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chlorpromazine (Rx)Brand and Other Names:Thorazine

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 10mg
  • 25mg
  • 50mg
  • 100mg
  • 200mg

injectable solution

  • 25mg/mL
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Schizophrenia, Psychotic Disorders

PO: 30-75 mg/day divided q6-12hr initially; maintenance: usually 200 mg/day (up to 800 mg/day in some patients; some patients may require 1-2 g/day)

IV/IM: 25 mg initially, followed PRN with 25-50 mg after 1-4 hours, then increased to maximum of 400 mg q4-6hr until patient is controlled; usual dosage 300-800 mg/day

Nausea & Vomiting

PO: 10-25 mg q4-6hr PRN

IV/IM: 25-50 mg q4-6hr PRN

Preoperative Apprehension

25-50 mg PO 2-3 hours before surgery

12.5-25 mg IM 1-2 hours before surgery

Intraoperative Sedation

12.5 IM q30min or 2 mg IV q2min; total dose not to exceed 25 mg

Intractable Hiccups

25-50 mg PO q6-8hr; if hiccups persist after 2-3 days of oral therapy, administer 25-50 mg IM q3-4hr; if symptoms persist, administer 25-50 mg by slow IV infusion with patient lying flat in bed; monitor BP

Acute Intermittent Porphyria

25-50 mg PO q6-8hr

Migraine Headache (Off-label)

5-50 mg IV as single dose

Dosage Forms & Strengths

tablet

  • 10mg
  • 25mg
  • 50mg
  • 100mg
  • 200mg

injectable solution

  • 25mg/mL
more...

Behavioral Disorders, Hyperactivity

<6 months: Safety and efficacy not established

>6 months: 50-100 mg/day PO/IM; 200 mg/day or more may be necessary for older hospitalized patients; for outpatients, may administer 0.55 mg/kg q4-6hr PRN  

Nausea & Vomiting

<6 months: Safety and efficacy not established

>6 months: 0.5-1 mg/kg PO/IM q6-8hr PRN 

Preoperative Apprehension

<6 months: Safety and efficacy not established

>6 months: 0.55 mg/kg PO/IM 1-2 hours before surgery 

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Interactions

Interaction Checker

chlorpromazine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Extrapyramidal symptoms

            • Akathisia
            • Dystonia
            • Muscle stiffness
            • Neuroleptic malignant syndrome (NMS; infrequent but serious)
            • Parkinsonism
            • Tardive dyskinesia

            Common

            • Anticholinergic effects
            • Sedation
            • Weight gain
            • Erectile dysfunction
            • Oligomenorrhea or amenorrhea

            Less common

            • Cerebral edema, orthostatic hypotension (after IM injection), tachycardia
            • Agitation, anxiety, depression, dizziness, euphoria, headache, insomnia, poikilothermia, restlessness, weakness
            • Anorexia, constipation, dyspepsia, ileus
            • Lens opacities (prolonged use)

            Uncommon

            • ECG changes
            • Photosensitivity
            • Pruritus
            • Galactorrhea
            • Ejaculatory disorder
            • Diarrhea
            • Blood dyscrasia

            Rare

            • Seizure
            • Priapism
            • Cholestatic jaundice
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            Warnings

            Black Box Warnings

            Patients with dementia-related psychosis who are treated with antipsychotic drugs are at increased risk for death, as shown in short-term controlled trials; deaths in these trials appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature

            This drug is not approved for treatment of patients with dementia-related psychosis

            Contraindications

            Hypersensitivity to phenothiazines

            Coma, severe hypotension, severe central nervous system (CNS) depression, concurrent administration of large amounts of CNS depressants, subcortical brain damage, poorly controlled seizure disorder

            Severe cardiovascular disease

            Lactation

            Cautions

            Avoid using in children with suspected Reye syndrome

            Use caution in glaucoma, prostatic hypertrophy, stenosing peptic ulcer disease (PUD), history of NMS, Parkinson disease, hypocalcemia, renal or hepatic impairment, history of severe reaction to insulin or electroconvulsive therapy (ECT), history of seizures, asthma, respiratory tract infection, cardiovascular disease, myelosuppression

            Risk of extrapyramidal symptoms (EPS), NMS, hypotension

            Significant hypotension may occur, especially with parenteral administraiton; hypotension may be particularly severe in patients with pheochromocytoma or mitral insufficiency; in case of severe hypotension, use norepinephrine or phenylepinephrine, and do not use epinephrine or dopamine

            May alter cardiac conduction; life threatening arrhythmias reported with therapeutic doses of phenothiazines; may cause QT prolongation and subsequent torsade de pointes; avoid use in patients diagnosed or suspected congenital long QT syndrome

            May cause anticholinergic effects; use caution in patients with paralytic ileus, gastrointestinal motility, urinary retention, xerostomia, or visual problems

            Agranulocytosis, leukopenia, and neutropenia reported with antipsychotic use; periodic blood count assessment recommended in patients with history of risk factors, including history of drug-induced leuko/neutropenia or preexisting low WBC

            Esophageal dysmotility and aspiration reported with antipsychotic use; use caution in patients at risk of pneumonia

            May cause extrapyramidal symptoms, including akathisia, acute dystonic reactions, and pseudoparkinsonism, and tardive dyskinesia; risk of dystonia greater with increased doses

            Therapy is associated with increased prolactin levels; significance unknown

            May cause pigmentary retinopathy, and lenticular and corneal deposits with prolonged therapy

            May cause orthostatic hypotension; use caution in patients with risk factors, including patients who do not tolerate transient hypotensive episodes such as hypovolemia, cerebrovascular disease, cardiovascular disease, or medicatioin predisposing to hypotension/bradycardia

            May impair physical or mental abilities due to sedating properties; use caution when operating heavy machinery

            Depresses hypothalamic thermoregulatory mechanism; exposure to extreme temperatures may cause hypo- or hyperthermia

            Antiemetic effect may obscure toxicity of chemotherapeutic drugs

            Anticholinergic antiparkinsonian agent may be needed to counter EPS

            Strong anticholinergic agent and alpha blocker

            Potential for priapism

            US Food and Drug Administration (FDA) warning regarding off-label use for dementia in elderly

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            Pregnancy & Lactation

            Pregnancy category: C; neonates exposed to antipsychotic drugs during 3rd trimester of pregnancy are at risk for EPS or withdrawal symptoms after delivery; these complications vary in severity, with some being self-limited and others necessitating ICU support and prolonged hospitalization 

            Lactation: Drug enters breast milk; not recommended (American Academy of Pediatrics [AAP] states that this is "of concern")

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Phenothiazine; antagonizes dopamine D2 receptors in brain; depresses release of hypothalamic and hypophyseal hormones; may also depress reticular activating system

            Absorption

            Bioavailability: 20%; extensive 1st-pass metabolism

            Onset: 30-60 min

            Duration: 4-6 hr; extended release, 10-12 hr

            Distribution

            Protein bound: 92-97%

            Vd: 20 L/kg

            Metabolism

            Metabolized by hepatic P450 enzyme CYP2D6

            Metabolites: 10-12 different compounds

            Elimination

            Half-life: 30 hr

            Excretion: Urine

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            Administration

            Direct IV injection is only for control of nausea and vomiting during surgery and for adjunctive treatment of tetanus 

            IV infusion is only for adjunctive treatment of intractable hiccups in adults 

            IV Administration

            Direct IV injection: Dilute with NS to concentration no higher than 1 mg/mL, and administer at rate of 1 mg/min in adults and 0.5 mg/min in children; avoid administering undiluted drug

            IV infusion: Add appropriate dose to 500-1000 mL of NS, and administer slowly

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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