Trade Names:Chlorpromazine Hydrochloride- Tablets 10 mg- Tablets 25 mg- Tablets 50 mg- Tablets 100 mg- Tablets 200 mg- Injection 25 mg/mLNovo-Chlorpramazine (Canada)
Effects apparently caused by dopamine receptor blockade in CNS.
Management of manic phase of manic-depressive disorder; treatment of schizophrenia; relief of anxiety and restlessness prior to surgery; adjunct in treatment of tetanus; management of acute intermittent porphyria and severe behavioral and conduct disorders in children 1 to 12 years of age; control of nausea and vomiting; relief of intractable hiccoughs.
Treatment of migraine headaches (IM or IV forms).
Comatose or severely depressed states; allergy to product or other phenothiazines; presence of large amounts of other CNS depressants.
IM 25 mg for prompt control; may repeat in 1 h. PO 25 to 50 mg 3 times daily after initial regimen. May initiate oral dosing with 10 mg 3 to 4 times daily or 25 mg 2 or 3 times daily.Children older than 6 mo of age
PO 0.5 mg/kg every 4 to 6 h as needed; IM 0.5 mg/kg every 6 to 8 h as needed.Psychiatric (inpatient)Adults
PO 25 mg 3 times daily; increase as needed; usually 400 mg/day. IM 25 mg initially; may give additional 25 to 50 mg in 1 h. Increase gradually until controlled. Up to 2,000 mg/day may be needed but generally not for extended periods.Children older than 6 mo of age
PO Start low and increase gradually; 50 to 100 mg/day may be needed in severe cases or 200 mg/day or more in older children. IM Up to 5 yr of age: Do not exceed 40 mg/day. 5 to 12 yr of age: Do not exceed 75 mg/day if possible.Acute Intermittent PorphyriaAdults
PO 25 to 50 mg 3 or 4 times daily; IM 25 mg 3 to 4 times daily.TetanusAdults
IM 25 to 50 mg 3 to 4 times daily usually in conjunction with barbiturates; IV 25 to 50 mg diluted to greater than or equal to 1 mg/mL and administered at rate of 1 mg/min.Children 6 mo of age and older
IM/IV 0.5 mg/kg every 6 to 8 h. When giving IV, dilute to at least 1 mg/mL and administer at rate of 1 mg per 2 min. In children 23 kg or under, do not exceed 40 mg/day; 23 to 45 kg, do not exceed 75 mg/day if possible.Nausea and VomitingAdults
PO 10 to 25 mg every 4 to 6 h as needed. IM 25 mg. If no hypotension, may give 25 to 50 mg every 4 to 6 h as needed.During surgery
IM 12.5 mg; repeat in 0.5 h if necessary and if no hypotension. IV 2 mg per fractional injection, at 2-min intervals (max, 25 mg). Dilute to 1 mg/mL (1 mL [25 mg]) mixed with 24 mL of saline.Children 6 mo of age and older
PO 0.55 mg/kg every 4 to 6 h. IM 0.55 mg/kg every 6 to 8 h as needed. Do not exceed 40 mg/day if younger than 5 yr of age (or 20 kg) or 75 mg/day if 5 to 12 yr of age (or 20 to 40 kg).During surgery
IM 0.25 mg/kg. Repeat in 0.5 h if necessary and no hypotension occurs. IV 1 mg per fractional injection at 2 minute intervals and not exceeding recommended IM dosage.Presurgical apprehensionAdults
PO 25 to 50 mg 2 to 3 h prior to surgery. IM 12.5 to 25 mg 1 to 2 h before surgery.Children 6 mo of age and older
PO 0.55 mg/kg 2 to 3 h before surgery. IM 0.55 mg/kg 1 to 2 h before surgery.Intractable HiccoughsAdults
PO 25 to 50 mg 3 to 4 times daily. IM May give 25 to 50 mg if symptoms persist 2 to 3 days. IV May use slow infusion if hiccoughs persist.
Store tablets and injection at controlled room temperature (59° to 86°F). Protect injection from light. Refrigeration is not required.
May cause increased CNS depression and may precipitate extrapyramidal reaction.Anticholinergics
May reduce therapeutic effects of and increase anticholinergic effects of chlorpromazine; may lead to tardive dyskinesia.Barbiturate anesthetics
May increase frequency and severity of neuromuscular excitation and hypotension.Beta-blockers
May result in increased plasma levels of beta-blocker and chlorpromazine.Cisapride, sparfloxacin
The risk of life-threatening cardiac arrhythmias, including torsades de pointes, may be increased.Epinephrine, norepinephrine
Actions of these drugs may be decreased or reversed.Guanethidine
The hypotensive effect of guanethidine may be inhibited.Lithium
May cause disorienting unconsciousness and extrapyramidal effects.Meperidine
May result in excessive sedation and hypotension.Metrizamide
Risk of seizure may increase.Paroxetine
Plasma levels of chlorpromazine may be elevated, increasing the risk of adverse reactions.
Chlorpromazine may discolor urine (pink to red-brown). False-positive pregnancy test results may occur (less likely with a serum test). Increases in protein-bound iodine have been reported. False-positive phenylketonuria test results may occur.
Orthostatic hypotension; hypertension; tachycardia; bradycardia; syncope; cardiac arrest; circulatory collapse; ECG changes.
Faintness; drowsiness; dystonias; dizziness; extrapyramidal adverse reactions (eg, pseudoparkinsonism, tardive dyskinesia); muscle spasms; motor restlessness; headache; weakness; tremor; fatigue; slurring; insomnia; vertigo; seizures; sedation; NMS; cerebral edema.
Photosensitivity; skin pigmentation; dry skin; exfoliative dermatitis; urticarial rash; maculopapular hypersensitivity reaction; seborrhea; eczema; contact dermatitis.
Pigmentary retinopathy; glaucoma; photophobia; blurred vision; increased IOP; mydriasis; nasal congestion; miosis.
Dry mouth; dyspepsia; constipation; adynamic ileus (with possible complications resulting in death); nausea; atonic colon; obstipation.
Urinary retention and hesitancy; impotence; sexual dysfunction; menstrual irregularities; lactation; moderate breast engorgement; priapism; breast enlargement; galactorrhea.
Agranulocytosis; eosinophilia; leukopenia; hemolytic anemia; thrombocytopenic purpura; pancytopenia.
Altered cholesterol levels.
Laryngospasm; bronchospasm; dyspnea, aspiration pneumonia; asthma; laryngeal edema.
Increased appetite and weight; polydipsia; heat stroke/hyperpyrexia; sudden death; angioneurotic edema; anaphylactoid reactions; systemic lupus erythematosus-like syndrome; increased prolactin levels.
Ensure medication is discontinued at least 48 h before myelography and not resumed until at least 24 h after procedure to reduce chance of seizures occurring.Neurologic status
Assess neurologic status before and during treatment. Observe for involuntary body and facial movements, excessive drowsiness, agitation, tremor, or anxiety. Inform health care provider if noted.Palpitations/Syncope
Notify health care provider immediately if palpitations or syncope occur.Review therapy
Ensure therapy is periodically reviewed to determine if it needs to be continued without change or if a dose change (eg, increase, decrease, discontinuation) is indicated.Test results
Ensure renal function, liver enzymes, and CBC with differential are evaluated before starting therapy and then periodically thereafter during prolonged treatment. Inform health care provider if abnormal results are noted.Treatment response
Frequently assess patient for response to treatment. Notify health care provider if condition being treated is not improving or is worsening.
Safety not established.
Excreted in breast milk.
Do not use in children younger than 6 mo of age unless considered life-saving. Do not use in conditions for which specific children's dosage is not established.
More susceptible to enhanced effects; consider lower dose.
Use caution in patients with CV disease or mitral insufficiency, history of glaucoma, EEG abnormalities or seizure disorders, prior brain damage, or hepatic or renal function impairment, or who will be exposed to extreme heat.
Abrupt withdrawal of high-dose therapy may cause symptoms resembling physical dependence such as gastritis, nausea, vomiting, dizziness, and tremulousness. Avoid sudden discontinuation of therapy if possible. Attempt to gradually reduce dose if decision to discontinue medication is made.
May mask the signs and symptoms of overdosage of other drugs and obscure the diagnosis and treatment of other conditions such as intestinal obstruction, brain tumor, or Reye syndrome.
As result of suppression of cough reflex, aspiration of vomitus possible.
Administer IM dose to patient who is bedfast. Keep patient lying down for at least 30 min after injection to minimize hypotensive effects.
Patients with bone marrow depression or who have previously demonstrated a hypersensitivity reaction with a phenothiazine should not receive chlorpromazine unless, in the judgment of the health care provider, the potential benefits outweigh the possible risks.
May impair mental or physical abilities, especially during the first few days of therapy. May lower convulsive threshold; dosage adjustments of anticonvulsants may be necessary.
Jaundice usually occurs between second and fourth weeks of treatment; considered hypersensitivity reaction. Usually reversible.
Patients treated with antipsychotic agents often have elevation in prolactin levels; however, there is no evidence of increased breast tumor risk.
Has occurred with agents of this class; is potentially fatal. Signs and symptoms are hyperpyrexia, muscle rigidity, altered mental status, irregular pulse, irregular BP, tachycardia, and diaphoresis.
Syndrome of potentially irreversible involuntary body and facial movements may develop. Prevalence highest in the elderly, especially women. Use smallest effective dose.
CNS depression, hypotension, extrapyramidal symptoms, agitation, restlessness, convulsions, fever, hypothermia, hyperthermia, coma, autonomic reactions, ECG changes, cardiac arrhythmias.
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