Monday, 27 January 2014

Trifluoperazine versus placebo for schizophrenia

Trifluoperazine (trade name Stelazine) is a long‐established antipsychotic drug that has been used since the 1950s to treat schizophrenia. It is one of the first generation (typical) drugs that have proven very effective for treating the ‘positive symptoms’ of schizophrenia, such as hearing voices, seeing things and having strange beliefs. These drugs may cause side effects such as involuntary shaking, restlessness and movement disorders such as having a strange posture.

There are also more modern drugs (second generation and atypical antipsychotic drugs). These are effective with the ‘positive symptoms’ of mental illness but also help treat ‘negative symptoms’ such as apathy, weight gain and loss of emotion in people with schizophrenia. These more modern drugs are much more expensive.

This review is based on a search for trials carried out in July 2012, and includes 10 studies with 686 participants. The aim was to determine the effects of trifluoperazine for schizophrenia when compared with placebo (a ‘dummy’ treatment). As expected, people given trifluoperazine showed a significant improvement compared to placebo in both the short and medium term, reinforcing the use of this well‐established typical antipsychotic for people with schizophrenia. However, trifluoperazine can cause side effects such as confusion, agitation, having a dry mouth and blurred vision, but causes less sedation and dizzy spells, so is generally well tolerated by people with schizophrenia.

The authors of the review conclude that trifluoperazine has similar effectiveness to other common antipsychotic drugs, although it may cause more side effects. Evidence used in the review was also graded as low or very low quality. In the light of this, use of other antipsychotic drugs should be considered before starting on trifluoperazine. Most of the included studies were conducted roughly 40 years ago so new, large, comprehensive and independent research trials are needed.

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