Thorazine Side Effects
Generic Name: chlorpromazine
Note: This page contains side effects data for the generic drug chlorpromazine. It is possible that some of the dosage forms included below may not apply to the brand name Thorazine.
It is possible that some side effects of Thorazine may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.
For the Consumer
Applies to chlorpromazine: oral tablets, parenteral injection
Side effects include:
Extrapyramidal reactions (e.g., Parkinson-like symptoms, dystonia, akathisia, tardive dyskinesia), drowsiness, dizziness, skin reactions or rash, dry mouth, orthostatic hypotension, amenorrhea, galactorrhea, weight gain.
For Healthcare Professionals
Applies to chlorpromazine: compounding powder, injectable solution, oral capsule extended release, oral concentrate, oral syrup, oral tablet, rectal suppository
General side effects have included cases of muscle necrosis after repeated injections of chlorpromazine (the active ingredient contained in Thorazine) The low pH of parenteral chlorpromazine solutions may be responsible for the necrosis. Subcutaneous injections should be avoided.[Ref]
Nervous system side effects are common and include sedation, drowsiness and rarely seizures. Tardive dyskinesia, dystonia, pseudoparkinsonism, increased neuromuscular excitability, and the neuroleptic malignant syndrome have also been reported.[Ref]
The drowsiness associated with chlorpromazine therapy may resolve after several doses.
Tardive dyskinesia involves involuntary, dyskinetic, repetitive movements and may be more common in elderly women receiving chlorpromazine. Tardive dyskinesia may be irreversible and is related to both the duration of therapy and the total amount of drug consumed. Frequent discontinuation and resumption of therapy may predispose patients to the development of tardive dyskinesia.
Dystonias frequently involve tongue protrusions, muscle rigidity, torticollis, and opisthotonos. Dystonias usually resolve after neuroleptic discontinuation, but may require antihistamine and antiparkinsonian therapy if symptoms are severe or if respiration is compromised. Treatment of dystonic reactions and extrapyramidal effects, in addition to general supportive measures, may include judicious use of one or more of the following: benztropine, trihexyphenidyl, biperiden or diphenhydramine.
Pseudoparkinsonism involves flat facies, pill- rolling tremor, shuffling gait, and cogwheel rigidity. Pseudoparkinsonism symptoms may respond to judicious use of one or more of the following: benztropine, trihexyphenidyl, biperiden or diphenhydramine.
Fever, altered consciousness, autonomic dysfunction and muscle rigidity are the hallmarks of the neuroleptic malignant syndrome. The neuroleptic malignant syndrome is associated with a case fatality rate of about 20%. Immediate discontinuation of neuroleptic therapy and intensive monitoring and supportive care are indicated.
Seizures associated with chlorpromazine have been reported, but many of the reports involve patients with a history of seizures or underlying organic brain disease.[Ref]
Psychiatric side effects including psychotic symptoms, excitability, and reversible catatonic states have been reported. There may also be rare paradoxical psychiatric effects with chlorpromazine (the active ingredient contained in Thorazine) therapy.[Ref]
Hematologic side effects have included reversible agranulocytosis (which occurs in about one out of 10,000 patients). Hemolytic anemia, thrombocytopenia, and eosinophilia have also been reported.[Ref]
A 40% decrease in platelet counts was observed in 21% of patients on chlorpromazine in one study. The thrombocytopenia persisted for up to 6 months after discontinuation of chlorpromazine.
Some clinicians have suggested that any sign or symptom of infection in patients on chlorpromazine therapy should be evaluated with a complete blood count and differential.[Ref]
Cases of cardiopulmonary arrest in otherwise healthy young patients have been reported rarely. Edema in association with chlorpromazine (the active ingredient contained in Thorazine) therapy has also been reported rarely.
Hypotension is more likely in patients with intravenous administration.[Ref]
Cardiovascular side effects have included profound orthostatic hypotension and reflex tachycardia. These effects may subside after several doses. Chlorpromazine has mild negative inotropic properties, which may be important in some patients with a history of congestive heart failure. ECG changes include prolongation of the PR interval, prolongation of QTc segments, diffuse T-wave flattening, and ST segment depression.[Ref]
Hypersensitivity side effects to chlorpromazine (the active ingredient contained in Thorazine) are usually mild and presents as an urticarial rash. Pustular eruptions, severe anaphylaxis and angioedema have been reported rarely.[Ref]
Rare cases of anaphylaxis, toxic epidermal necrolysis, and angioedema have been reported. A case of contact dermatitis associated with crushed chlorpromazine tablets has been reported.[Ref]
Chlorpromazine- induced cholestatic jaundice usually resolves without sequelae 2 to 8 weeks after discontinuation of the drug. However, severe and prolonged jaundice, resembling primary biliary cirrhosis, has been reported in a minority of cases. The prognosis of this condition is generally favorable. However, progression to biliary cirrhosis has been reported.
A case of chronic active hepatitis associated with chlorpromazine (the active ingredient contained in Thorazine) has been reported. A Danish study has reported 5 cases of fatal hepatitis associated with chlorpromazine. A recent study of 10,502 users of chlorpromazine has reported 14 illnesses which were considered to be compatible with drug induced liver disease. The frequency of drug induced liver disease in that group was 1.3 per 1,000 users of chlorpromazine.
Monitoring of liver function tests during chlorpromazine therapy may be helpful in patients with liver disease.[Ref]
Hepatic side effects including mild reversible elevations of liver function tests have been reported. Cholestatic jaundice has been reported in as many as 1% of patients taking chlorpromazine, however many clinicians believe that the reported frequency of cholestatic jaundice may be referable to impurities in early formulations of the drug. Severe hepatitis has also been reported.[Ref]
In one study 35% of patients on chlorpromazine (the active ingredient contained in Thorazine) tested positive for the lupus anticoagulant. In another study of 64 patients on chlorpromazine, 45% tested positive for the lupus anticoagulant, 39% for positive ANA titers, 34% for the anticardiolipin antibody, 50% for rheumatoid factor, and 27% for an elevation in IgM.
A case of Henoch-Schonlein purpura has been associated with chlorpromazine.
Chlorpromazine- induced antiphospholipid antibody syndrome developed in a patient after taking chlorpromazine 100 mg daily for a year. Symptoms included encephalopathy, seizures (i.e., generalized tonic-clonic, status epilepticus), confusion, and drowsiness. All symptoms resolved following discontinuation of chlorpromazine.[Ref]
Immunologic side effects have included a variety of adverse immunologic effects including antiphospholipid antibody syndrome which appear to be related to the total dose consumed.[Ref]
The gastrointestinal side effects may result from the anticholinergic properties of chlorpromazine (the active ingredient contained in Thorazine) [Ref]
Gastrointestinal side effects including dry mouth, constipation, and less commonly, diarrhea have been reported.[Ref]
Endocrine side effects including hyperglycemia, hyperprolactinemia, galactorrhea, amenorrhea, and the syndrome of inappropriate secretion of antidiuretic hormone have been reported.[Ref]
Dermatologic side effects including skin hyperpigmentation has been reported in patients after long-term chlorpromazine (the active ingredient contained in Thorazine) therapy (doses of 500 to 1,500 mg over 2 to 3 years). The hyperpigmentation commonly presents as a gray- blue discoloration in exposed areas, including the eyelids.[Ref]
The hyperpigmentation associated with chlorpromazine therapy appears to be reversible in some patients after discontinuation of chlorpromazine and initiation of alternative neuroleptic therapy. Contact dermatitis has been reported in a person who crushed chlorpromazine tablets for a patient. Leukocytoclastic vasculitis associated with Henoch-Schonlein purpura has been reported during chlorpromazine use.[Ref]
Genitourinary side effects including urinary retention, impotence and priapism have been associated with chlorpromazine (the active ingredient contained in Thorazine) therapy.[Ref]
Chlorpromazine may induce lens and corneal pigmentary changes which have produced visual impairment such as halos around lights, hazy vision, photophobia, and watering eyes. One case of orbital cellulitis has been reported following the retrobulbar injection of chlorpromazine (the active ingredient contained in Thorazine) for intractable pain in a patient with irreversible blindness.
Ocular changes seem to be related to dosage levels and/or duration of therapy. Therefore, long term chlorpromazine patients on moderate to high dosage levels should have periodic ocular examinations.[Ref]
Ocular side effects have been reported primarily in patients receiving chlorpromazine for two or more years in dosages of 300 mg daily or more. Ocular changes are characterized by deposition of fine particulate matter in the lens and cornea. In more advanced cases, star- shaped opacities have also been reported in the anterior portion of the lens. The nature of the deposits has not been reported. Anterior capsular cataracts have also been reported. Some visual impairment has been reported in a small number of patients with more severe ocular changes. Epithelial keratopathy and pigmentary retinopathy have also been reported. Reports suggest that the eye lesions may regress after withdrawal of the drug.[Ref]
1. O'Connor M "Further toxic effect of parenteral chlorpromazine." Med J Aust 2 (1980): 227
2. Prunier P, Frankel B "Atypical fatal hyperpyrexia: a case report." J Clin Psychopharmacol 6 (1986): 322-3
3. Price W, Giannini A "A paradoxical response to chlorpromazine: a possible variant of the neuroleptic malignant syndrome." J Clin Pharmacol 23 (1983): 567-9
4. Stemp L, Taswell C "Spastic torticollis during general anesthesia: case report and review of receptor mechanisms." Anesthesiology 75 (1991): 365-6
5. Rajput A, Rozdilsky B, Hornykiewicz O, et al "Reversible drug-induced parkinsonism." Arch Neurol 39 (1982): 6446
6. Dorevitch A, Gabbay F "Neuroleptic-associated catatonic reaction." Clin Pharm 2 (1983): 581-2
7. Morris H, McCormick W, Reinarz J "Neuroleptic malignant syndrome." Arch Neurol 37 (1980): 462-3
8. McAllister C, Scowden E, Stone W "Toxic psychosis induced by phenothiazine administration in patients with chronic renal failure." Clin Nephrol 10 (1978): 191-5
9. Mueller J, Aminoff M "Tourette-like syndrome after long-term neuroleptic drug treatment." Br J Psychiatry 141 (1982): 191-3
10. Mariani P "Adverse reactions to chlorpromazine in the treatment of migraine." Ann Emerg Med 17 (1988): 380-1
11. Yassa R, Dimitry R "Single phenothiazines and tardive dyskinesia." J Clin Psychiatry 44 (1983): 233-4
12. Muskin P, Mellman L, Kornfeld D "A "new" drug for treating agitation and psychosis in the general hospital: chlorpromazine." Gen Hosp Psychiatry 8 (1986): 404-10
13. Wood G, Waters A "Prolonged dystonic reaction to chlorpromazine in myxoedema coma." Postgrad Med J 56 (1980): 192-3
14. Schreiber G, Belmaker R "In vivo differentiation of cardiac vagal blocking effects of chlorpromazine and haloperidol." Biol Psychiatry 22 (1987): 1417-21
15. Brooks J, Matoba A "Chlorpromazine-induced anterior segment changes." Arch Ophthalmol 110 (1992): 126
16. Nurnberg G, Greenwald B "Stuttering: an unusual side effect of phenothiazines." Am J Psychiatry 138 (1981): 386-7
17. Markowitz J, Brown R "Seizures with neuroleptics and antidepressants." Gen Hosp Psychiatry 9 (1987): 135-41
18. Aram H "Henoch-Schonlein purpura induced by chlorpromazine." J Am Acad Dermatol 17 (1987): 139-40
19. Yassa R "Agranulocytosis in the course of phenothiazine therapy." J Clin Psychiatry 46 (1985): 341-3
20. Holt R "Neuroleptic drug-induced changes in platelet levels." J Clin Psychopharmacol 4 (1984): 130-2
21. Young A, Kehoe R "Two cases of agranulocytosis on addition of a butyrophenone to a long-standing course of phenothiazine treatment." Br J Psychiatry 154 (1989): 710-12
22. Stein P, Inwood M "Hemolytic anemia associated with chlorpromazine therapy." Can J Psychiatry 25 (1980): 659-61
23. Zengotita H, Holt R "Neuroleptic drug-induced coagulopathy: mechanism of reaction and duration of effect." J Clin Psychiatry 47 (1986): 35-7
24. Ben-Yehuda A, Bloom A, Lijhovetzky G, et al "Chlorpromazine-induced liver and bone marrow granulomas associated with agranulocytosis." Isr J Med Sci 26 (1990): 449-51
25. Witz L, Shapiro M, Shenkman L "Chlorpromazine induced fluid retention masquerading as idiopathic oedema." Br Med J 294 (1987): 807-8
26. Dorson P, Crismon M "Chlorpromazine accumulation and sudden death in a patient with renal insufficiency." Drug Intell Clin Pharm 22 (1988): 776-8
27. Varia I, Krishnan R, Davidson J "Deep-vein thrombosis with antipsychotic drugs." Psychosomatics 24 (1983): 1097-8
28. Fruncillo R, Gibbons W, Vlasses P, Ferguson R "Severe hypotension associated with concurrent clonidine and antipsychotic medication." Am J Psychiatry 142 (1985): 274
29. Stevenson R, Blanshard C, Patterson D "Ventricular fibrillation due to lithium withdrawal: an interaction with chlorpromazine?" Postgrad Med J 65 (1989): 936-8
30. Balon R, Berchou R, Han H "Priapism associated with thiothixene, chlorpromazine, and thioridazine." J Clin Psychiatry 48 (1987): 216
31. Burrows NP, Ratnavel RC, Norris PG "Pustular eruptions after chlorpromazine." BMJ 309 (1994): 97
32. Lovell C, Cronin E, Rhodes E "Photocontact urticaria from chlorpromazine." Contact Dermatitis 14 (1986): 290-1
33. Ward D, Krzeminska E, Tanner N "Treatment of toxic epidermal necrolysis and a review of six cases." Burns 16 (1990): 97-104
34. Derby LE, Gutthann SP, Jick H, Dean AD "Liver disorders in patients receiving chlorpromazine or isoniazid." Pharmacotherapy 13 (1993): 353-8
35. Dossing M, Andreasen B "Drug-induced liver disease in Denmark." Scand J Gastroenterol 17 (1982): 205-11
36. Bach N, Thung S, Schaffner F, Tobias H "Exaggerated cholestasis and hepatic fibrosis following simultaneous administration of chlorpromazine and sodium valproate." Dig Dis Sci 34 (1989): 1303-7
37. Moradpour D, Altorfer J, Flury R, Greminger P, Meyenberger C, Jost R, Schmid M "Chlorpromazine-induced vanishing bile duct syndrome leading to biliary cirrhosis." Hepatology 20 (1994): 1437-41
38. Seeff L "Drug-induced chronic liver disease, with emphasis on chronic active hepatitis." Semin Liver Dis 1 (1981): 104-15
39. Podevin P, Biour M "Drug-induced ''allergic hepatitis''." Clin Rev Allergy Immunol 13 (1995): 223-44
40. Canoso R, Sise H "Chlorpromazine-Induced Lupus Anticoagulant and Associated Immunologic Abnormalities." Am J Hematol 13 (1982): 121-9
41. Iyer HV, Moudgil H, Newman P, Srinivasan KS "Chlorpromazine-associated antiphospholipid antibody syndrome." Ann Pharmacother 41 (2007): 528
42. Goldman L, Hudson J, Weddington W "Lupus-like illness associated with chlorpromazine." Am J Psychiatry 137 (1980): 1613-4
43. Canoso R, de Oliveira R, Nixon R "Neuroleptic-associated autoantibodies." Biol Psychiatry 27 (1990): 863-70
44. "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham, Philadelphia, PA.
45. Erle G, Basso M, Federspil G, Sicolo N, Scandellari C "Effect of chlorpromazine on blood glucose and plasma insulin in man." Eur J Clin Pharmacol 11 (1977): 15-8
46. Tildesley H, Toth E, Crockford P "Syndrome of inappropriate secretion of antidiuretic hormone in association with chlorpromazine ingestion." Can J Psychiatry 28 (1983): 487-8
47. Jori A, Carrara MC "On the mechanism of the hyperglycaemic effect of chlorpromazine." J Pharm Pharmacol 18 (1966): 623-4
48. Bloom D, Krishnan B, Thavundayil JX, Lal S "Resolution of chlorpromazine-induced cutaneous pigmentation following substitution with levomepromazine or other neuroleptics." Acta Psychiatr Scand 87 (1993): 223-4
49. Goldstein JH "Effects of drugs on cornea, conjunctiva, and lids." Int Ophthalmol Clin 11 (1971): 13-34
50. Margo CE, Wilson T "Orbital cellulitis after retrobulbar injection of chlorpromazine." Arch Ophthalmol 111 (1993): 1322
51. Leung ATS, Cheng ACK, Chan WM, Lam DSC "Chlorpromazine-induced refractile corneal deposits and cataract." Arch Ophthalmol 117 (1999): 1662-3
More about Thorazine (chlorpromazine)
Related treatment guides
Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. 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 substances you are taking, check with your doctor, nurse, or pharmacist.