Stelazine versus Selegiline — A Hazard in Prescription Writing

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Abstract
Selegiline (Eldepryl), a selective monoamine oxidase type B inhibitor, is a new medication recently approved as adjunctive therapy for Parkinson's disease. Trifluoperazine (Stelazine) is a neuroleptic agent that blocks dopamine receptors and can induce parkinsonism. During a six-month period, two patients with Parkinson's disease were dispensed trifluoperazine (5 mg) instead of selegiline (5 mg). The first patient was a 74-year-old woman with an eight-year history of Parkinson's disease responsive to treatment with carbidopa and levodopa (Sinemet) who was given a handwritten prescription for selegiline (5 mg twice daily). A pharmacy mistakenly filled this prescription by dispensing trifluoperazine (5 mg twice daily). The patient took the trifluoperazine for four weeks and was noted to have substantially increased rigidity and mental changes. Upon discontinuing the misdispensed trifluoperazine, she recovered quickly. No lasting effects were noted. A second patient received trifluoperazine from a different pharmacy under similar circumstances. He took one tablet of the drug and on noting worsening symptoms, stopped subsequent use. The error was noted during a routine review of medications at a follow-up appointment.