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chlorpromazine

Pronunciation

Generic Name: chlorpromazine (oral) (klor PROE ma zeen)
Brand Name: Thorazine, Ormazine, Thorazine Spansule

What is chlorpromazine?

Chlorpromazine is an anti-psychotic medication in a group of drugs called phenothiazines (FEEN-oh-THYE-a-zeens). It works by changing the actions of chemicals in your brain.

Chlorpromazine is used to treat psychotic disorders such as schizophrenia or manic-depression, and severe behavioral problems in children ages 1 through 12.

Chlorpromazine is also used to treat nausea and vomiting, anxiety before surgery, chronic hiccups, acute intermittent porphyria, and symptoms of tetanus.

Chlorpromazine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about chlorpromazine?

Stop using this medicine and call your doctor at once if you have twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs. These could be early signs of dangerous side effects.

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Chlorpromazine is not approved for use in psychotic conditions related to dementia. Chlorpromazine may increase the risk of death in older adults with dementia-related conditions.

What should I discuss with my healthcare provider before taking chlorpromazine?

You should not use this medicine if you are allergic to chlorpromazine or other phenothiazines (such as fluphenazine, perphenazine, prochlorperazine, promethazine, thioridazine, or trifluoperazine).

Do not take chlorpromazine if you have recently used large amounts of alcohol or taken a medicine that makes you sleepy.

Chlorpromazine is not approved for use in psychotic conditions related to dementia. Chlorpromazine may increase the risk of death in older adults with dementia-related conditions.

To make sure chlorpromazine is safe for you, tell your doctor if you have:

  • bone marrow suppression;

  • a brain tumor;

  • heart disease;

  • liver or kidney disease;

  • severe asthma, emphysema, or other breathing problem;

  • a history of breast cancer;

  • glaucoma;

  • seizures or epilepsy;

  • pheochromocytoma (tumor of the adrenal gland);

  • an enlarged prostate or urination problems; or

  • if you also take lithium or a blood thinner (warfarin, Coumadin).

Talk with your doctor before giving chlorpromazine to a child who has been ill with a fever or flu symptoms.

Tell your doctor if you will be exposed to extreme heat or cold, or to insecticide poisons while you are taking chlorpromazine.

Taking antipsychotic medication during the last 3 months of pregnancy may cause problems in the newborn, such as withdrawal symptoms, breathing problems, feeding problems, fussiness, tremors, and limp or stiff muscles. However, you may have withdrawal symptoms or other problems if you stop taking your medicine during pregnancy. If you become pregnant while taking chlorpromazine, do not stop taking it without your doctor's advice.

Chlorpromazine can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

How should I take chlorpromazine?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

This medicine can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using chlorpromazine.

If you need to have any type of x-ray scan or MRI of your spinal cord, tell the doctor ahead of time that you are using chlorpromazine. You may need to stop using the medicine for a short time.

Do not stop using chlorpromazine suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using chlorpromazine.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include dry mouth, bloating or stomach cramps, feeling restless or agitated, fever, muscle stiffness, jerky muscle movements, changes in heart rate, or seizure (convulsions).

What should I avoid while taking chlorpromazine?

This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Avoid drinking alcohol. It can increase some of the side effects of chlorpromazine.

Avoid exposure to sunlight or tanning beds. Chlorpromazine can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Chlorpromazine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement);

  • stiffness in your neck, tightness in your throat, trouble breathing or swallowing;

  • sudden weakness or ill feeling, fever, chills, sore throat, swollen gums, painful mouth sores, pain when swallowing, skin sores, cold or flu symptoms, cough;

  • pale skin, easy bruising or bleeding;

  • jaundice (yellowing of the skin or eyes); or

  • severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

Older adults may be more likely to have side effects from this medication.

Common side effects may include:

  • drowsiness;

  • breast swelling or discharge;

  • changes in menstrual periods;

  • dry mouth or stuffy nose, blurred vision;

  • constipation; or

  • impotence, trouble having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Chlorpromazine dosing information

Usual Adult Dose for Psychosis:

IM: Initial Dose 25 to 50 mg. The dose may be repeated in one hour. Subsequent doses may be increased and given every 2 to 4 hours as needed.

Oral: Initial Dose: 10 to 25 mg orally 3 times a day. Total daily doses should be increased in 20 to 50 mg increments every 3 or 4 days until symptoms are controlled.
Usual Maintenance Dose: 200 mg/day orally
Some patients require higher dosages (e.g., 800 mg daily is not uncommon in discharged mental patients). Increase dosage gradually until symptoms are controlled. Maximum improvement may not be seen for weeks or even months. Continue optimum dosage for 2 weeks, then gradually reduce dosage to the lowest effective maintenance level.

Usual Adult Dose for Mania:

Oral: 10 mg orally 3 to 4 times a day or 25 mg orally 2 to 3 times a day.
More severe cases: 25 mg orally 3 times a day.
After 1 to 2 days, dose may be increased by 20 to 50 mg/day at semiweekly intervals.
Prompt control of severe symptoms: 25 mg IM one time.
If necessary, repeat in 1 hour. Subsequent doses should be oral, 25 to 50 mg three times a day.

IM: 25 mg injection one time. If necessary, may give additional 25 to 50 mg injection in 1 hour.
Increase subsequent doses gradually over several days up to 400 mg every 4 to 6 hours in exceptionally severe cases.
Usually patient becomes quiet and cooperative within 24 to 48 hours and oral doses may be substituted.
Oral: 500 mg/day is generally sufficient. Gradual increases to 2000 mg/day or more may be necessary.
There is usually little therapeutic gain to be achieved by exceeding 1000 mg/day for extended periods.
Less acutely disturbed Oral: 25 mg three times a day.
May increase gradually until effective dose is reached, usually 400 mg/day.

Usual Adult Dose for Nausea/Vomiting:

Oral: 10 to 25 mg every 4 to 6 hours as needed. May increase, if necessary.
IM: 25 mg one time. If no hypotension occurs, give 25 to 50 mg every 3 to 4 hours as needed, then switch to oral dosage.
Rectal: One 100 mg suppository every 6 to 8 hours as needed. In some patients, half this dose will do.

Nausea/Vomiting During Surgery:
IM: 12.5 mg one time. May repeat in 30 minutes if necessary and if no hypotension occurs.
IV: 2 mg at 2 minute intervals. Do not exceed 25 mg. Dilute to 1 mg/mL.

Usual Adult Dose for Light Sedation:

For light sedation prior to a medical or surgical procedure:

Oral: 25 to 50 mg, 2 to 3 hours before the operation.
IM: 12.5 to 25 mg, 1 to 2 hours before operation.

Usual Adult Dose for Hiccups:

Oral: 25 to 50 mg 3 to 4 times a day.
IM: If symptoms persist for 2 to 3 days, give 25 to 50 mg IM.
IV infusion: Should symptoms persist, use slow IV infusion: 25 to 50 mg in 500 to 1000 mL of saline.

Usual Adult Dose for Porphyria:

Oral: 25 to 50 mg 3 to 4 times a day.
Can usually be discontinued after several weeks, but maintenance therapy may be necessary for some patients.
IM: 25 mg injection 3 to 4 times a day until patient can take oral therapy.

Usual Adult Dose for Tetanus:

IM: 25 to 50 mg given 3 to 4 times daily, usually in conjunction with barbiturates. Total doses and frequency of administration must be determined by the patient's response, starting with low doses and increasing gradually.
IV: 25 to 50 mg diluted to at least 1 mg/mL and administered at a rate of 1 mg/min.

Usual Pediatric Dose for Opiate Withdrawal:

less than 1 month:
Neonatal abstinence syndrome (withdrawal from maternal opioid use; controls CNS and gastrointestinal symptoms):
Intramuscular: Initial: 0.55 mg/kg/dose given every 6 hours; change to oral after approximately 4 days, decrease dose gradually over 2 to 3 weeks. Note: Chlorpromazine is rarely used for neonatal abstinence syndrome due to adverse effects such as hypothermia, cerebellar dysfunction, decreased seizure threshold, and eosinophilia; other agents are preferred.

Usual Pediatric Dose for Schizophrenia:

6 months and older:
Oral: 0.5 to 1 mg/kg/dose orally every 4 to 6 hours; older children may require 200 mg/day or higher
intramuscular or intravenous: 0.5 to 1 mg/kg/dose every 6 to 8 hours
Maximum recommended doses:
less than 5 years (less than 22.7 kg): 40 mg/day
5 years and older: (22.7 to 45.5 kg): 75 mg/day

Usual Pediatric Dose for Nausea/Vomiting:

Nausea and vomiting:
Oral: 0.5 to 1 mg/kg/dose every 4 to 6 hours as needed
intramuscular or intravenous: 0.5 to 1 mg/kg/dose every 6 to 8 hours;

Maximum recommended doses:
less than 5 years (less than 22.7 kg): 40 mg/day
5 and older (22.7-45.5 kg): 75 mg/day

What other drugs will affect chlorpromazine?

Taking this medicine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking chlorpromazine with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Other drugs may interact with chlorpromazine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about chlorpromazine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 13.01. Revision Date: 2014-06-23, 3:07:43 PM.

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