A COMPARATIVE STUDY OF OXYPERTINE AND TRIFLUOPERAZINE IN CHRONIC SCHIZOPHRENIA--A NEW APPLICATION OF THE WING RATING SCALE

Trifluoperazine for schizophrenia

BACKGROUND

Trifluoperazine is an inexpensive accessible 'high potency' antipsychotic drug, widely used to treat schizophrenia or related psychoses.

OBJECTIVES

To estimate the effects of trifluoperazine compared with placebo and other drugs.

SEARCH STRATEGY

Searches of the Cochrane Schizophrenia Group's register of trials (March 2002), supplemented with hand searching, reference searching, personal communication and contact with industry.

SELECTION CRITERIA

All clinical randomised trials involving people with schizophrenia and comparing trifluoperazine with any other treatment.

DATA COLLECTION AND ANALYSIS

Studies were reliably selected and quality rated and data was extracted. For dichotomous data, relative risks (RR) were estimated, with 95% confidence intervals (CI). Where possible, we undertook intention-to-treat analyses. For statistically significant results, the number needed to treat (NNT) was calculated. We estimated heterogeneity (I-square technique) and publication bias.

MAIN RESULTS

1162 people from 13 studies were randomised to trifluoperazine or placebo. For global improvement, small short-term studies favoured trifluoperazine (n=95, 3 RCTs, RR 0.62 CI 0.49 to 0.78 NNT 3 CI 2 to 4). Loss to follow up was about 12% in both groups (n=280, 7 RCTs, RR 0.99 CI 0.62 to 1.57) and more people allocated trifluoperazine used antiparkinson drugs to alleviate movements disorders compared with placebo (n=195, 4 RCTs, RR 5.06 CI 2.49 to 10.27, NNH 4 CI 2 to 9). 2230 people from 49 studies were randomised to trifluoperazine or another older generation antipsychotic. Trifluoperazine was not clearly different in terms of 'no substantial improvement' (n=1016, 27 RCTs, RR 1.06 CI 0.98 to 1.14) or leaving the study early (n=930, 22 RCTs, RR 1.15 CI 0.83 to 1.58). Almost identical numbers of people reported at least one adverse event (60%) in each group (n=585, 14 RCTs, RR 0.99 CI 0.87 to 1.13), although trifluoperazine was more likely to cause extrapyramidal adverse effects overall when compared to low potency antipsychotics such as chlorpromazine (n=130, 3 RCTs, RR 1.66 CI 1.03 to 2.67, NNH 6 CI 3 to 121). One small study (n=38) found no clear differences between trifluoperazine and the atypical drug, sulpiride.

REVIEWER'S CONCLUSIONS

Although there are shortcomings and gaps in the data, there appears to be enough consistency over different outcomes and periods to confirm that trifluoperazine is an antipsychotic of similar efficacy to other commonly used neuroleptics for people with schizophrenia. Its adverse events profile is similar to that of other drugs. It has been claimed that trifluoperazine is effective at low doses for patients with schizophrenia but this does not appear to be based on good quality trial based evidence.

Trifluoperazine for schizophrenia

BACKGROUND

Trifluoperazine is an inexpensive accessible 'high potency' antipsychotic drug, widely used to treat schizophrenia or related psychoses.

OBJECTIVES

To estimate the effects of trifluoperazine compared with placebo and other drugs.

SEARCH STRATEGY

Searches of the Cochrane Schizophrenia Group's register of trials (March 2002), supplemented with hand searching, reference searching, personal communication and contact with industry.

SELECTION CRITERIA

All clinical randomised trials involving people with schizophrenia and comparing trifluoperazine with any other treatment.

DATA COLLECTION AND ANALYSIS

Studies were reliably selected and quality rated and data was extracted. For dichotomous data, relative risks (RR) were estimated, with 95% confidence intervals (CI). Where possible, we undertook intention-to-treat analyses. For statistically significant results, the number needed to treat (NNT) was calculated. We estimated heterogeneity (I-square technique) and publication bias.

MAIN RESULTS

1162 people from 13 studies were randomised to trifluoperazine or placebo. For global improvement, small short-term studies favoured trifluoperazine (n=95, 3 RCTs, RR 0.62 CI 0.49 to 0.78 NNT 3 CI 2 to 4). Loss to follow up was about 12% in both groups (n=280, 7 RCTs, RR 0.99 CI 0.62 to 1.57) and more people allocated trifluoperazine used antiparkinson drugs to alleviate movements disorders compared with placebo (n=195, 4 RCTs, RR 5.06 CI 2.49 to 10.27, NNH 4 CI 2 to 9). 2230 people from 49 studies were randomised to trifluoperazine or another older generation antipsychotic. Trifluoperazine was not clearly different in terms of 'no substantial improvement' (n=1016, 27 RCTs, RR 1.06 CI 0.98 to 1.14) or leaving the study early (n=930, 22 RCTs, RR 1.15 CI 0.83 to 1.58). Almost identical numbers of people reported at least one adverse event (60%) in each group (n=585, 14 RCTs, RR 0.99 CI 0.87 to 1.13), although trifluoperazine was more likely to cause extrapyramidal adverse effects overall when compared to low potency antipsychotics such as chlorpromazine (n=130, 3 RCTs, RR 1.66 CI 1.03 to 2.67, NNH 6 CI 3 to 121). One small study (n=38) found no clear differences between trifluoperazine and the atypical drug, sulpiride.

REVIEWER'S CONCLUSIONS

Although there are shortcomings and gaps in the data, there appears to be enough consistency over different outcomes and periods to confirm that trifluoperazine is an antipsychotic of similar efficacy to other commonly used neuroleptics for people with schizophrenia. Its adverse events profile is similar to that of other drugs. It has been claimed that trifluoperazine is effective at low doses for patients with schizophrenia but this does not appear to be based on good quality trial based evidence.

Comparison of the acute actions of amine-depleting drugs and dopamine receptor antagonists on dopamine function in the brain in rats

The effects of the monoamine depleting drugs oxypertine, tetrabenazine and reserpine were compared with those of the dopamine receptor antagonists, chlorpromazine and trifluoperazine, on behavioural and biochemical indices of dopamine function in the brain. Oxypertine (0.625-20 mg/kg, i.p.), chlorpromazine (0.625-20 mg/kg i.p.) and trifluoperazine (0.0625-2.0 mg/kg i.p.), administered to rats 1 hr previously, inhibited stereotyped behaviour induced by both amphetamine (5.0 mg/kg i.p.) and apomorphine (1.0 mg/kg, s.c.) in a dose-dependent manner. Tetrabenazine (0.625-20 mg/kg i.p., 1 hr previously) inhibited stereotypy induced by amphetamine but not that induced by apomorphine. Reserpine (0.1 10 mg/kg i.p., 6 hr previously) did not inhibit, but in larger doses, tended to enhance the stereotyped responses to both amphetamine and apomorphine. Oxypertine (10 mg/kg, i.p., 1 hr previously), tetrabenazine (5 mg/kg i.p., 1 hr previously) and reserpine (2.5 mg/kg i.p., 6 hr previously) reduced the content of dopamine in the striatum but increased the concentrations of homovanillic acid (HVA) and 3,4-dihydroxyphenylacetic acid (DOPAC). Chlorpromazine (5 mg/kg i.p.) and trifluoperazine (0.5 mg/kg i.p.), given 1 hr previously, did not alter concentrations of dopamine in the striatum but increased those of HVA and DOPAC. Oxypertine, chlorpromazine and trifluoperazine weakly inhibited dopamine-stimulated adenylate cyclase in homogenates of the striatum in the rat. Tetrabenazine and reserpine had no effect. Similarly, trifluoperazine and chlorpromazine displaced the specific binding of [3H]piflutixol to membranes from the striatum. Oxypertine also was weakly effective, but tetrabenazine and reserpine were without effect. Trifluoperazine, chlorpromazine and oxypertine displaced specific binding of [3H]spiperone and [3H]N,n-propylnorapomorphine (NPA) to preparations of the striatum.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of the effects of oxypertine and trifluoperazine in withdrawn schizophrenics

There is a growing body of evidence that oxypertine (Win. 18,501), a recently developed indolylalkyl-phenyl-piperazine (1, 9), is of value in the treatment of schizophrenia (6). Oxypertine has been described as superior to trifluoperazine in its effect on certain aspects of schizophrenic behaviour (2, 5).

A double-blind trial of amitriptyline/perphenazine, perphenazine and placebo in chronic withdrawn inert schizophrenics

Since the introduction of chlorpromazine in the early 1950's, various phenothiazine tranquillizers have become established as standard treatment in schizophrenia. However, it is recognized that these drugs have their limitations; every mental hospital contains a large group of schizophrenics whose illness is unaffected or only partially modified by phenothiazines, and some patients develop side-effects sufficiently severe to preclude these drugs being given in fully effective doses.

An extended trial of oxypertine in five selected cases of chronic schizophrenia

The value of oxypertine in the treatment of chronic schizophrenia has been the subject of several clinical trials, the results of which have been reviewed recently (Skarbek and Jacobsen, 1965). In particular a comparison of the effects of oxypertine and trifluoperazine in thirty-five schizophrenic women revealed statistically significant differences between the drugs, oxypertine showing a tendency to activate the withdrawn cases (Calwell, Jacobsen and Skarbek, 1964). An opportunity arose to study five of these patients again under controlled conditions, and it was felt that this would be useful for two reasons. First, it would show whether the response to oxypertine was repeatable, as the patients had meanwhile resumed their previous treatment. Secondly, by a detailed examination over an extended period, using a battery of tests and flexible dosage, a more exact delineation of the optimal symptomatic response to oxypertine could be made.

Oxypertine. A review of clinical experience

Oxypertine (also known as WIN 18,501–2) is a member of a new series of indolylalkylphenyl-piperazines synthesized by Archer et al (1). It resembles serotonin in respect of its indole nucleus, and the piperazine side-chain indicates a structural relationship with some of the major phenothiazines. Pharmacological studies by Wylie and Archer (17) showed oxypertine to have tranquillizing properties, and following preliminary human tolerance investigations (15) the psychotherapeutic nature of the agent was investigated by various workers in the United States and Europe.