Dixyrazine (Esucos): Why This Phenothiazine Is Not in U.S. Pharmacies and What Telehealth Can Still Do

Last updated: August 25, 2026

Dixyrazine (also written dixypazin as the oxalate) is a typical phenothiazine antipsychotic. Public chemistry records list it as DrugBank DB13784, ATC N05AB01, CAS 2470-73-7, PubChem CID 17182, UNII 7H368W3AYC, and formula C24H33N3O2S (about 427.60 g/mol). Brand names in older European use include Esucos, Ansiolene, Esocalm, Metronal, and Roscal. U.S. retail pharmacies do not stock it. If you saw Esucos abroad, or a relative still takes it, a U.S. visit is about evaluation and FDA-available options, not a mail-order refill of this molecule.

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TL;DR

• Dixyrazine is a piperazine phenothiazine (WHO ATC N05AB01) described as a neuroleptic, anxiolytic, and antihistamine. Wikipedia summarizes first German introduction in 1969 and historic daily doses of 12.5-75 mg.
• DrugBank’s public card is largely unannotated. Categories still place it with antiemetics, tranquilizing agents, and neurotoxic agents.
• It is not a U.S. retail product. Do not import leftover Esucos or crush foreign tablets.
• Klarity’s 2,000+ licensed clinicians can evaluate psychosis-spectrum symptoms, anxiety, and related conditions on video. They prescribe only medicines they can legally issue in your state.
• Insurance may help pay for a telehealth visit. Coverage varies by plan. Verify benefits before you book.
• If you have thoughts of suicide or cannot stay safe, call or text 988 now. Telehealth is the wrong channel for that emergency.

Contents

• What is dixyrazine?
• Identifiers and chemistry
• How clinicians used it outside the U.S.
• Why U.S. pharmacies do not carry Esucos
• Class risks of phenothiazines
• What a U.S. telehealth visit can still do
• FAQ

What is dixyrazine?

Dixyrazine is a typical (first-generation) antipsychotic in the phenothiazine family. Wikipedia’s monograph lists the code name UCB-3412 and the IUPAC name (RS)-2-[2-[4-(2-methyl-3-phenothiazin-10-ylpropyl)piperazin-1-yl]ethoxy]ethanol. The same page groups it with neuroleptics and antihistamines and records German introduction in 1969 (Wikipedia: Dixyrazine).

WHO’s ATC index files it under phenothiazines with piperazine structure as N05AB01, the first code in that subgroup (WHOCC ATC N05AB01). Wikipedia’s antipsychotic list repeats Esucos as the common trade name (List of antipsychotics).

DrugBank accession DB13784 exists, but the public background field is empty. That is a catalog stub, not a U.S. label. Do not treat DrugBank’s interaction engine as a substitute for a clinician who can see your full medication list.

A 2025 review of phenothiazine antipsychotics in the Journal of Heterocyclic Chemistry notes dixyrazine (also dixypazin) in the same chemical series as other piperazine phenothiazines (J. Heterocyclic Chem. 2025). The review is chemistry history, not a reason to restart an unavailable product.

Identifiers and chemistry

MassBank Europe’s dixyrazine record repeats CAS 2470-73-7, PubChem CID 17182, KEGG D07865, and ChEBI 135695 (MassBank HB000716). Those IDs help a U.S. clinician match a foreign blister pack. They do not mean a U.S. NDC exists.

Do not confuse dixyrazine with nearby piperazine phenothiazines already covered on this site: thioproperazine (Majeptil, DrugBank DB01622, ATC N05AB08), thiopropazate (Dartal, DB13557, N05AB05), butaperazine (Repoise), or carphenazine (Proketazine). Same ring system, different side chains, different regulatory histories.

How clinicians used it outside the U.S.

Wikipedia’s summary of historic use is modest: neuroleptic, anxiolytic, and antihistamine activity in daily doses of 12.5-75 mg after 1969 German introduction. Brazil lists it as Class C1 (other controlled substances) on that same page. That is a foreign scheduling note, not a DEA schedule for U.S. patients.

DrugBank files the molecule under antiemetics and tranquilizing agents even though the monograph itself is “Not Annotated.” Older European practice sometimes used low-dose phenothiazines for nausea or preoperative sedation. Without a current U.S. label, those historic uses do not transfer to an American telehealth visit.

If a discharge summary from Europe or Latin America lists Esucos, bring the pack photo and the dose in milligrams. Your U.S. clinician will map symptoms, not the brand.

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Why U.S. pharmacies do not carry Esucos

Typical reasons a named phenothiazine never becomes a U.S. retail SKU:

• No current FDA-approved NDA or ANDA for dixyrazine tablets or injection.
• A thin English-language evidence base compared with chlorpromazine, perphenazine, fluphenazine, and later atypicals.
• Manufacturers concentrated supply in a few European markets (historic Esucos / Ansiolene branding) rather than a U.S. launch.
• U.S. formularies already cover multiple first- and second-generation antipsychotics with established REMS, labs, and prior-authorization pathways.

Medicare telehealth policy is a separate issue from this molecule. HHS last updated its telehealth policy page on February 5, 2026 and notes that recent legislation extends many Medicare telehealth flexibilities through December 31, 2027 (HHS telehealth policy updates). That extension may help you see a U.S. clinician on video. It does not authorize Esucos imports.

Class risks of phenothiazines

NCBI LiverTox’s phenothiazine records (for example the fluphenazine chapter, Bookshelf ID NBK548610) describe the class as older dopamine D2 antagonists with a well-known extrapyramidal, anticholinergic, and occasional liver-injury profile (LiverTox: Fluphenazine / phenothiazine class). Dixyrazine sits in that chemical family even though LiverTox does not give it a dedicated U.S. chapter.

Expect a U.S. clinician to screen for movement symptoms, sedation, orthostatic dizziness, constipation, urinary retention, and drug–drug interactions (other dopamine blockers, QT-prolonging medicines, strong CYP inhibitors). DrugBank’s interaction pages flag combinations such as raised serum levels of some beta blockers when listed with dixyrazine. Treat those as class alerts until a pharmacist reviews your actual list.

Never stop a foreign antipsychotic abruptly because a U.S. site “doesn’t carry it.” Abrupt dopamine-blocker withdrawal can worsen psychosis or produce withdrawal dyskinesia. Plan a supervised switch.

What a U.S. telehealth visit can still do

A licensed Klarity clinician can:

• Take a structured history of psychosis, mania, severe anxiety, insomnia, or nausea that led someone to Esucos abroad.
• Review photos of foreign packs and translate milligram doses into a U.S. differential.
• Discuss FDA-available first-generation options (for example perphenazine or fluphenazine) or second-generation options when those better match your diagnosis and labs.
• Coordinate labs, AIMS-style movement checks, and follow-up video visits.
• Talk through how your commercial or Medicare Advantage plan may treat mental-health visits. Coverage is not guaranteed. Ask the plan.

Klarity does not ship dixyrazine, compound Esucos, or help you buy it from overseas websites. Controlled-substance and antipsychotic decisions stay inside U.S. law and the clinician’s license.

If anxiety, not psychosis, is the main problem, start at the condition hub or the online anxiety treatment page. Same-day visits are available in many states. More than 2,000 licensed providers work in the network.

FAQ

Is dixyrazine the same as Esucos?

Esucos is a historic trade name for dixyrazine. Other brands in public records include Ansiolene, Esocalm, Metronal, and Roscal. Confirm the INN on the pack, not only the logo.

Can I get Esucos through Klarity?

No. U.S. clinicians on this platform prescribe medicines they can legally issue. Dixyrazine is not a U.S. retail product.

What dose did European labels use?

Wikipedia’s monograph cites 12.5-75 mg per day for historic neuroleptic, anxiolytic, and antihistamine use. That is not a U.S. dosing instruction. Do not self-titrate leftover tablets.

Does insurance cover a visit about a foreign antipsychotic?

A medically necessary mental-health evaluation may be covered. Plans vary. Prior authorization is common for antipsychotics. Verify benefits before you book. Do not assume a plan “covers Esucos.”

When should I skip telehealth?

Go to an ER for new catatonia, neuroleptic malignant syndrome warning signs (high fever, rigidity, confusion), severe dystonia, or if you cannot stay safe. Call or text 988 for a suicidal crisis.

Disclaimer

This article is educational. It is not a diagnosis, a prescription, or a promise of insurance payment. Coverage varies by plan. Confirm benefits with your insurer. Klarity clinicians practice within U.S. licenses and do not dispense dixyrazine / Esucos.

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