STELAZINE Trifluoperazine (Eskazinyl, Eskazine, Jatroneural, Modalina, Terfluzine)

[Sue_P]

I couldn't find any reference to this in the new edition, perhaps it has a different name other than how we know it in NZ.
Woman currently pregnant diagnosed with a long term anxiety disorder, recently commenced Stelazine.
Your comments please re risk to baby through pregnancy and breastfeeding. Has also increasing disassociation with pregnancy. Successful bonding and attachment is at risk with this woman so I will also read your web mental health pages and will also consult Kathleen Kendall-Tackett's work.

Sue

[admin]

Sue:

Trifluoperazine (Stelazine) is a strong and rather old antipsychotic drug. It is used for many conditions, including schizophrenia, bipolar disorder, and even anxiety disorder. However, it is rarely used today for anxiety disorder. In the US (and in NZ), the major treatment of "anxiety disorder" is the SSRI family, sertraline, fluoxetine, escitalopram and in some instances, the benzodiazepine (valium) family.

That said, I do not mean to second guess this physicians choice in this patient. We have several studies suggesting that at 5 and 10 mg doses, milk levels of Trifluoperazine is undetectable. See below. So it would probably be OK to breastfeed. The only complication reported with this family of drugs in infants is usually apnea. I would not use this in an infant subject to breathing difficulties or apnea.

Tom Hale Ph.d.

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Psychol Med. 1998 Jan;28(1):81-91.
Neuroleptic drugs in breast-milk: a study of pharmacokinetics and of possible adverse effects in breast-fed infants.
Yoshida K, Smith B, Craggs M, Kumar R.

Section of Perinatal Psychiatry, University of London.
Abstract
BACKGROUND: Very little is known about the pharmacokinetics of neuroleptic drugs in breast-feeding mothers and their infants or about possible adverse effects in the infants.

METHOD: Twelve mothers who breast-fed their infants were prescribed haloperidol, chlorpromazine or trifluoperazine. Two methods, enzyme immunoassay (EIA) and high performance liquid chromatography (HPLC) were used to assay these drugs in samples from mothers, but infants' samples were assayed only by the more sensitive EIA. Repeated clinical and developmental assessments of the breast-fed infants were carried out up to 30 months of age. The control subjects were 18 bottle-fed infants whose mothers were also prescribed neuroleptic or mood-stabilizing drugs.

RESULTS: The total concentrations of neuroleptic drugs and their principal metabolites in maternal plasma were correlated with concentrations in fore-milk. Infants were ingesting up to 3% of the maternal daily dose per kg body weight and small amounts of the drugs were detected in infants' plasma and urine. Concentrations of haloperidol in the adult range were found in plasma from 2 of 5 infants assayed by EIA but there was no evidence of any acute or delayed adverse effects. Three other breast-fed infants whose mothers were prescribed both haloperidol and chlorpromazine showed a decline in their developmental scores from the first to the second assessment at 12-18 months.

CONCLUSION: More extensive longitudinal studies are needed but, in the meantime, there appears to be grounds for caution if breast-feeding mothers are prescribed doses of single or two neuroleptic drugs at the upper end of their recommended ranges.

PMID: 9483685 [PubMed - indexed for MEDLINE]