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

Last updated: August 25, 2026

Carphenazine is a first-generation phenothiazine that U.S. clinicians once sold as Proketazine (Schering). You may also see the spelling carfenazine. Families type either name after an old hospital chart, a 1960s trial reprint, 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 carphenazine was, how NCATS and DrugBank describe it, what the historic hospital dose schedule looked like, 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 (DB01038) describes carphenazine as an antipsychotic used in hospitalized patients in the management of chronic schizophrenic psychoses. Salt record: DBSALT001419 (carphenazine maleate). (DrugBank DB01038, DBSALT001419)
• NCATS Inxight lists carphenazine maleate as US Previously Marketed, first approved in 1963, originator Schering, brand Proketazine. UNII 0HX1Z0A2MC. Parent UNII CLY16Y8Z7E. Salt formula C24H31N3O2S·2C4H4O4, molecular weight 657.731. (NCATS 0HX1Z0A2MC)
• PubChem CID 18104 lists the parent as C24H31N3O2S, about 425.6 g/mol, CAS 2622-30-2, and restates the DrugBank hospital-use line. Synonyms include carfenazine. (PubChem CID 18104)
• NCATS mechanism note: Proketazine blocks postsynaptic mesolimbic D1 and D2 receptors; listed possible effects include akathisia, tardive dyskinesia, extrapyramidal symptoms, and allergic purpura. Historic oral “sample use guide”: week 1, 25 mg three times daily; week 2, 50 mg three times daily; week 3, 75 mg three times daily; week 4, 100 mg three times daily; week 5 and after, 100 mg four times daily. That is an archived field, not a current prescription.
• Do not buy research-grade powder or unlabeled overseas tablets and swallow them. Phenothiazines as a class still carry LiverTox cautions. (LiverTox phenothiazines)
• 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 carphenazine?
• Proketazine, 1963 approval, and identifiers
• How this phenothiazine worked
• Historic hospital doses
• Safety, class risks, and what not to do
• What telehealth can still do
• How Klarity fits
• FAQ

What is carphenazine?

Carphenazine is a phenothiazine antipsychotic. DrugBank’s public summary is short and specific: clinicians used it in hospitalized patients to manage chronic schizophrenic psychoses. PubChem copies that same DrugBank sentence onto the CID 18104 record. NCATS uses the preferred name carfenazine maleate for the salt and lists Proketazine as the brand.

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

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

Proketazine, 1963 approval, and identifiers

NCATS lists first approval in 1963, originator Schering, and status US Previously Marketed. Condition on that card: schizophrenia, product PROKETAZINE, highest phase Approved. Route of administration for the sample use guide: oral.

Useful identifiers when a records team traces an old order:

• Salt UNII: 0HX1Z0A2MC
• Parent UNII: CLY16Y8Z7E
• DrugBank parent: DB01038; salt: DBSALT001419
• PubChem CID 18104; CAS 2622-30-2 (parent)
• EPA CompTox DTXSID2047852; NSC 71755; NCI Thesaurus C65289
• InChIKey for the maleate salt (NCATS): TVPJGGZLZLUPOB-SPIKMXEPSA-N

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

How this phenothiazine worked

NCATS describes Proketazine as blocking postsynaptic mesolimbic dopaminergic D1 and D2 receptors. The same card says it depresses hypothalamic and hypophyseal hormone release and is believed to depress the reticular activating system, which can affect basal metabolism, body temperature, wakefulness, vasomotor tone, and emesis. Primary targets listed: dopamine D1 receptor (antagonist) and dopamine D2 receptor (antagonist). NCI Thesaurus also classifies the salt as a phenothiazine antiemetic and an antipsychotic agent.

That is curator language from an archived card. It is not a reason to import powder or to copy a 1960s ward schedule at home.

Historic hospital doses

NCATS “sample in vivo use guide” (oral):

• First week: 25 mg three times daily
• Second week: 50 mg three times daily
• Third week: 75 mg three times daily
• Fourth week: 100 mg three times daily
• Fifth week and thereafter: 100 mg four times daily

The same card records a historic adverse-event snapshot at 100 mg four times daily, oral, in adults 18-60: faintness in one patient; skin rash listed as a grade 4 discontinuation event in one patient. NCATS also points to three 1967 PubMed titles on carphenazine in schizophrenic psychoses (PMID 4889058, 4863506, 6021593). Those are old hospital papers, not modern outpatient trials.

Do not treat that titration as a DIY plan. Hospital phenothiazine starts in that era assumed close observation for movement side effects, blood pressure drops, and rash.

Browse conditions and next steps

Safety, class risks, and what not to do

NCATS lists possible Proketazine effects as akathisia, tardive dyskinesia, extrapyramidal symptoms, and allergic purpura. Phenothiazines as a class still carry a LiverTox caution for drug-induced liver injury. That is a class note, not a unique carphenazine trial.

Typical antipsychotics also carry a class boxed warning on later labels: older adults with dementia-related psychosis who take antipsychotics have a higher chance of death. Proketazine is not a current option for that use, or for any other use, at a U.S. retail counter.

Do not buy carphenazine from a research catalog or an overseas seller and swallow it. If someone is in crisis now, call or text 988. Telehealth is the wrong channel for neuroleptic malignant syndrome, severe rigidity, collapse, or inability to stay safe.

What telehealth can still do

HHS (page last updated February 5, 2026) states that Medicare patients can permanently receive telehealth services for behavioral and mental health care in their home, with no geographic originating-site restriction, and that audio-only remains permanently allowed for those behavioral services. Several other Medicare telehealth flexibilities run through December 31, 2027, including the pause on the six-month in-person visit rule for Medicare behavioral telehealth.

A Klarity visit can cover current symptoms, prior hospital records, and whether a medicine that U.S. pharmacies still stock makes sense. It cannot restart Proketazine. New or worsening psychosis with danger to self or others still needs in-person or emergency care.

How Klarity fits

Klarity’s network includes 2,000+ licensed U.S. providers. You can start with a condition overview, then book a visit if a clinician agrees telehealth is appropriate. We do not promise that any plan will cover a specific medicine or visit type. Coverage varies. Verify benefits before you book.

See if a Klarity visit may fit

FAQ

Is Proketazine still available in the United States?

NCATS marks carphenazine maleate as U.S. previously marketed, first approved in 1963. It is not a current retail fill. Ask a clinician about medicines pharmacies actually stock.

Is carphenazine the same as carfenazine?

Yes. NCATS prefers carfenazine maleate for the salt. PubChem and DrugBank use carphenazine for the parent.

Can a telehealth clinician prescribe carphenazine?

No. The product is not a living U.S. outpatient option. A telehealth clinician can still evaluate symptoms and discuss available treatments.

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

Coverage varies by plan. Verify benefits before you book. Klarity cannot guarantee coverage.

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 DB01038; DrugBank DBSALT001419; NCATS 0HX1Z0A2MC; PubChem CID 18104; LiverTox NBK548793; HHS telehealth policy updates.