- Chlorpromazine Hydrochloride
- Some patients exposed chronically to antipsychotics will develop tardive dyskinesia, Chlorpromazine should be administered cautiously to persons with cardiovascular, liver or renal disease. There is evidence that patients with a history of hepatic encephalopathy due to cirrhosis have increased sensitivity to the CNS effects of chlorpromazine (i.e., impaired cerebration and abnormal slowing of the EEG). Because of its CNS depressant effect, chlorpromazine should be used with caution in patients with chronic respiratory disorders such as severe asthma, emphysema and acute respiratory infections, particularly in children (1 to 12 years of age). Because chlorpromazine can suppress the cough reflex, aspiration of vomitus is possible. Lactation: Drug enters breast milk; not recommended (American Academy of Pediatrics [AAP] states that this is “of concern”)
- Schizophrenia, Bipolar disorder, Anxiety, Psychoses, Delirium, Porphyria, Hiccups, Nausea,Vomiting
- Do not use in patients with known hypersensitivity to phenothiazines. Do not use in comatose states or in the presence of large amounts of central nervous system depressants (alcohol, barbiturates, narcotics, etc.).
- Oral Intractable hiccup Adult: Initially, 25-50 mg 3-4 times daily for 2-3 days; if unresponsive, may admin 25-50 mg via IM inj. If still necessary, 25-50 mg in 500-1000 ml of normal saline may be given via slow IV infusion. Child: 1-12 yr: 500 mcg/kg every 4-6 hr. Max: >5 yr: 75 mg daily; 1-5 yr: 40 mg daily. Psychoses Adult: 25 mg tid; may be given as a single 75 mg dose at night. Maintenance: 25-100 mg tid increased to >1 g daily as required in psychotic patients. Child: 1-12 yr: 500 mcg/kg every 4-6 hr. Max: >5 yr: 75 mg daily; 1-5 yr: 40 mg daily. Intramuscular Psychoses Adult: 25-50 mg repeated every 6-8 hr. Substitute with oral therapy as soon as possible. Child: 1-12 yr: 500 mcg/kg every 4-6 hr. Max: >5 yr: 75 mg daily; 1-5 yr: 40 mg daily. Intramuscular Nausea and vomiting Adult: Initially, 25 mg via IM inj, followed by 25-50 mg every 3-4 hr until vomiting stops. Child: 1-12 yr: 500 mcg/kg every 4-6 hr. Max: >5 yr: 75 mg daily; 1-5 yr: 40 mg daily. Elderly: Initially, 1/3-½ the normal adult dose.
Common Side Effects:
- Extrapyramidal symptoms. Tardive dyskinesia (on long-term therapy). Involuntary movements of extremities may also occur. Dry mouth, constipation, urinary retention, mydriasis, agitation, insomnia, depression and convulsions; postural hypotension, ECG changes. Allergic skin reaction, amenorrhoea, gynaecomastia, weight gain. Hyperglycaemia and raised serum cholesterol. Potentially Fatal: Agranulocytosis. Instantaneous deaths associated with ventricular tachyarrhythmias. Marked elevation of body temperature with heat stroke. Neuroleptic malignant syndrome, extrapyramidal dysfunction.
Mode Of Action:
- Chlorpromazine is a neuroleptic that acts by blocking the postsynaptic dopamine receptor in the mesolimbic dopaminergic system and inhibits the release of hypothalamic and hypophyseal hormones. It has antiemetic, serotonin-blocking, and weak antihistaminic properties and slight ganglion-blocking activity.
- Potentiation of anticholinergic effects of antiparkinson agents and TCAs may lead to an anticholinergic crisis. Additive orthostatic hypotensive effect in combination with MAOIs. Reverses antihypertensive effect of guanethidine, methyldopa and clonidine. Potentially Fatal: Additive depressant effect with sedatives, hypnotics, antihistamines, general anaesthetics, opiates and alcohol.
- Pregnancy Category – C Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks
- Anti-emetic drugs,Phenothiazine drugs