Stellazine - anyone know anything about it?

[yellowbutterflies]

Hi,

My name is Sarah and I've been diagnosed with BP. For the last three and a half years I've been on and off Olanzapine/Zyprexa and due to the side effects I'm considering other options. My last pdoc mentioned "stellazine". I just want to know if anyone here has tried it and get your opinions on it. NB: I'm also on Lamictal for depression and Lithium for mood stability. The last two weeks I've suffered acute depression (about three weeks after discontinuing Zyprexa), however I am not willing to go back on Zyprexa. I'm about to suggest stellazine to my new pdoc, however, it thought it would be useful to talk to people who are actually taking it or have done in the past.

Look forward to reading any replies,

Sarah

[LikeMinded]

Because Stelazine (chemically named trifluoperazine) is a relatively older "typical" antipsychotic, I am not sure how many on this board will say they've had personal experience with the drug. In fact, the drug name hadn't popped into my mind until I read it in this post and recalled it being mentioned at a research lecture I went to a few years ago.

I went through withdrawal with Zyprexa (a newer, "atypical" psychotic), too, though, and that resulted in an immediate, inconsolable insomnia followed a week later by one of the worst depressions I've ever been in. I was med-free for about a month, and then only did the combination of Cymbalta and trazodone pull me out of my misery.

In any event, Stelazine (this is in the US, things may vary down under) has regulatory approval for treating schizophrenia as well as chronic anxiety.

The following is what the manufacturer states in its US prescribing information leaflet:

INDICATIONS:

1) For the management of schizophrenia.

2) Stelazine (trifluoperazine HCl) is effective for the short-term treatment of generalized non-psychotic anxiety. However, Stelazine is not the first drug to be used in therapy for most patients with non-psychotic anxiety because certain risks associated with its use are not shared by common alternative treatments (i.e., benzodiazepines).

When used in the treatment of non-psychotic anxiety, Stelazine should not be administered at doses of more than 6 mg per day or for longer than 12 weeks because the use of Stelazine at higher doses or for longer intervals may cause persistent tardive dyskinesia that may prove irreversible (see WARNINGS).

The effectiveness of Stelazine as a treatment for non-psychotic anxiety was established in a 4-week clinical multicenter study of outpatients with generalized anxiety disorder (DSM-III). This evidence does not predict that Stelazine will be useful in patients with other non-psychotic conditions in which anxiety, or signs that mimic anxiety, are found (i.e., physical illness, organic mental conditions, agitated depression, character pathologies, etc.).

There's nothing I can find about the drug on its treatment of bipolar and bipolar depression, and the drug also carries risks of serious side effects, including TD (mentioned above), as well as toxic interactions with lithium:

(Again, from the manufacturer:)

An encephalopathic syndrome (characterized by weakness, lethargy, fever, tremulousness and confusion, extrapyramidal symptoms, leukocytosis, elevated serum enzymes, BUN and FBS) has occurred in a few patients treated with lithium plus an antipsychotic. In some instances, the syndrome was followed by irreversible brain damage. Because of a possible causal relationship between these events and the concomitant administration of lithium and antipsychotics, patients receiving such combined therapy should be monitored closely for early evidence of neurologic toxicity and treatment discontinued promptly if such signs appear.

From what I have read, it appears that Stelazine is a risky drug and perhaps you should look into drugs that like Zyprexa, are newer, before attempting to take an older "typical" antipsychotic. Several "atypical" antipsychotics are available for your "enjoyment", so please discuss the atypical antipsychotics (abbreviated here on CB often as "AAPs") that are available where you live.

[Silver]

I quite like Stelazine (trifluoperazine.) It's one of the gentler 'old-school' antipsychotics, quite a bit more tolerable for me than haloperidol. Perphenazine/Trilafon is my other pick, but Stelazine is quite notable for its anti-anxiety effects.

It's my 'rescue' drug for manic or depressive psychosis. It actually has quite a wide dose range, which is nice - the tiny doses are good for anxiety, I'm told; the higher doses are the antipsychotic doses.

[yellowbutterflies]

Hi LM, thanks for the info... after some research I may cross this one off my list of potential "rescue meds". This is pretty much like some dark-humoured elimination game where you're your own guinea pig, isn't it? However, it's still something I am considering on the advice of my old pdoc.

I have tried Zyprexa and, like you, have come off to to experience "an immediate, inconsolable insomnia followed a week later by one of the worst depressions I've ever been in" in your words plus an increased anxiety and restlessness for me (these symptoms may be due to the side-effects of the lamotrigine I am on - which the Zyprexa was masking). Anyway I am just pushing through the said depression now, particularly acute dark morning depression (did you get that?), and am considering other AAPs (hence this topic) but not sure where to go from here yet. I like to imagine I can get over this bump without extra meds and hope that it is just the withdrawal phase but with increased suicidal thoughts it may not be sensible. Sign. Sarah

[yellowbutterflies]

I quite like Stelazine (trifluoperazine.) It's one of the gentler 'old-school' antipsychotics, quite a bit more tolerable for me than haloperidol. Perphenazine/Trilafon is my other pick, but Stelazine is quite notable for its anti-anxiety effects.

It's my 'rescue' drug for manic or depressive psychosis. It actually has quite a wide dose range, which is nice - the tiny doses are good for anxiety, I'm told; the higher doses are the antipsychotic doses.

Hey Silver, may I ask you why you chose this medication over something such as Zyprexa? Ie: what are it's benefits for you? Obviously it's different for everyone I know, just curious. Sarah

[Silver]

For whatever reason, Stelazine worked better for me; I have always already had lithium on board as a mood stabilizer, so haven't needed that part from the Zyprexa; the antipsychotic effect of the Stelazine is pretty rapid. Same holds true for perphenazine, by the way.

Anxiety is -not- a predominant symptom for me, by the way - but the dose range has been very useful with Stelazine for me, because I have been on some interacting medications, and so my psychiatrist has wanted that flexibility.

[AirMarshall]

My wise and brilliant post apparently got lost in the server shuffle. LOL.

in short, my mom was on Stelazine for 40 years for depression and anxiety and loved it. the last year of so she developed a bit of hand tremor, but refused to give it up. The Pdoc had to pry the bottle out of her hand before switching her to some SSRI's and a wee bit of benzo.

It's an oldy but goody, probably a bit more sedating than the newer AP's. As I recall it was the second or third AP (after Thorazine) introduced in the mid 1950's. A true miracle drug. Imagine being able to actually treat Schizophrenia, depression and anxiety! Let us not forget that we have only recently emerged from the dark ages of MI treatment.

a.m.

[Silver]

Certainly not more sedating than Seroquel, in my case, although, to be fair, I'm usually taking it in a state of sufficient agitation (one way or another) that, hey, I really couldn't tell... Anyway, without going into a long discussion on relative sedation and why the dose matters - Stelazine's a darned good anxiolytic at low doses, and a rather handy antipsychotic.

Hard to find at times in the US, so, if anyone's prescribed it, do remember to make sure that it's written as "generic acceptable" (as this is the only option these days in the US - trifluoperazine is, actually, how it should be written... but Stelazine is a lot easier to spell) - and a lot of pharmacies will need to special-order it, so it'll take a day or two to show up. Depending, heh, on the crazy-quotient of your neighborhood. In my psychosis-prone area, the pharmacy had several bottles on hand. I was amused.

My psychiatrist was very annoyed because brand Stelazine isn't listed in the NDCs anymore, and so it isn't in the electronic rx systems.

And so, if one searches for "Stelazine," it doesn't show up. So your prescriber has to know to look for "trifluoperazine" instead. (Same problem comes up with Serzone - she has to look for nefazodone.) Just a little annoyance. Fun ways to amuse your doc while all the cross-walks get worked out on the electronic rx systems for retired brand-names.

[LikeMinded]

Okay, screw my scientific stereotypes of the phenothiazines... (n.B. - my foot tastes HORRIBLE!)

Looks like even I should consider this drug as a potential replacement for my Lamictal, or, to treat my depression as unipolar and use the Stelazine for crises as I used to use Zyprexa for.

Then again, the arrhythmia risk with Stelazine and its family does exist (and I've been told to watch my heart after one surgery, conditioning, de-conditioning, and then an infection, in no particular order).

And then the risk of TD is only for some (probably those with specific neurological infections).

Anyways, carry on. Pretend I never posted that information in my initial reply.

</embarrassed>