CHLORPROMAZINE hydrochloride

Indications & Dose:

Schizophrenia and other psychoses Mania

Short-term adjunctive management of severe anxiety

Psychomotor agitation, excitement, and violent or dangerously impulsive behaviour

•   BY MOUTH

Adult: Initially 25 mg 3 times a day, adjusted according to response, alternatively initially 75 mg once daily, adjusted according to response, dose to be taken at night; maintenance 75–300 mg daily, increased if necessary up to 1 g daily, this dose may be required in psychoses; use a third to half adult dose in the elderly or debilitated patients

•   BY RECTUM

Adult: 100 mg every 6–8 hours, dose expressed as chlorpromazine base

Intractable hiccup

•   BY MOUTH

Adult: 25–50 mg 3–4 times a day continued’!

Relief of acute symptoms of psychoses (under expert supervision)

•  BY DEEP INTRAMUSCULAR INJECTION

Adult: 25–50 mg every 6–8 hours

Nausea and vomiting of terminal illness (where other drugs have failed or are not available)

•   BY MOUTH

Child 1–5 years: 500 micrograms/kg every 4–6 hours; maximum 40 mg per day

Child 6–11 years: 500 micrograms/kg every 4–6 hours; maximum 75 mg per day

Child 12–17 years: 10–25 mg every 4–6 hours

Adult: 10–25 mg every 4–6 hours

•  BY DEEP INTRAMUSCULAR INJECTION

Child 1–5 years: 500 micrograms/kg every 6–8 hours; maximum 40 mg per day

Child 6–11 years: 500 micrograms/kg every 6–8 hours; maximum 75 mg per day

Child 12–17 years: Initially 25 mg, then 25–50 mg every 3–4 hours until vomiting stops

Adult: Initially 25 mg, then 25–50 mg every 3–4 hours until vomiting stops

•  BY RECTUM

Adult: 100 mg every 6–8 hours

Contraindications:

Circulatory collapse, liver damage, cerebral arteriosclerosis, coronary disease, severe hypertension/hypotension, blood dyscrasias, coma, child <2 yr, brain damage, bone marrow depression, alcohol and barbiturate withdrawal. 

Side Effects:

Cautions:

Precautions:

Seizure disorders, hypertension, hepatic disease, cardiac disease, elderly (orthostatic upon arising), COPD 

Interaction:

Drugs

Amodiaquine, chloroquine, sulfadoxinepyrimethamine: Increased chlorpromazine concentrations

Anticholinergics: May inhibit neuroleptic response; excess anticholinergic effects

Antidepressants: Potential for increased therapeutic and toxic effects from increased levels of both drugs

Barbiturates: Decreased neuroleptic levels

Clonidine, guanadrel, granethidine: Severe hypotensive episodes possible

Epinephrine: Blunted pressor response to epinephrine

Ethanol: Additive CNS depression

Levodopa: Inhibited antiparkinsonian effect of levodopa

Lithium: Lowered levels of both drugs, rarely neurotoxicity in acute mania

Narcotic analgesics: Hypotension and increased CNS depression

Orphenadrine: Lower neuroleptic concentrations, excessive anticholinergic effects

Propranolol: Increased plasma levels of both drugs with accentuated responses

Warnings:

Adverse Effects:

Lactations:

Enters breast milk in small concentrations; report of drowsy and lethargic infant who consumed milk with 92 ng/ml concentration 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Extrapyramidal symptoms (pseudoparkinsonism, akathisia, dystonia), headache, seizures, tardive dyskinesia

CV: Cardiac arrest, ECG changes, hypertension, orthostatic hypotension, tachycardia

EENT: Blurred vision, dry eyes, glaucoma

GI: Anorexia, constipation, diarrhea, dry mouth, jaundice, nausea, vomiting, weight gain

GU: Amenorrhea, breast engorgement, enuresis, gynecomastia, impotence, urinary frequency, urinary retention

HEME: Agranulocytosis, anemia, leukocytosis, leukopenia

RESP: Dyspnea, laryngospasm, respiratory depression

SKIN: Dermatitis, photosensitivity, rash

MISC: Neuroleptic malignant syndrome (NMS) 

Patient And Carer Advice: