Chlorpromazine

Aka: Chlorpromazine, Thorazine

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II. Indications

  1. Psychosis (Schizophrenia, Mania)
  2. Intractable Hiccups
  3. Nausea or Vomiting
  4. Acute Intermittent Porphyria
  5. Tetanus

III. Mechanism

  1. Phenothiazine released in the early 1950s and among the first Antipsychotic agents
  2. Low potency Dopamine D2 receptor Antagonist (Antipsychotic effect)
  3. Also blocks Histamine H1 and muscarinic M1 receptors (Antiemetic effect)

IV. Dosing: Schizophrenia, Mania or other acute Psychosis

  1. Adult Oral Dosing
    1. Start: 25 mg orally three times daily
    2. Titrate to 400 mg/day in divided doses
      1. May increase dose 20 to 50 mg/day every few days in severe cases
    3. Target: 200 to 500 mg/day in most cases (800-1000 mg/day may be needed in some severe cases)
    4. Maximum: 1000 mg/day in divided doses
  2. Adult IM Dosing (hospitalized patients)
    1. Start 24 mg IM
    2. May repeat 25 to 50 mg IM in next hour
    3. May increase dose as needed over days to maximum of 400 mg every 4 to 6 hours

V. Dosing: Adult Miscellaneous

  1. Intractable Hiccups
    1. Oral: 25 to 50 mg orally every 6 to 8 hours as needed
    2. IM: 25 to 50 mg IM (if refractory to oral dosing)
    3. Infusion: 25 to 50 mg in 500 to 1000 ml NS slow IV infusion (if refractory to IM dosing)
  2. Presurgical Apprehension
    1. Oral: 25 to 50 mg orally 2 to 3 hours before procedure
    2. IM: 12.5 to 25 mg IM 1 to 2 hours before procedure
  3. Nausea or Vomiting
    1. Avoid in hypotensive patients
    2. Oral: 10 to 25 mg orally every 4 to 6 hours as needed
      1. May increase to 25 to 50 mg every 3 to 4 hours as needed
    3. IM: 12.5 mg IM for perioperative Nausea, Vomiting
      1. May repeat 12.5 mg IM dose at 30 minutes if not hypotensive
    4. IV: 2 mg IV injected over 2 minutes (no faster than 1 mg/min) every 2-3 minutes as needed
      1. Cummulative maximum: 25 mg
      2. Use a diluted solution of Chlorpromazine 1 mg/ml
  4. Acute Intermittent Porphyria
    1. Oral: 25 to 50 mg orally every 6 to 8 hours as needed
    2. IM: 25 mg IM every 6 to 8 hours as needed (if patient unable to take oral doses)
  5. Tetanus
    1. IM: 25 to 50 mg IM every 6 to 8 hours
    2. Infusion: 25 to 50 mg in 500 to 1000 ml NS slow IV infusion (no faster than 1 mg/ml)

VI. Dosing: Children

  1. Indications
    1. Psychosis or severe behavioral disorder
    2. Nausea or Vomiting
  2. Dosing (age 6 months to 12 years)
    1. Oral: 0.55 mg/kg orally every 4 to 6 hours
    2. IM: 0.55 mg/kg IM every 6 to 8 hours
      1. Maximum IM dose up to age 5 years (23 kg): 40 mg/day
      2. Maximum IM dose up to age 5 to 12 years (23 to 46 kg): 75 mg/day

VII. Adverse Effects

  1. Alpha adrenergic blockade
    1. Postural Hypotension
    2. Tachycardia
  2. Anticholinergic Symptoms
    1. Dry Mouth
    2. Sedation
  3. Extrapyramidal Side Effects
  4. Hyperprolactinemia
  5. Weight gain and Glucose Intolerance
  6. QTc Prolongation

VIII. Drug Interactions

  1. Potentiates Central Nervous System Depressants (e.g. Alcohol, Opioids) with apnea risk
  2. Metabolized by CYPA12, CYP2D6 and CYP3A4

IX. Safety

  1. Unknown safety in pregnancy (but may be Teratogenic in animal studies)
  2. Avoid in Lactation

X. Resources

  1. Chlorpromazine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=aa086a21-de85-4b03-af58-49b70acf8cf0
  2. Chlorpromazine (Stat Pearls)
    1. Mann (2022) Chlorpromazine, StatPearls, Treasure Island
      1. https://www.ncbi.nlm.nih.gov/books/NBK553079/

XI. References

  1. (2016) Med Lett Drugs Ther 58(1510): 160-5
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 42-3
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

chlorpromazine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CHLORPROMAZINE 10 MG TABLET Generic $1.14 each
CHLORPROMAZINE 100 MG TABLET Generic $1.16 each
CHLORPROMAZINE 200 MG TABLET Generic $2.34 each
CHLORPROMAZINE 25 MG TABLET Generic $0.56 each
CHLORPROMAZINE 50 MG TABLET Generic $1.09 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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