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

Last updated: August 24, 2026

Piperacetazine is a first-generation phenothiazine that U.S. clinicians once sold as Quide. Families still type the generic name after an old chart, a pill bottle photo, or a paper from a long hospital stay. The medicine is not a current U.S. retail option. This guide explains what piperacetazine was, what the historic 10 mg Quide tablets were for, why it left pharmacies, 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

• Piperacetazine was an antipsychotic. PubChem and DrugBank (DB06808) both use that past-tense label. Brand name Quide. Other codes: PC-1421, SC-9794. CAS 3819-00-9. UNII KL6248WNW4. Molecular formula C24H30N2O2S, about 410.6 g/mol. (PubChem CID 19675, DrugBank DB06808)
• NCATS Inxight lists piperacetazine as US Previously Marketed, first approved in 1969, originator Searle, oral route, preferred name QUIDE, condition chronic schizophrenia. NCI classifies it as a phenothiazine antiemetic and an antipsychotic agent. (NCATS KL6248WNW4)
• A 1969 Clinical Pharmacology & Therapeutics product note, cited by Cayman Chemical, described Quide tablets as 10 mg (orange) in bottles of 100 and 1,000 and said Quide was useful in chronic schizophrenic states of long duration. Cayman still sells the chemical as a typical antipsychotic for lab use only, not for human use. (Cayman 35220)
• NCATS restates a historic clinical note: Quide was viewed as useful for some chronically hospitalized patients with schizophrenia; side effects were generally mild in that write-up, with no evidence then of blood dyscrasias or liver impairment. That is historic language, not a current safety clearance. Phenothiazines as a class still carry LiverTox cautions. (LiverTox phenothiazines)
• Do not buy piperacetazine from a research catalog or an overseas seller and swallow it. Cayman states the product is not for human or veterinary use.
• 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 piperacetazine?
• Quide brand, 10 mg tablets, and 1969 approval
• How this phenothiazine worked
• Who historically received Quide
• Why Quide left U.S. pharmacies
• Safety, class risks, and what not to do
• What telehealth can still do
• How Klarity fits
• FAQ

What is piperacetazine?

Piperacetazine is a member of the phenothiazines. PubChem gives the systematic name 1-[10-[3-[4-(2-hydroxyethyl)-1-piperidinyl]propyl]-2-phenothiazinyl]ethanone and lists synonyms Quide, Piperacetazina, PC-1421, and UNII-KL6248WNW4. DrugBank’s one-line background is blunt: piperacetazine was an antipsychotic. That past tense matches NCATS status “US Previously Marketed.”

Cayman Chemical catalogs it as a typical antipsychotic with lab codes PC-1421 and SC-9794. The company notes formulations containing piperacetazine have been used in the treatment of schizophrenia. It also reports animal pharmacology from the 1969 product literature: the compound inhibited spontaneous motor activity and food-reinforced responding in rats and potentiated hexobarbital-induced narcosis in mice. Those are historic lab findings, not a home-dosing guide.

If you found “piperacetazine” next to Quide on an old discharge list, you are looking at the same molecule. If you only searched the word “Quide,” confirm the context. That string also appears on unrelated products and pages, which is why this article uses the generic name in the title and throughout the body.

Quide brand, 10 mg tablets, and 1969 approval

NCATS lists first approval in 1969, originator Searle, and QUIDE as the preferred English name. Identifiers include MeSH C067601, RxNorm RXCUI 8338, ECHA 223-312-0, and EPA CompTox DTXSID7023481. The Orange Book and Green Book name strings still appear in the NCATS name table, which is typical for a withdrawn U.S. product that once had official listings.

Cayman cites Pitman-Moore, “Piperacetazine (Quide tablets),” Clinical Pharmacology & Therapeutics 10(5):749-754 (1969). Search snippets of that note describe Quide as useful in chronic schizophrenic states of long duration and list Quide tablets 10 mg (orange) in bottles of 100 and 1,000. Treat those strengths as historic commercial facts. They are not a current prescription you can fill at a U.S. retail pharmacy.

Route of administration on the NCATS card is oral. Sample in-vivo “use guide” fields on that card are marked unknown, which is another signal that this is an archived molecule, not a living label with a modern Medication Guide.

How this phenothiazine worked

Typical antipsychotics in this family block dopamine D2 receptors in mesolimbic pathways. That action can reduce hallucinations and delusions. It can also produce extrapyramidal symptoms, prolactin changes, and sedation. NCATS classifies piperacetazine under NCI Thesaurus as both an antipsychotic agent and a phenothiazine antiemetic. Antiemetic activity is common in the phenothiazine class because dopamine blockade also hits the chemoreceptor trigger zone.

NCATS description language calls piperacetazine an “antipsychotic prodrug.” That phrase sits on the government card; it does not come with a published conversion table or active-metabolite dose on the same page. Do not infer a milligram-to-milligram swap with chlorpromazine, thioridazine, or a modern atypical from that one word.

A 2015 dose-equivalent paper that includes older first-generation agents lists a piperacetazine figure of 10.5 (with a reported 4.1 companion value) in a table of chlorpromazine-style equivalents. That is a research conversion used by trialists, not a home conversion chart. (Leucht et al., PMC4601707)

Who historically received Quide

The approved condition on the NCATS card is chronic schizophrenia, product QUIDE. The NCATS narrative says a study indicated Quide was a useful addition for the physician treating the chronic hospitalized patient with a schizophrenic illness. Side effects in that write-up were generally mild, and the authors reported no evidence that it would produce blood dyscrasias or liver impairment.

Read that as 1960s–1970s hospital-era language. It does not mean piperacetazine was gentle by 2026 standards. Phenothiazines later accumulated boxed warnings for increased mortality in elderly patients with dementia-related psychosis, tardive dyskinesia risk, neuroleptic malignant syndrome, and, for some members of the class, QT prolongation. A 1975 PubMed record on the NCATS card is titled “Atypical tardive dyskinesia” (PMID 1119614), which is a reminder that movement effects were already in the literature.

Piperacetazine also appears in older trial search strategies and in a Cochrane-era comparison line of chlorpromazine versus piperacetazine for schizophrenia. Those citations show researchers still index the name. They do not mean a U.S. clinic can order Quide tomorrow.

Why Quide left U.S. pharmacies

Public cards do not publish a single FDA “why we pulled Quide” press release in the sources retrieved for this article. What they do show is status: DrugBank “was an antipsychotic,” NCATS “US Previously Marketed,” first approved 1969, no current DailyMed consumer label, and research vendors selling the powder with a human-use prohibition.

Many first-generation phenothiazines left the U.S. market as newer antipsychotics arrived, as manufacturers stopped making low-volume SKUs, and as class safety expectations tightened. Mesoridazine (Serentil), triflupromazine (Vesprin), acetophenazine (Tindal), and promazine (Sparine) followed similar paths. Piperacetazine sits in that same historic shelf.

If a relative still has orange 10 mg Quide tablets, do not take them. Potency, identity, and storage after decades are unknown. Bring the bottle or a photo to a licensed clinician and ask what current options match the original problem, not the original brand.

Safety, class risks, and what not to do

LiverTox groups phenothiazines as a class that can injure the liver, even when a specific withdrawn member has little modern case detail. Sedation, low blood pressure on standing, dry mouth, constipation, blurred vision, photosensitivity, and movement disorders (dystonia, parkinsonism, akathisia, tardive dyskinesia) are class-typical. Neuroleptic malignant syndrome is rare and urgent: rigidity, high fever, confusion, unstable vitals.

Do not combine leftover phenothiazines with alcohol, opioids, or extra sedatives. Do not start a research-grade vial. Cayman’s warning is explicit: not for human or veterinary use. A later lab paper also reported piperacetazine can inhibit lysosome acidification and showed antiviral activity against Ebola in cell culture (IC50 <8.5 µM). That is a bench finding. It is not a reason to self-dose. (Cayman product description)

If you or someone near you has thoughts of self-harm, call or text 988 (Suicide & Crisis Lifeline) or use local emergency services. Telehealth is the wrong channel for an emergency.

What telehealth can still do

Piperacetazine itself is not a telehealth medicine. A video visit cannot magically restock Quide. A visit can still:

• Take a history of the original diagnosis (schizophrenia, schizoaffective disorder, severe agitation, or something else that got labeled loosely in an old chart).
• Screen for current psychosis, mania, depression, anxiety, insomnia, and substance use.
• Review what you actually take now, including leftover bottles and supplements.
• Discuss antipsychotics and related medicines that U.S. pharmacies still dispense, when a clinician judges they fit.
• Coordinate labs, an ECG, or an in-person referral when the story needs it.

HHS summarizes current Medicare telehealth rules on a page last updated February 5, 2026. Medicare patients can permanently receive behavioral and mental 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. Broader Medicare telehealth flexibilities for non-behavioral care also run through that date. State licensing and controlled-substance rules still apply to the clinician and the patient location.

Klarity is not a Medicare billing desk. The federal rules above explain why video psychiatry is now ordinary care. They do not guarantee that your commercial plan, Medicaid plan, or Medicare Advantage contract will pay a specific visit or drug. Ask the plan.

How Klarity fits

Klarity Health is an online clinic with 2,000+ licensed providers. Visits focus on conditions people actually present with today: anxiety, depression, ADHD, insomnia, OCD, and related concerns, plus some primary-care needs. If your question is “I found Quide / piperacetazine on a 1970s list; what should I do now?”, a licensed clinician can hear the current symptoms and talk through options that exist in 2026.

Insurance may help with the visit or with a current medicine. It may not. Prior authorization is common for antipsychotics. Klarity does not promise coverage. Verify benefits before you book.

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FAQ

Is piperacetazine the same as Quide?

Yes in historic U.S. branding. PubChem, NCATS, and Cayman all list Quide as the trade name for piperacetazine. Confirm you are not looking at an unrelated product that happens to use the same four letters.

Can I still get Quide 10 mg tablets in the United States?

Not as a routine retail product. NCATS marks the drug US Previously Marketed (1969 approval). DrugBank says it was an antipsychotic. Research vendors sell the chemical for lab work only.

What dose did people take?

The 1969 product note described 10 mg orange tablets. NCATS does not publish a modern start/usual/max schedule. Do not reconstruct a home dose from tablet color or from chlorpromazine-equivalent tables meant for researchers.

Is piperacetazine a controlled substance?

The sources retrieved for this article do not assign a DEA schedule. Phenothiazine antipsychotics are typically not scheduled the way stimulants are. That does not make an old bottle safe to swallow.

Can telehealth prescribe piperacetazine?

A U.S. telehealth clinician cannot supply a discontinued commercial product. They can evaluate you and, when appropriate, discuss currently marketed alternatives.

Does insurance cover a visit about an old antipsychotic?

Maybe. Coverage varies by plan, diagnosis codes, and whether the clinician is in network. Verify benefits. Do not treat any page on this site as a coverage determination.

Sources

• PubChem: Piperacetazine (CID 19675)
• DrugBank: Piperacetazine (DB06808)
• NCATS Inxight: PIPERACETAZINE (KL6248WNW4)
• Cayman Chemical: Piperacetazine (item 35220), citing Clin. Pharmacol. Ther. 1969;10(5):749-754
• Leucht et al., dose equivalents (PMC4601707)
• NCBI LiverTox: Phenothiazines
• HHS: Telehealth policy updates (updated February 5, 2026)

Educational content only. Not medical advice. If this is an emergency, call 911. For a mental health crisis, call or text 988.