-term treatment of generalized non-psychotic anxiety (label). The label emphasizes that trifluoperazine is not a first-choice anxiety medication because antipsychotic risks (including tardive dyskinesia) are not shared by many alternatives (label).

Label evidence for anxiety benefit comes from a four-week outpatient study in generalized anxiety disorder and does not predict usefulness in other non-psychotic conditions where anxiety-like symptoms can occur (label).
Because it is high potency, movement-disorder risk (parkinsonism, dystonia, akathisia) is often the limiting factor more than sedation; this is a key trade-off when compared with low-potency agents (label/clinical).
Like all antipsychotics, trifluoperazine carries the class boxed warning for increased mortality in elderly patients with dementia-related psychosis (label).
The compare view, trifluoperazine evidence feed, and trifluoperazine print page help teams balance EPS risk against sedation and metabolic considerations.

Dosing & Formulations

Oral tablets are available in 1 mg, 2 mg, 5 mg, and 10 mg strengths (label/manufacturer-dependent). For non-psychotic anxiety, the label describes a usual dose of 1–2 mg twice daily and states: do not exceed 6 mg/day and do not use longer than 12 weeks (label).

For psychotic disorders, the label describes a usual starting oral dose of 2–5 mg twice daily (starting at the lower end for small/emaciated patients) (label).
The label notes that many patients have an optimum response around 15–20 mg/day, though some may require 40 mg/day or more; dose is individualized to response and tolerability (label).
The label notes some patients may be controlled on twice-daily dosing and some on once-daily dosing after stabilization; dosing cadence is individualized to response and tolerability (label).

Monitoring & Risks

Movement-disorder monitoring is central (akathisia, parkinsonism, dystonia, tardive dyskinesia), especially at higher doses or longer durations (label/clinical). The label includes standard antipsychotic warnings including neuroleptic malignant syndrome, seizure-threshold lowering, and fall risk from somnolence or postural hypotension (label).

Hyperprolactinemia can occur with FGAs; symptom review (amenorrhea, galactorrhea, sexual dysfunction) is a practical screen (clinical).
For anxiety-label use, duration is part of safety monitoring: the label links higher dose or longer use to persistent tardive dyskinesia risk (label).

Drug Interactions

Additive CNS depression can occur with alcohol, opioids, benzodiazepines, and other sedatives (clinical). QT-prolonging combinations and electrolyte abnormalities can increase arrhythmia risk; ECG monitoring is commonly considered when risk factors accumulate (clinical).

When used as an anxiolytic adjunct in patients already on SSRIs/SNRIs, teams often re-check the broader regimen for duplicated risks (sedation, QT, movement symptoms) (clinical).

Practice Notes

For anxiety, trifluoperazine is best understood as a short-term, label-restricted option with a built-in stop date (≤12 weeks) and dose ceiling (≤6 mg/day) (label). For psychotic disorders, the “high potency” profile means early follow-up often centers on akathisia and rigidity screening rather than metabolic labs (clinical).

If adherence is a primary barrier, teams typically evaluate LAI alternatives because trifluoperazine has no depot formulation (APA/clinical).

References

Trifluoperazine hydrochloride tablets prescribing information — DailyMed (2025)
First Generation Versus Second Generation Antipsychotics IN Adults: Comparative Effectiveness — Agency for Healthcare Research and Quality (NCBI Bookshelf) (2012)
The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia — American Psychiatric Association (2020)
AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology — Pharmacopsychiatry (2018)