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Chlorpromazine Dosage

Applies to the following strength(s): 30 mg/mL ; 100 mg/mL ; 25 mg/mL ; 30 mg ; 75 mg ; 150 mg ; 25 mg ; 100 mg ; 10 mg/5 mL ; 10 mg ; 50 mg ; 200 mg

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for Mania

HOSPITALIZED PATIENTS:
Acute Schizophrenia/Manic States:
Oral:
-Usual dose: 500 mg/day orally
-Maximum dose: 2000 mg/day

Parenteral:
-Usual dose: 25 mg IM once, with a subsequent 25 to 50 mg injection in 1 hour if necessary
-Maintenance dose: 400 mg IM every 4 to 6 hours until the patient is controlled

Prompt Control of Severe Symptoms:
Oral:
-Usual dose: After an initial IM dose, 25 to 50 mg orally 3 times a day

Parenteral:
-Usual dose: 25 mg IV once, repeated in 1 hour if necessary

Less Acutely Disturbed:
Oral:
-Initial dose: 25 mg orally 3 times a day
-Usual dose: 400 mg/day

OUTPATIENTS:
Oral:
-Usual dose: 10 mg orally 3 to 4 times a day OR 25 mg orally 2 to 3 times a day

More Severe Cases:
Oral:
-Usual dose: 25 mg orally 3 times a day, increasing by 20 to 50 mg at semiweekly intervals until the patient is calm and cooperative

Comments:
-Patients have experienced little therapeutic gain with doses over 1000 mg/day given for extended periods.
-Patients usually become quiet and cooperative within 24 and 48 hours.
-The dosage should be increased gradually until symptom improvement occurs; this dose should be continued for 2 weeks, and then gradually reduced to the lowest effective dose.
-Maximum improvement with oral formulations may take weeks to months.

Uses:
-Management of manifestations of psychotic disorders
-Treatment of schizophrenia
-To control the manifestations of the manic type of manic-depressive illness

Usual Adult Dose for Psychosis

HOSPITALIZED PATIENTS:
Acute Schizophrenia/Manic States:
Oral:
-Usual dose: 500 mg/day orally
-Maximum dose: 2000 mg/day

Parenteral:
-Usual dose: 25 mg IM once, with a subsequent 25 to 50 mg injection in 1 hour if necessary
-Maintenance dose: 400 mg IM every 4 to 6 hours until the patient is controlled

Prompt Control of Severe Symptoms:
Oral:
-Usual dose: After an initial IM dose, 25 to 50 mg orally 3 times a day

Parenteral:
-Usual dose: 25 mg IV once, repeated in 1 hour if necessary

Less Acutely Disturbed:
Oral:
-Initial dose: 25 mg orally 3 times a day
-Usual dose: 400 mg/day

OUTPATIENTS:
Oral:
-Usual dose: 10 mg orally 3 to 4 times a day OR 25 mg orally 2 to 3 times a day

More Severe Cases:
Oral:
-Usual dose: 25 mg orally 3 times a day, increasing by 20 to 50 mg at semiweekly intervals until the patient is calm and cooperative

Comments:
-Patients have experienced little therapeutic gain with doses over 1000 mg/day given for extended periods.
-Patients usually become quiet and cooperative within 24 and 48 hours.
-The dosage should be increased gradually until symptom improvement occurs; this dose should be continued for 2 weeks, and then gradually reduced to the lowest effective dose.
-Maximum improvement with oral formulations may take weeks to months.

Uses:
-Management of manifestations of psychotic disorders
-Treatment of schizophrenia
-To control the manifestations of the manic type of manic-depressive illness

Usual Adult Dose for Schizophrenia

HOSPITALIZED PATIENTS:
Acute Schizophrenia/Manic States:
Oral:
-Usual dose: 500 mg/day orally
-Maximum dose: 2000 mg/day

Parenteral:
-Usual dose: 25 mg IM once, with a subsequent 25 to 50 mg injection in 1 hour if necessary
-Maintenance dose: 400 mg IM every 4 to 6 hours until the patient is controlled

Prompt Control of Severe Symptoms:
Oral:
-Usual dose: After an initial IM dose, 25 to 50 mg orally 3 times a day

Parenteral:
-Usual dose: 25 mg IV once, repeated in 1 hour if necessary

Less Acutely Disturbed:
Oral:
-Initial dose: 25 mg orally 3 times a day
-Usual dose: 400 mg/day

OUTPATIENTS:
Oral:
-Usual dose: 10 mg orally 3 to 4 times a day OR 25 mg orally 2 to 3 times a day

More Severe Cases:
Oral:
-Usual dose: 25 mg orally 3 times a day, increasing by 20 to 50 mg at semiweekly intervals until the patient is calm and cooperative

Comments:
-Patients have experienced little therapeutic gain with doses over 1000 mg/day given for extended periods.
-Patients usually become quiet and cooperative within 24 and 48 hours.
-The dosage should be increased gradually until symptom improvement occurs; this dose should be continued for 2 weeks, and then gradually reduced to the lowest effective dose.
-Maximum improvement with oral formulations may take weeks to months.

Uses:
-Management of manifestations of psychotic disorders
-Treatment of schizophrenia
-To control the manifestations of the manic type of manic-depressive illness

Usual Adult Dose for Nausea/Vomiting

Oral:
-Usual dose: 10 to 25 mg orally every 4 to 6 hours as needed for nausea/vomiting

Parenteral:
-Usual dose: 25 mg IM once. If hypotension does not occur, administer 25 to 50 mg IM every 3 to 4 hours as needed until vomiting stops, and then patients should be switched to oral formulations.

Nausea/Vomiting During Surgery:
IM:
-Usual dose: 12.5 mg IM, repeated in 30 minutes as needed AND in the absence of hypotension
IV:
-Usual dose: 2 mg IV every 2 minutes, diluted to 1 mg/mL
-Maximum IV dose: 25 mg

Comment:
-The frequency of dosing in the oral formulations may be increased if necessary.

Use: To control nausea and vomiting

Usual Adult Dose for Light Sedation

Oral:
-Usual dose: 25 to 50 mg orally 2 to 3 hours before the operation

Parenteral:
-Usual dose: 12.5 to 25 mg IM 1 to 2 hours before the operation

Use: Relief of restlessness and apprehension before surgery

Usual Adult Dose for Hiccups

Oral:
-Usual dose: 25 to 50 mg orally 3 to 4 times a day

Parenteral:
-If symptoms persist after 2 to 3 days with oral therapy: 25 to 50 mg IM once
-Symptoms that persist after IM administration: 25 to 50 mg slow IV infusion in 500 to 1000 mL of saline

Comments:
-If symptoms persist after 2 to 3 days with oral formulations, parenteral therapy should be started.
-Slow IV infusions should be administered to patients who are lying flat in bed, and blood pressure should be monitored closely.

Use: For relief of intractable hiccups

Usual Adult Dose for Porphyria

Oral:
-Usual dose: 25 to 50 mg orally 3 to 4 times a day

Parenteral:
-Usual dose: 25 mg IM 3 to 4 times a day, continued until the patient is able to take oral formulations

Comments:
-Patients usually may discontinue treatment after several weeks; however, some may require maintenance therapy.
-Parenteral formulations: Patients should lay down prior to and at least 30 minutes after administration.

Use: Acute intermittent porphyria

Usual Adult Dose for Tetanus

Parenteral:
IM:
-Usual dose: 25 to 50 mg IM 3 to 4 times a day, usually with barbiturates

IV:
-Usual dose: 25 to 50 mg IV, diluted to at least 1 mg/mL and given at a rate of 1 mg/min

Comments:
-Patients should be started on low IM doses; subsequent dosing and frequency should be determined by patient response.
-IM doses should be given slowly.
-Patients should lay down prior to and at least 30 minutes after administration.

Use: Adjunct to the treatment of tetanus

Usual Pediatric Dose for Aggressive Behavior

6 months to 12 years:
INPATIENTS:
Severe Behavior Disorders:
-Usual dose: 50 to 100 mg/day orally or IM (younger patients); at least 200 mg/day orally or IM (older patients)
-Maximum IM dose: 40 mg/day (up to 5 years OR 22.7 kg); 75 mg/day (5 to 12 years OR 22.7 to 45.5 kg)

OUTPATIENTS:
Oral:
-Usual dose: 0.55 mg/kg orally every 4 to 6 hours as needed
Parenteral:
-Usual dose: 0.55 mg/kg IM every 6 to 8 hours as needed

Comments:
-Route of administration should be determined by the condition of the patient.
-Patients with mental disabilities who are disturbed have experienced little therapeutic gain with doses over 500 mg/day.

Uses:
-Treatment of severe behavioral problems marked by combativeness and/or explosive hyperexcitable behavior (out of proportion to immediate provocation)
-Short-term treatment of hyperactive children with excessive motor activity and accompanying conduct disorders marked by impulsivity, difficulty sustaining attention, aggressiveness, mood lability, and/or poor frustration tolerance

Usual Pediatric Dose for Nausea/Vomiting

Oral:
-Usual dose: 0.55 mg/kg orally every 4 to 6 hours as needed

Parenteral:
-Usual dose: 0.55 mg/kg IM every 6 to 8 hours as needed
-Maximum dose: 40 mg/day (up to 22.7 kg); 75 mg/day (22.7 to 45.5 kg)

Nausea/Vomiting During Surgery:
IM:
-Usual dose: 0.275 mg/kg IM, repeated in 30 minutes as needed AND in the absence of hypotension
IV:
-Usual dose: 1 mg IV every 2 minutes, diluted to 1 mg/mL
-Maximum dose: 40 mg/day (up to 22.7 kg); 75 mg/day (22.7 to 45.5 kg)

Comment:
-The duration of action for parenteral doses may last up to 12 hours.

Use: To control nausea and vomiting

Usual Pediatric Dose for Light Sedation

Oral:
-Usual dose: 0.55 mg/kg orally 2 to 3 hours before the operation

Parenteral:
-Usual dose: 0.55 mg/kg IM 1 to 2 hours before the operation

Use: Relief of restlessness and apprehension before surgery

Usual Pediatric Dose for Tetanus

6 months to 12 years:
Parenteral:
IM:
-Usual dose: 0.55 mg/kg IM every 6 to 8 hours
-Maximum dose: 40 mg/day (up to 22.7 kg); 75 mg/day (22.7 to 45.5 kg)

IV:
-Usual dose: 0.55 mg/kg IV, diluted to at least 1 mg/mL and given at a rate of 0.5 mg/min
-Maximum dose: 40 mg/day (up to 22.7 kg); 75 mg/day (22.7 to 45.5 kg)

Comments:
-Patients should be started on low IM doses; subsequent dosing and frequency should be determined by patient response.
-Patients weighing 22.7 to 45.5 kg should not exceed 75 mg/day except in severe cases.
-Patients should lay down prior to and at least 30 minutes after administration.

Use: Adjunct to the treatment of tetanus

Renal Dose Adjustments

Use with caution.

Liver Dose Adjustments

Use with caution.

Dose Adjustments

-Parenteral administration: This route should be limited to bedfast patients and/or acute ambulatory situations.
-Excessive Drowsiness: Patients may decrease the dose if drowsiness is troublesome and/or persists after 2 weeks of initiation.
-Patients who are elderly, emaciated, and/or debilitated: Dosing should be lower in the treatment of mania, psychosis, and/or schizophrenia.

Precautions

US BOXED WARNING:
-INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS: This drug has an increased risk of mortality when administered to elderly patients with dementia-related psychosis. Elderly patients with dementia-related psychosis treated with antipsychotic drugs have an increased risk of death. This drug is not approved for use in patients with dementia-related psychosis.

Safety and efficacy have not been established in patients younger than 6 months.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-IM doses should be given deep into the upper outer quadrant of the buttock and/or into the deltoid. If patients require multiple IM doses, injection sites should be rotated to avoid irritation.
-IV formulations should be diluted before administration. Patients who develop irritation with IM formulations may benefit from dilution of the drug with saline or the addition of 2% procaine.
-Tablets should not be crushed.

Storage requirements:
-See manufacturer product information.

Reconstitution/preparation techniques:
-See manufacturer product information.

IV compatibility:
-See manufacturer product information.

General:
-All patients on prolonged treatment should be reassessed regularly to determine whether the dosage could be lowered or treatment discontinued.
-Patients receiving long-term treatment may have a higher risk of developing liver damage, corneal/lenticular deposits, and/or irreversible dyskinesia.
-Treatment has not been effective for the management of behavioral complications in patients with mental impairments.
-Oral syrup formulations are recommended for patients who refuse to take or have difficulty swallowing tablets.
-Healthcare providers administering parenteral formulations should consider using rubber gloves to decrease the risk of developing contact dermatitis.

Monitoring:
-ECG and heart rate monitoring for patients at risk of QT prolongation (e.g., arrhythmias, concurrent QT prolonging drug use)
-Periodic WBC with differential tests, especially in patients with signs/symptoms of infection/sore throat, at increased risk of blood dyscrasias, and/or with a history of low WBCs or drug-induced neutropenia/leukopenia
-Periodic liver function tests, especially in patients with liver dysfunction
-Blood pressure, especially in patients with impaired cardiovascular systems and pediatric patients
-Eye examinations, especially in patients on prolonged treatment
-Blood glucose levels in patients with diabetes mellitus
-Periodic renal function tests, especially in patients on prolonged treatment
-Yearly learning capacity examinations in pediatric patients
-Body temperature measurements, especially in patients at risk of hypothermia

Patient advice:
-Patients should be warned to avoid abrupt discontinuation of this drug.
-Patients should be instructed to immediately report any signs/symptoms of neutropenia/leukopenia, liver toxicity, neuroleptic malignant syndrome, or tardive dyskinesia.
-Inform patients that this drug may cause or impair mental/physical abilities, and they should avoid driving or operating machinery until the full effects of the drug are seen.
-Patients should be advised to speak to a healthcare provider if they are pregnant, intend to become pregnant, or are breastfeeding.

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