Which phenothiazine is considered a strong sedative with fewer EPS?

The correct answer is piperidine. Piperidine derivatives are known for their notable sedative effects while typically presenting a lower incidence of extrapyramidal symptoms (EPS) compared to other phenothiazines, particularly the piperazine and aliphatic types.

Piperidine compounds, such as thioridazine, exhibit a stronger sedative action due to their ability to effectively block dopamine receptors, particularly within the central nervous system, contributing to their calming effects in patients. Additionally, their lower affinity for D2 dopaminergic receptors compared to other phenothiazines results in reduced risk of EPS, which are movement disorders caused by dopamine receptor blockade.

In contrast, piperazine derivatives, such as perphenazine and fluphenazine, are typically more potent antipsychotics but are associated with a higher likelihood of causing EPS due to their stronger interaction with dopaminergic pathways. Aliphatic phenothiazines, while also sedative, may still lead to significant EPS ramifications. Fluphenazine is more associated with a higher risk of these movement disorders while being less effective as a sedative.

Thus, the sedative properties and reduced risk of EPS make the piperidine class a favorable choice in certain clinical scenarios