Butaperazine (Repoise): Why This Phenothiazine Left U.S. Pharmacies and What Telehealth Can Still Do

Last updated: August 25, 2026

Butaperazine is a first-generation phenothiazine that U.S. clinicians once sold as Repoise (maleate salt). You may also see the brand Tyrylen. Families type either name after an old hospital chart, a 1968 Council on Drugs note, or a bottle photo from a long stay on a psychiatric ward. It is not a current U.S. retail option. This guide explains what butaperazine was, how DrugBank and identifier registries describe it, what the 1968 JAMA evaluation covered, and how telehealth can still help someone who needs an evaluation for psychosis, agitation, or related symptoms.

This page is educational. It is not a diagnosis, a refill promise, or a claim that any plan will pay for a specific drug. Coverage varies by plan. Verify benefits before you book.

See conditions Klarity treats or start with online anxiety treatment if worry, restlessness, or tension is the main problem you want to discuss.

TL;DR

• DrugBank (DB13213) lists butaperazine as approved in 1967 and possibly discontinued in the 1980s. Formula on DrugBank browse cards: C24H31N3OS, about 409.59 g/mol. Class language: phenothiazines with a piperazine structure. (DrugBank DB13213)
• Public identifier records commonly list CAS 653-03-2 (parent), PubChem CID 12598, ChemSpider 12078, UNII TXP4T9106S, KEGG D02642, ChEBI CHEBI:135663, ChEMBL CHEMBL1697826, EPA CompTox DTXSID1022712, ATC N05AB09. Maleate salt listings often use CAS 1063-55-4. Treat those as catalog IDs, not a current prescription.
• JAMA published “Evaluation of a new antipsychotic agent. Butaperazine maleate (repoise maleate)” on December 2, 1968 (206(10):2307-8; PMID 4386884). PubMed MeSH points to phenothiazines, piperazines, and schizophrenia drug therapy. There is no abstract on the PubMed record. (PubMed 4386884)
• Do not buy research-grade powder or unlabeled overseas tablets and swallow them. Phenothiazines as a class still carry LiverTox cautions, including cholestatic injury patterns best documented with chlorpromazine and reported, less often, with other phenothiazines. (LiverTox phenothiazines / chlorpromazine chapter)
• Medicare behavioral telehealth in the home remains available on a permanent basis, with several other Medicare telehealth flexibilities extended through December 31, 2027 (HHS page last updated February 5, 2026). Klarity’s 2,000+ licensed providers can evaluate current symptoms and discuss medicines that U.S. pharmacies still stock. (HHS telehealth policy updates)

On this page

• What is butaperazine?
• Repoise, Tyrylen, and the 1967 approval
• What the 1968 JAMA evaluation actually is
• Safety, class risks, and what not to do
• What telehealth can still do
• How Klarity fits
• FAQ

What is butaperazine?

Butaperazine is a typical (first-generation) antipsychotic in the phenothiazine family. The piperazine side chain puts it nearer to drugs such as perphenazine and trifluoperazine than to more sedating aliphatic phenothiazines such as chlorpromazine. DrugBank’s public card is short: approved in 1967, and possibly discontinued in the 1980s.

If you found “Repoise” on a late-1960s ward order, you are usually looking at butaperazine maleate. If you only searched “Tyrylen,” you are still looking at the same parent molecule. Related Klarity first-generation guides include carphenazine (Proketazine), acetophenazine (Tindal), and piperacetazine (Quide).

Klarity does not restart Repoise. A licensed clinician can still review current symptoms and talk through medicines U.S. pharmacies actually stock.

Repoise, Tyrylen, and the 1967 approval

DrugBank dates U.S. approval to 1967 and notes possible discontinuation in the 1980s. That matches the pattern of several piperazine phenothiazines that left retail shelves once later antipsychotics took over new starts.

Useful identifiers when a records team traces an old order:

• DrugBank: DB13213
• UNII: TXP4T9106S
• CAS (parent): 653-03-2
• CAS often listed for the maleate: 1063-55-4
• PubChem CID: 12598
• ChemSpider: 12078
• KEGG: D02642; ChEBI: CHEBI:135663; ChEMBL: CHEMBL1697826
• EPA CompTox: DTXSID1022712
• ATC: N05AB09
• InChIKey (parent): DVLBYTMYSMAKHP-UHFFFAOYSA-N
• IUPAC-style name in public registries: 1-[10-[3-(4-methylpiperazin-1-yl)propyl]phenothiazin-2-yl]butan-1-one

Treat every milligram figure you find in old monographs as historic. They are not a current U.S. label you can fill at a chain pharmacy.

What the 1968 JAMA evaluation actually is

On December 2, 1968, JAMA published a Council-style note titled “Evaluation of a new antipsychotic agent. Butaperazine maleate (repoise maleate)” (volume 206, issue 10, pages 2307-2308). PubMed indexes it as PMID 4386884. The public PubMed record has no abstract. MeSH terms include phenothiazines (administration and dosage, adverse effects, pharmacology, therapeutic use), piperazines (therapeutic use), schizophrenia (drug therapy), and tranquilizing agents.

That is enough to say clinicians evaluated Repoise maleate as an antipsychotic for schizophrenia-related care in the late 1960s. It is not enough to reconstruct a modern dose table, response rate, or side-effect percentage from this page. Do not treat a 1968 evaluation title as a current Medication Guide.

If a family still has a paper reprint, bring it to a licensed clinician. Do not use it as a home-dosing chart.

Safety, class risks, and what not to do

Butaperazine sits in the same chemical family as chlorpromazine, fluphenazine, perphenazine, and trifluoperazine. LiverTox documents chlorpromazine as a well-known cause of cholestatic liver injury and notes that most other phenothiazines used for psychosis have also been implicated in cholestatic jaundice with a similar course, usually at a lower frequency than chlorpromazine. Cross-sensitivity among phenothiazines can occur.

First-generation antipsychotics as a class also carry movement risks (acute dystonia, parkinsonism, akathisia, tardive dyskinesia), neuroleptic malignant syndrome, sedation, and a boxed-style warning on later labels for higher death risk when antipsychotics are used in older adults with dementia-related psychosis. Those class facts still apply even when a specific brand left the market.

Do not import unlabeled capsules, “research chemical” powder, or veterinary leftovers. A U.S. clinician cannot restart Repoise at a standard retail pharmacy. If someone is already unstable, hallucinating, or unable to stay safe, that is emergency care, not a mail-order chemistry project.

If you or someone you know is in crisis, call or text 988.

What telehealth can still do

A video visit cannot resurrect a discontinued phenothiazine. It can still do useful work: review current symptoms, map an old ward list onto medicines that exist today, screen for danger, and decide whether outpatient care is enough.

HHS (page last updated February 5, 2026) states that Medicare patients can permanently receive behavioral and mental health telehealth in the home, without geographic originating-site limits, including audio-only when video is not possible. An in-person visit within six months of an initial Medicare behavioral telehealth service is not required through December 31, 2027. Several non-behavioral Medicare telehealth flexibilities also run through that date.

Go in person or to an emergency department for first-episode or worsening psychosis with danger to self or others, suspected neuroleptic malignant syndrome, severe dystonia, high fever, collapse, or if the person cannot stay safe at home.

How Klarity fits

Klarity Health connects adults with 2,000+ licensed providers for online mental health care. Coverage varies by plan. Verify benefits before you book. A visit is a chance to talk through diagnosis questions and current options. It is not a promise that butaperazine, or any named drug, will be prescribed or paid for.

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FAQ

Is Repoise still available in the United States?

DrugBank says butaperazine was approved in 1967 and possibly discontinued in the 1980s. It is not a current U.S. retail option. Ask a licensed clinician about medicines pharmacies still stock.

Is butaperazine the same as Tyrylen?

Public records treat Repoise and Tyrylen as brand names for butaperazine. Confirm any old bottle with a clinician or pharmacist before you assume they match.

Can I start butaperazine online?

No. U.S. pharmacies do not fill this drug as a routine outpatient product. Telehealth can still evaluate symptoms and discuss alternatives.

Does insurance cover a visit to talk about an old antipsychotic?

Coverage varies by plan. Verify benefits before you book. Klarity cannot guarantee that any plan will pay for a visit or a specific medicine.

Disclaimer

This article is education, not medical advice, diagnosis, or a promise of treatment or insurance payment. Medication decisions belong to you and a licensed clinician. If you may harm yourself or someone else, call 911 or 988.

Sources: DrugBank DB13213; PubMed 4386884 / JAMA 1968; LiverTox NBK548793; HHS telehealth policy updates.