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. It 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 medication 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.

Chlorpromazine is not for use in psychotic conditions related to dementia. Chlorpromazine may cause heart failure, sudden death, or pneumonia in older adults with dementia-related conditions.

Slideshow: Herbal Supplements & Drugs: Interactions to Avoid

Herbal and Dietary Supplements Deserve Your Attention

Do not use chlorpromazine if you have brain damage, bone marrow depression, or are also using large amounts of alcohol or medicines that make you sleepy. Do not use if you are allergic to chlorpromazine or other phenothiazines.

Before you take chlorpromazine, tell your doctor if you have liver or kidney disease, heart disease or high blood pressure, glaucoma, severe breathing problems, past or present breast cancer, low levels of calcium in your blood, adrenal gland tumor, enlarged prostate or urination problems, a history of seizures, Parkinson's disease, or if you have ever had a serious side effect while using chlorpromazine or similar medicines.

Before taking chlorpromazine, tell your doctor about all other medications you use.

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

Chlorpromazine is not for use in psychotic conditions related to dementia. Chlorpromazine may cause heart failure, sudden death, or pneumonia in older adults with dementia-related conditions.

Do not use chlorpromazine if you have brain damage, bone marrow depression, or are also using large amounts of alcohol or medicines that make you sleepy. Do not use if you are allergic to chlorpromazine or other phenothiazines such as fluphenazine (Permitil), perphenazine (Trilafon), prochlorperazine (Compazine, Compro), promethazine (Adgan, Pentazine, Phenergan), thioridazine (Mellaril), or trifluoperazine (Stelazine).

To make sure you can safely take chlorpromazine, tell your doctor if you have any of these other conditions:

  • liver or kidney disease;

  • heart disease or high blood pressure;

  • severe asthma, emphysema, or other breathing problem;

  • glaucoma;

  • past or present breast cancer;

  • low levels of calcium in your blood (hypocalcemia);

  • adrenal gland tumor (pheochromocytoma);

  • an enlarged prostate or urination problems;

  • a history of seizures;

  • Parkinson's disease; or

  • if you have ever had a serious side effect while using chlorpromazine or any other phenothiazine.

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. Do not use this medication without telling your doctor if you are breast-feeding a baby.

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

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

How should I take chlorpromazine?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results.

This medication 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, constipation, bloating or stomach cramps, feeling restless or agitated, fever, seizure, muscle stiffness, jerky muscle movements, changes in heart rate, extreme drowsiness, and fainting.

What should I avoid while taking chlorpromazine?

Chlorpromazine 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; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop taking chlorpromazine and call your doctor at once if you have a serious side effect such as:

  • twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs;

  • tremor (uncontrolled shaking), drooling, trouble swallowing, problems with balance or walking;

  • feeling restless, jittery, or agitated;

  • feeling like you might pass out;

  • seizure (black-out or convulsions);

  • nausea upper stomach pain, itching, and jaundice (yellowing of the skin or eyes);

  • pale skin, easy bruising or bleeding, fever, sore throat, flu symptoms;

  • high fever, stiff muscles, confusion, sweating, fast or uneven heartbeats, rapid breathing;

  • unusual thoughts or behavior;

  • decreased night vision, tunnel vision, watery eyes, increased sensitivity to light;

  • urinating less than usual or not at all;

  • joint pain or swelling with fever, swollen glands, muscle aches, chest pain, vomiting, and patchy skin color; or

  • slow heart rate, weak pulse, fainting, slow breathing (breathing may stop).

Less serious side effects may include:

  • dizziness, drowsiness, anxiety, sleep problems (insomnia);

  • breast swelling or discharge;

  • changes in menstrual periods;

  • weight gain, swelling in your hands or feet;

  • 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?

Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can interact with chlorpromazine and cause medical problems or increase side effects. Tell your doctor if you regularly use any of these medicines, or any other anti-psychotic medications.

Tell your doctor about all other medicines you use, especially:

  • atropine (Atreza, Sal-Tropine);

  • lithium (Eskalith, Lithobid);

  • phenytoin (Dilantin);

  • an antibiotic;

  • birth control pills or hormone replacement estrogens;

  • blood pressure medication;

  • a blood thinner such as warfarin (Coumadin, Jantoven);

  • certain asthma medications or bronchodilators;

  • incontinence medications;

  • insulin or diabetes medications you take by mouth;

  • medication for nausea, vomiting, or motion sickness;

  • medications to treat or prevent malaria;

  • medications used for general anesthesia;

  • medicines used to prevent organ transplant rejection;

  • numbing medicine such as lidocaine or Novocain;

  • a stimulant or ADHD medication;

  • ulcer or irritable bowel medications; or

  • medicines to treat Parkinson's disease, restless leg syndrome, or pituitary gland tumor (prolactinoma).

This list is not complete and there are many other medicines that can interact with chlorpromazine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

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: 12.01. Revision Date: 2011-03-14, 2:29:08 PM.

Hide
(web1)